तेजपुर विश्िविद्यालय
/ TEZPUR UNIVERSITY
(केंद्रीय विश्िविद्यालय /A Central University)
कुलाध्यक्ष का सर्वोत्तम वर्वश्र्ववर्वद्यालय परु स्कार , 2016 और एनआईआरएफ़ भारत रैंककिं ग 2016: निं. 05
Visitor's Best University Award, 2016 and NIRF India Rankings 2016: No. 05
परीक्षा नियंत्रक का कायाालय / OFFICE OF THE CONTROLLER OF EXAMINATIONS
तेजपुर-784028 :: असम / TEZPUR-784028 :: ASSAM ________________________________________________________________________
NOTIFICATION No. F. 14-1 / 2003(Acad)/1430 Date – 28.10.2016 As per the information received from the Sub-Divisional Welfare Officer, Tezpur vide their letter no. DSWO(T)6/2013/42 dated 18/10/2016 it is notified for information of all concerned that Government of Assam has decided to implement a new scheme to provide scholarship @ Rs. 3000/per month to the students with disabilities pursuing Medical and Technical Education during the year 2016 – 17. The eligible students belonging PWD category of this University are hereby advised to apply for the Scholarship in the prescribed format. The letter issued by Director of Social Welfare, Govt. of Assam along with the prescribed format of application is attached here with. The application forms may also be collected from the office of the undersigned during office hours of working days. Duly filled in application forms should be submitted to the office of the Controller of Examinations, Tezpur University on or before 04.11.2016 for onward submission to the Sub-Divisional Welfare Office, Tezpur for further necessary action. Applications found incomplete will not be accepted.
(L. Boral) Controller of Examinations
Letter issued by the Director Social Welfare, Govt. of Assam with Prescribed format of application
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GOVT. OF ASS,AM
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LF'AR}J,A S SAM [T ZANBAZA [d., G UWAF{ATI-O 1
CT OT{.AT E O F'' S O CTA.I, W
No. DSW{st)87 /70i6103
Fronr
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Dateci Guwahati, the 2p{h Sep, 2016
Sni S.S"Meemakshi Sr.rndararn/TAS DEnector Social Welfare/Assam
The DirectoB"/
To
HiEher Education, Assam Kahilipara, Guwahati- 19
Action Plan fcr implementation of new Scholarship Scheme for
5uh
Student with Disabilities pursuing Medical & Education under Budget Announcement 2Ot6-77
Technical
'
Govt. letter No. SWD . 526/2014/348, dtd 5th September,20T6
Ref Sir,
With reference to the suDject cited above, I have the honour to inform you that Govt. has cjecideci to implement a new scheme to provide scholarship of Rs. 3,000.00 (three thousand) per month per student with
disabilities pursuing Medical & Technical Education during the year 2Ot6-I7 ' you are therefone, requested to subrnit the beneficiary list duly approved by the concerned HeaC of the Institutions as per following normsa, The student must be Indian citizen' b, The Stucierrts iviih Disabilit',' having c,
disability and having a disability certificate issued by the competent authority' Total income of parents/ guardians etc. shall not exceed Rs' 6,00,000/per annum which wili oe duly certified by the competent authority'
not less thair
4Colo
d. Two copies of recent passport size photos of applicant,
e. Fersonal Bank account Detaiis along with IFSC" f'Hard&SoftCopyoftheapprovedbeneficiarylist.
