Instructions: 1 Fill in the form completely and do not leave any column blank.

. If any column is not applicable to your case, specifically Nil. 2 Attestations and other documents are not required at this stage; simply fill-in the form and submit via email. 3 Any false statement or incomplete information will make you ineligible.

Guidelines: 1 Personal Details: Your name must match with the exact name printed on your CNIC. Make sure that your CNIC number is absolutely correct. Well prefer to have your personal mobile number listed here.

2 Course Details State the exact title of your programme like MBBS, BE Electrical, BS Information systems etc. Course beginning and completion dates mean the time period starting from your enrollment in university / college to your expected graduation. Let us know very clearly which semester or year you are currently enrolled in.

3 Academic Records Examination Level means different stages of your programme like 3rd semester, 2nd Prof or 1st year etc.

List all semester / yearly / professional examinations that have been held since your enrollment and whether you have pas those or not.

If the result has not been declared for your recent exam, then say Not declared yet in the results status column.

4 Guardian Details

You are required to provide specific details of your guardians occupation. Whether employed or retired, you should state h exact designation and organization. Do not provide vague statements like Government servant.

If your guardian is engaged in a commercial activity or self-employed, e.g. if he is farmer or shopkeeper, then provide deta his farm / business in the relevant section of Household Details. Make sure to state your guardians yearly income from all sources.

5 Educational Expenditure If you possess sources of financing other than guardians monthly salary / income, then you must state its amount in the relevant column. Say Nil for columns that do not apply.

If your guardians income can be broken down into fixed salary and other income, such as rental income from property etc, then you must state these other sources in the space provided here.

As for the educational fee of the institutes previously attended, quote the sum of yearly tuition fee and hostel charges (inca you were living in a hostel).

6 Household Details Family members include father, mother, brothers and sisters. You must state the yearly figures for all salaries, earnings and fee.

DIYA PAKISTAN REGISTERED

1304/474, Hasan Street, Defence Road, New Lalazar, Rawalpindi Tel: 051-5859582, Mobile: 0300-5322592 Email: getinvolved@diyapak.org

APPLICANT'S DETAILS Name: CNIC No: Muhammad Usman Aqib 36104-03270181 Abdul Majeed Qadri
Male Female

Age: 20

Father's Name: Gender: Email:

Domicile:

Khanewal Tel: 3136091930

mithoo332@yahoo.com

Present Address:

House #01 St # 388 fazal colony mian channu district khanewal

Permanent Address:

same as above

Applicant's Status:

Orphan

Disabled

Poor & Deserving

Orphan's Only: Mention year of father's death: Disabled Only: Indicate nature of disability:

COURSE DETAILS Name of University / College: Title of Programme / Course: Roll No: 2 7/10/2008 College of Veterinary & Animal Sciences Jhang (sub campus UVAS Lhr) Doctor of Veterinary Registration No: 2008-VA-264 will complete on: Years: 5 30-06-2013 Semesters: 10

Programme started on:

Total Duration of your Programme / Course: Currently Enrolled in: Mode of Admission: 6th semester
Open Merit

Reserved Seats

Self Finance

Key person to be contacted in your department: Name: Designation: Dr Kamran Rafique Lectuerer Tel: 3134048737

ACADEMIC RECORD Examination Matriculation Intermediate Bachelors Are you Hafiz-e-Quran? Do you retain Hifz? Current Academic Performance Provide complete details of all examinations that have been administered by your university / college so far, including examinations for which the result has not been declared yet. Year 2005 2008 Roll No. 3309 4288 Marks Obtained 680 856 Total Marks 850 1100 % 80.00 77.82 Position pass pass

Yes Yes

No No

Examination Level Month / Year when exam Results Declaration Date Average Percentage or (Mention Year, Prof or was conducted / Status GPA obtained Semester) 2008(1st) 2009(2nd) 2009(3rd) 2010(4th) 2011(5TH) 2011(6TH) February(2009) June(2009) February(2010) June(2010) February(2011) June(2011) 30 February 3-Jul 30 February 8-Jul 30 February 8-Jul 3.46 3.23 3.3 3.58 3.59 3.43

GUARDIAN DETAILS Name: CNIC No: Abdul Majeed Qadri 36104-0461851-1 Relationship with Applicant: son Yearly Income: 84000 Organization: mannowal textile mills main chanu house # 388 st# 01 fazal colony mian chanu

Guardian's Occupation: watchman Exact Designation: Telephone: worker 3317041727 Address:

EDUCATIONAL EXPENDITURE Current Expenses on Education Yearly Tuition Fee 16864 Yearly Hostel Fee 30000 Yearly Messing Expenses 48000 Total Expenditure 92864

Sources of Educational Financing other than Guardian's Monthly Income Loan from Relatives / Friends Loan from some organization Scholarship from another organization Remission from College / University Income from other sources nil nil nil nil nil

If you are receiving scholarship from another organization, then please provide the details of this scholarship: Name of the Donor / Organization: Type of Scholarship:
One-time

nil
Yearly Monthly

If you have stated any amount for 'Income from other sources', then provide complete details of all such sources: nil

Tuition Fee of Institutes Previously Attended Matriculation Name of the Institute Location Yearly Fee Amount of any Scholarship / Remission Availed GMH School MIAN CHANU mian chanu gt road 400 Intermediate GD College mian chanu mian chanu tulamba road 900

nil

nil

Note: For matriculation you should state the yearly expenses you had to incur in class Xth only. Similarly, for Intermediate you should state the yearly expenses of class XIIth only.

HOUSEHOLD DETAILS Family Accommodation Details: Note: Family includes father, mother, brothers and sisters. Type: Status:
House Rented Flat Quarter Mud House Provided by Govt. / Organization

Family Owned

If rented, annual rent: Average monthly electricty bills during the months April to Sept. 2000

Details of family members currently employed / retired Name Age Exact Designation Employer Yearly Salary

Details of family members currently engaged in business / commercial activity Name Age Type of Business Location of Business Yearly Earnings

Details of family members currently studying Name Adnan Sohaib Irfan Shoaib Hanan Zohaib Nadia Majeed Age 25 23 18 21 Institute BZU Multan UAF GC Gulberg Lhr GC Faisalbad Yearly Fee 5000 35000 5000 18000

Any other thing that you would like to add or say (related to this application): please help me to continue my studies

Declaration by the Applicant and his/her Guardian:

We, the undersigned solemnly affirm that the details/information provided are accurate and that we shall be responsible for any inaccurate or false information.

Applicant's Signature

Guardian's Signature

Verification by Tehsildar or Competent Authority:

I attest that the information contained in application form is accurate and the applicant deserves the grant of scholarship award.

Signature

Stamp / Seal

Note: Competent authority includes Area Magistrate, Tehsildar, Naib Tehsildar, Mukhtiarkar or Area Nazim

For Diya's Office Use Only Decision

Reason (if required)

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