FE / SE / TE / BE / ME :- COMP / E&TC / IT / MECH / CIVIL / ELECT
----------------------------------------------------------------------FE / DSE - 20
/ 20
HS / DS
Sr.No.________ Merit No - __________ Round No.______
APPLICATION FOR FREESHIP FOR THE CHILDREN OF
SECONDARY SCHOOL TEACHERS / NON- TEACHING STAFF
(To be filled by the parent in duplicate)
(2015-2016)
To,
The Principal
VPCOE, Baramati
Subject :- Application for Award of Freeship Admissible to the Sons and
Daughters of Full Time Secondary School Teachers / Non-Teaching Staff.
Sir,
I have read the rules regulation the above mentioned scheme and request that my son /
Daughter whose particulars are given below be granted student freeship during the current
academic year 2015 - 2016 under the above mentioned scheme
1. Name of the Applicant Teacher
______________________________________________
2. Name of Son / Daughter in respect of ______________________________________________
Whom concession is sought.
3. Place of ordinary residence of parents _____________________________________________
4. Name and address of the School /
Institution attended by the Son / Daughter __________________________________________
during the previous year.
5. Name of the College joined
Current year & Branch
V.P. COLLEGE OF ENGINEERINR, BARAMATI – 413133
______________________________________________
6. Whether promoted to the next class/ ______________________________________________
Passed or detained in the last annual
Examination.
7. Which class and what is the percentage ____________________________________________
of marks obtained at such examination.
8. (a) Whether any other School / Inst. has ___________________________________________
Been joined during the current year?
(b) If so,the name of School / Institution_____________________________________________
and the Standard / Class joined.
(c) Whether applied for freeship__________________________________________________
in School / Institution.
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VPCOE, Baramati - STC 2015-2016
9. (a) Whether the student (Son / Daughter)___________________________________________
was getting freeship under the above
mention Scheme during the previous year.
(b) If not the reasons therefore
_____________________________________________
10. Whether I have more than three living ____________________________________________
children, If so, the total number of living
children and the date of birth of last child.
The certificate of Employment in prescribed form from the appropriate authority is attached.
Yours faithfully,
Date -
/
/ 2015
Signature
(Father / Mother)
Staff Name :- ____________________________________________
Phone No :- _____________________________________________
Note :- Where the application for concession is to be made in respect of a Son / Daughter of a
Secondary School Teacher / Non-Teaching Staff who unfortunately died while in service [vide Rule 5
(vi)] it may be made by the natural guardian.
Applicant’s Details –
Student Name - _________________________________________________________________
SSC Board ____________________________________________________________________
Passing Year ______________ SSC Seat No ___________________ SSC Marks ___________
Date of Birth _____________________ Gender ________________ Marital Status ___________
Caste __________________________________ Caste Category _________________________
Student Prequalifying Details Academic
Year
Institute Name
Course
Course
Year
Percentage
Result
2014-2015
2013-2014
2012-2013
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VPCOE, Baramati - STC 2015-2016
Institution Details Name of College :- VIDYA PRATISHTHAN’S COLLEGE OF ENGINEERING, BARAMATI PUNE
BARAMATI - 413133
Course Name :- Bachelor of Engineering
Course Year & Branch ______________________
CAP Number _________________________ Is Admission after Diploma __________________
Fees Paid ______________ Fee Receipt No___________ Fee Receipt Date ________________
EID Number____________________________________________________________________
UID Number ___________________________________________________________________
Hostel Information –
Name of Hostel _________________________________________________________________
Hostel Address _________________________________________________________________
Hostel Admission Date ____________________________ Hostel Fee ______________________
Hostel Mess Fee __________________________
Student Bank Account Details Bank of Maharashtra Account No -__________________________________________________
Bank of Maharashtra (Only) Branch - Baramati / Jalochi _________________________________
Branch Code ____________________________ IFSC Code _____________________________
MICR Code ____________________________
Declaration by the Student
I have read the above details which are correct to the best of my knowledge and I agree that I shall
abide by the rules governing the abovementioned Scheme of STC freeship.
Date :-
/
/ 2015
Signature of the Student
Student Name -________________________________________
Phone No - ___________________________________________
E-mail -_______________________________________________
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VPCOE, Baramati - STC 2015-2016
ANNEXURE-I
(Rule-10)
CERTIFICATE OF EMPLOYMENT
Certified that Shri/Smt____________________________________________________________
Age _____________
Relation with Applicant _________________________________________
Profession ______________________________ Annual Income _________________________
Resident of ____________________________________________________________________
Taluka_________________________________ District__________________________________
is bonafied full time Secondary School Teacher / Non-teaching staff in the
recognized Corporation / Zilla Parishad / Municipal / Cantonment Boards / non-Government
Primary School at _______________________________________________________________
School Name ___________________________________________________________________
School Grant Type ______________________________________________________________
School Reg. Number & Date _______________________________________________________
School Address _________________________________________________________________
_________________________________________________________________
The said teacher died while in service / retired from service / was dismissed/ Discharged /
discontinued / compulsorily retired from service on______________________________________
Place :-__________________
Date :-
/
/ 2015
Designation
This will apply only when concession is sought under. the provision of Rule 5 (vi) of the scheme for
award of STC freeship to Son and Daughter of Secondary School Teacher. Strike out if applicable
or such portions as are not applicable.
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VPCOE, Baramati - STC 2015-2016