Further you are also requesied to submit the proposai for providing Education scholarship to stuclent with disabilities pursuing Medical & Technical this latter' during the year 2arc-17 within L5 days from the date of receipt of Matter is most ulrEerlt" Your faithfullY
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Directo r
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Memo. No. DSW(SJ) 87l2A1613 - A Copy to:
Social Welfare, Assam Uzanbazar, Guwahati -1 2016 Dateci Guwahati, the 2qrrt t" SeP,
|u::i:t:
AND ORTHOPEDICALLY HANDICAPPED STUDENT
:
Si
Photogrqph of
The Director
the appl'rc.ant
Social Welfare, Assam, Guwahati-1
showing'il1l,r
.,
nis/ner ,,!li
I'
(Submitted through the Principal /Head of the institution)
disability
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lbegtoapplyforascholarshipforBlind/Deaf&Dumb/orthopedically Flandicapped Person. The Course for which I Propose
to study is-
School/College/ Dist: Sonitpur. lf I am University, PO: Governing its awards' I Shall also inform avrarcled a scholarslrip, f rgru" to .fiJe by the rules so long as held the Present scholarship other any Take lf I the Director of social welfare, ,
for which I have
joint
Scholarship.
l,FurtherStatethatlam(1)Blind/Deaf&Dumb/orthopedically Handicapped,(2) the income of my Parents /Guardian is less
than Rs.6,00,000
PA and (3) I am
the Student of lndian Citizen. A Certificate from civil surgeon or Gazetted officer of the Assam Medical
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Service will therefore be necessary to the application'
.
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{Signature of the Candidate)
[rstruction to candidate to fill in the form:According
to rule, a totally blind persons has been define
as "(a)
total absence of sight'
with correcting (i:) visual acquity not exceeding 3/60 or 10 /200(snellen) in the better eye for the ordinary is nonfunctional lense,, And the Deaf are those in whom the Sense of hearing does not have th'e pur.pose of life. A Deaf & Dumb person is one who is Deaf as defined above one who has power ofspeech. An orthopedically Handicapped person has been defined as " deformity or has partially or totally lost any limb or the body thereby bones, muscles and Joints"' causing an interference which normal functional ofthe a physical clefect or
the Assam Medical service A certificated form a Civjl surgeon or Gazetted officer of be necessary to the effect that the candidate is BIind /Deaf &
wjll therefore
Dr,rmb/Orthopedically handicapped as defined in rule'2'
the attached at Appendix'B' Should be filled in by the Parent/ should Guardian of the candidate regarding his/her annual income). This declaration is studying or by some be attested by the head of the institution in which the candidate
2.
A declaration
( in
president or the Gaon or Anchalik responsible person such as Gazetted officer,Local MLA., pa
nchayat.
rl'it"
j.
stating the lf proof of the date of birth of the candidate is n.ot available, a certificate
officercertifyingthe approximateageofthecandidateshould beobtainedfromtheMedical rlate and should be attached to the applicant'
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Yours FaithfullY
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llE APPLI(AN I ) },AK I l\!{Lr\KJ lName of the aPPlicant in full
1.
( IN BLOCK LETTER
Father's
z.
name
)
(lN BLOCK LETTER)
Date of Birth (According to christian era.)
applicant's domicile '' (b) Cast/Community (certificate to be
(a) The
4.
Furnished) .:
5.
Present address
6.
(a) Educational attainment reached at
The time of applying for scholarship' (b) Hostelier/N on-Hostelle Year in which the aPPlicant first
7.
Joined the school/College/lnstitution Which he/she bow is reading and age
on
1tt June of
the Year.
(a) Course of study for which he/she has
Joined tlre school/college/lnstitution (b) Date of joining the course (a) Date of commencing of the course (b) Duration of the course
1.0.
Place of Birth(Village/Mouza & District)
11.
Full name and address of the school/:-
College/lnstitution from whiclr the Applicant passed his/her last examination Giving the village, Mouza, PO and District Where the school,/college/lnstitution is Situated.
t2. 13. 14.
15.
