ANNA UNIVERSITYALAGAPPA COLLEGE OF TECHNOLOGY

GHENNAt 600025

Date: 21-10-2020

BG / BGM / MBC Scholarship Renewal Gircular

The students those who have availed *BC / *BCM / *MBC Scholarship, are directed tosubmit the "Renewal Application" for this year 2020-2021 to renew the GovernmentScholarship.

The Renewal applications can be downloaded from the Alagappa college ofTechnology Website (https://www.annauniy.edu/act). The students are requested todownload and print the application.

The filled up applications with necessary enclosures should be send by postal or

courier on or before 10th November 2020 (Tuesday) by Superscribe the envelope as

" BC/BC M/M BC Schola rs h i p Renewa I Appl i cation 2020" .

Address:To,

The Dean

Alagappa college of Technology,' Anna University, Chennai - 600025.

phone: 044-2235-9 1 0 1 /91 27 1912819129

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a) Gopy of Community Gertificate,

b) Gopy of Bank Pass Book 1st Page, (IFSC& MICR CODE should be available visibly)

c) Gopy of last 2 Semester Mark Sheets.

d) Copy of Aadhaar Card

e) Copy of First Graduate Gertificate (if applicable)

f) Copy of SSLG & HSC mark statements

NOTE: INCOMPLETE APPLICATION WILL BE SUMMARILYREJECTED

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ACTECH, ANNA UNIVERSITY, CHENNAI – 600025

(Dont’ leave any column in blank) (Tick the Option wherever necessary) 2020 - 2021 RENEWAL APPLICATION Check List

Name of the Scholarship BC BCM MBC

Name of the Student (In CAPITAL LETTERS)

.

Roll Number( Given by Institution)

Name of Degree & Course

B.Tech.,

Course Name: Regular

*M.Tech., (GATE Student Not Eligible)

Course Name: Regular

Year of Studying & Semester IInd Yr IIIrd Yr IVth Yr Semester : _____

Name

Father : Mother :

Student's Date of Birth (DD/MM/YYYY) Date: Month: Year:

Permanent Address for Correspondence (Taluk & District to be written)

Street:

City/Town/Village:

Taluk:

District: Pincode:

Gender Male Female Transgender

Religion Hindu Muslim Christian Christian- AdiDravida Others

Community BC BCM MBC

Name of Caste

Annual Family Income

**First Graduate (Only UG Program) YES / NO

Mobile Number (Personal)

E-Mail ID:

Aadhaar Card Number:

SSLC Registration Number ( Copy of Mark Statement to be attached)

HSC Registration Number ( Copy of Mark Statement to be attached)

Bank Details

Name of the Bank in (CAPITAL LETTER)

: ______________________________________ Bank Branch Name : _______________________ Account Number

:____________________ IFSC Number : ____________________________MICR Number

: _____________________ Are You Hosteller : if Yes, Hostel Details to be produced (AU Hostel Only)

Hostel Name : ACTech Hostel / Other Date of Joining in Hostel: / /

Signature of the Student