Year in which passed the last examination
Marks obtained at the last examination
. * . ..,:l 'ii." ": i: "1 .p
Whether at present holder of any other ScholarshiP' lf so, give details' Whether suffering from any physically or Handicapped other than blindness disability' Deafness or orthopaedically
Gontc{. .prt'9
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full
N;rr"rre: an
l.rLrrni;:ile
adrJress
0f parents 0r 6uardian Ii{:,1;!
tio
n
C)i.;r:upation
:
,ll.:rnual income f r
I ,,r:.r,i r,ll bank Account number along wil.lr ir.,1r',r', lir;1p6ft name rvith lF$C Code {'., rrr), r-opy of pass Book for Bank accourrt. i,l i.rinlrirr, llranch,lFSC C
(Signature of the applicant in full)
,: ', .:
c.' rtificate oI the principar /Headmaster of the institution in which th'e andirJaie is str:clying
:
.'t '. - :]: I certilty that ,.j
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the schoo l/co
11r'r1;'iitlrr $tudent
I
le
.1]ril$mti,-gelin stitution
on..__.
has
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il
and has been
of my institUtion since tl.re 6ut".
My lnstitution is recognized by Assam state Govt. Vi
Ihe d;jite of his/!rrrr birth as enters in the school/college/institution Register is
My rem{rks rognrding his/her progress conduct etc,are as under:_
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bitity
aracte
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llli .:
r)arcnts or guardians
r,
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)-i.{}gularity of attendance
;iealth ,,::neral recommentlation
.(Principal /Head Master of schoq.iicollec.,
,c1}rtlrlcate to he siF;ned by the |,,4ulclical o,Fficer Examining the candldotq :-
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rl
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)
I, Civil Surgeon/Medical Ol'ficer
inised Sri/Srnt i. i\r r.;ir{, !5 1() BInd as to perform any work {or which eye sip,ht is r:ssential. Lr\/{:
}:: r.'.r
i?)
l, Civil 5r.rr1i
.iAl
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t, Civil Surgeoni Medical of f icer
f:
certifv -*','t'I ti'l i
Sri/Snrii.
.,,.r i ,l.rrnined
, i r,irt: i:; so Deaf ttral lrisiltcr sense of lrearing is lon-f unctional f or rhe ordinary purpose
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(,1)
t,
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CivilsurgoonlMedical{}lficer
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;
cei'tilty
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if any .-: *-- ;t,. hr.;/hcr orthopar:dicaily condition as bclow extent and charactcr of a limb weakness of paralysis of rny nrus;:r, nature and elterlt of disabilitY :' ls the di:;ability accompariied by any pain and mental deficiency'
ill)
l, l,;rther ccrtify that 5ri/Smti'
stur-1''' ;:nd rrrentally fir apart from Irr:;/her orthopaedically clisability to undertak6 in llri interfere with his/her education , rlio'-ricdic rli.saliility is/is not of a nature as to
rr..rtly
.r
1l
,,
i
.
rnanner.
tlis/her agt ,rilpearance abr:r-lt
is according
ro lris/her own staterrrqrnt
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ye
ar'
5ignalttrc
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-:1
Designation
proof of his/her date of Birth'i" (This curti{icaLr:: is to be given where the candidate
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inform ......,........,...,._*_J
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lhe dcrails ol'age/scholarship received etc. Furnished by ,.rr"') 5ri/5mti.
of
ri:i 1. I declare that the atrove named of candidate my son/darrghter ward.
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the family
ndent on me. :ji I also undertake to refund whatever amount by way of scholarship *6ili; .y ',r,r),,cj;irrflhter ward tras rcceived on the strength of this statemc,nt made by 1ne, ir anf]incoi, r ii r'rd prescribed by Govt. I aware that to make a false statenrrint with regard to n1yiiinid,n, '' , i '1ilgsslly to claim a scholarship when the same is not admissible to my son/daughieil#;
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(Signature or thumb lmpression oi$irr 'i
parent/guar'Jian of the
pupii)
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ATTEST/ITION CFRTI FICATE
-1.i I 5r
r,u
Smti.
of village;ii: to,, lrir"'
of lVlouza
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l';.'iit[;:rut attestcd the declaration signature /thumb mark of the person abovefiitlsirin. rn
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presence.
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Signature
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, '.!'(iifcnceforwhichpranel proceedingwill betakenagainstrne. lflagreethateoy,{nlrd;y, "i:.r');cr thc s,:irnc from r.rly property as arraar of lancl revenue. f.j.'p i,:tuj:,, .:.t i
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