g.$l.u.g. 73pr-61$pn@ gra

GOVERNMENT OF TAMIL NADU. SJ$l$rlnaSlL-ri Ln$Erb ugraL g g ufl nnri,D zu pg1cop

ADI DRAVIDAR AND TRIBAL WELFARE DEPARTMENTL0p6lu / Lon$zu gryrra orirofl e-p6flp Glpneoo $lL-L-Lb - ueirerfl 6tgtl5t Gpfqti,g GLoSuiL_

u g uL9l$ g rfl u o_ p ofl $ Gl p n-nD 5 Gl uE zu p$ o nffr afl afuremru u Lb.

FORM TO APPLY FOR THE GRANT OF GOVERNMENT OF INDIA /STATE GOVERNMENT POST MATRIC SCHOLARSHIPSFRESH FORM

oeterfl $lEufurp$l5dr GluurfName of the institution

pfrGung oeta9 uuflgLb oolnfluneinr@Academic Year

$l eareudr u uu 66r uni g bb Lnnernzu 1ry d; 19

ggld;ouuL-r grleoL-unor nrror :

Scholeirship Student Id Generated in Online:(To be filled by the institution)

inner6rilrfl6ir

p$Guneorpu.r

qeoouur posir

$leoeour&oriurGelcurr@Lir.

1 mnerorolri Glu u.rri (Gl p ofl erin6u r erlg $g1& o erfl eil)

Full Name of the Student (in Biockletters)

sr-6L6lei:

English

z unsr5lerLb / Gender (+e { GoriuqLir)

j *T I rvrare [-l 2.Glumor/Fema]e D 3.greurpnLb uroslcmLir / Transgena.'l-l3 Appp Gpfl lDate of BirthAa Glu$Gpnri g{sirzugr ungtonerouri ogerrrLir / parent or Guardian netaits :

(GluFGpnri Eleireozu rrerflet ungrsnerzuf nglzuryLb lgpilurfrL-uur- Gernrur@Lb)

gnut Gluu:ri / Name of the Mother

pS6Dp Gluuri/Name of the Father

ungloncuzuri Gluu-rf /Name of the Guardian

en$ erflolryLir / Community Details:(a) uL-guril gcmggerlri(SC)(b) uplllgguflenri(ST)( c ) 6l$l$gl6u Lnpp$l$ g Lr ndlu uL g uLeir $t6n$9 6uri

Scheduled Caste Convertedto Christianitv (SCC)on$) lrr5lrflq Gluuri / Sub caste Name:

so/tz 4.fl.u.p.73 - 2,47,800 Cps.-2019 -s.61.€x.,qg;doa

6 GlurhGmnri -qrouzusr unsrsns.rzuri Glonr-61eir

Parent or Guardian Occurcation

ionerurzurfleir Glu$Gpnri gl6t6ugl ungtono'ueuri

Lnpdlu gylo / Lnn$|zu elra / proflu:nri 8gl.-oor$luri ereoflei:, ugnfluSleir Gluu:ri, uerrfurflqdl

$lEzuotr$$lem nflzurrLb. If the student'sParent / Guardian is working in Govt ofIndia / State Govt I Pivate Sector,Designation and Ofiice details.uourflqrflrqLir up$iu 94116 / L0q6l6u gr;fi / peuflurni

6lU.*p$lL-r-6ltD,rgl GlupriuL-r- eulgLnncur&

eneorSlp$leil gt'lur9i-@eiren eugLonen$rrrp 6r(Up

Germur@Lb. (oo$u6,eneirE poeil @eneurrtiorluL-

GzuororGld) Income as per Salary Certificateobtained from the Govt of India / StateGovt / Private Organisation (SalaryCertificate is to be enclosed)

7 gGlLiru gJ6rur@ nugLonrmrb / Family AnnualIncome (zurL-nl*dluf nLprrdlu oqgLonorrl}

urmrflp$leir gglur5|r--uui-Oeirrn erlqLnneor$eorp

ngp Gerntn($Lir.)

gdnq / Note: $1qgLnemrl0n60l Glun:r-r n9anneumuupnrJri crorflru, scrurerrflsft GLurfloir Glupriui-L- culSLoneor&

onfildlp$ LoL-@GLn $lenerfl&ouuL- Gzumur@Li:. Married women applicants should enclose incomecertificate of their husband.

R $lrpprr 19: oerrfl g(gsct qggflnfu@L-eir

Permanent Address with Postal Pincodepf onofl o g: oeurfl gl(9e6il gt'lufL-@L-rm

Temporary Address with Postal Pincode

9 Lo nermerrfl sir 4pnri nenor.

Student'q Aadhaar Number10 r.r r f 6rur6'ur gr{ zu zugl t"lup Gpnd-l 6fi Gl pnoo zuG udl

n-mor/Student's or Parentls Phone Number1l Lnnermeurfl em r-floirrrr@ueil glozurfl

Student's e-mail id

so/tz es.$.uF.73- | a

TZ pi-riunnfr,gsir Lonruurerri oeiloSl uuflg6 ggo-O / Ciass of study in Cuiierrt year

(a) I Year

(d) IV Year

f---l (b) II Yeart_J D (c) III Year DDD (e) V Year D (0 VI Year

13

Lnnerneuri uuSlgdr unL-$$em Gluuri LopELb Lnnag6ur

Gluuri / Course&gubject of Study of theapplicant (Examble: Course - 8.A.,Subiect -Tamil)

Course NameMain subject

g: goinnnLnu unL-rir9rfl q

i)GLoeU$lcozu 6xguq / Higher SecondaryClass(+ Ior+2),Maths Biologr, CommerceComputer, History, etc.)2)Slen$rozuu uir-uuguq i U.G. DegreeCourse. Eg. 8.A.,(tamii) B.Sc., (.Maths)etc.. .

3)g:g1$lenzuu uLL GLn$uguq lP.G.l ResearchCourseEg, M.A., (Tamil) ,M.Sc.,(Maths),MPhil.,(Tamil/Maths) P.hD., etc...a) Gpn$l$uguq / Professional CourseEg.B.E.,M.E.,B.L.,M:L.,M.8.8.S.,'B.D.S.,B.Sc,.(Nursing), C.A., etc...S)uir-uuuguq / Diploma CourseEe. D.E.C.E.. D.E.E.E..etc6)onrwSlg$ ugur-l / Certificate Course(uguLgeir 5n6u g{dTrdr.l96 eugr-Lb 6lO&"Gzurour@rir / Duration of Course should beatleast one year)

L4 oeirofl uuflgLb gleop/Category of Study

1)uooir GprrnlDay Time2 )r.oneurzu GprrLir / Evening Time3)ug6l6prrn /Part Time

.

4 ) Glpnco eugrq.Lir / Corresp ondencel5 Loneuuzuri uuflgLir ugur9rir GlLnn$g 6r6u g{6nol

Duration of the course ql,rrsued by thestudent

T6 Lnnrdnduri u$prni il(guLl Glungp Gpriafloil Ggri&AGlrpp Snrur@ / uStq nnnr I Year andRegister number of Passing 10ft PublicExamination.

gb6ml6l

Yearu$lal cranr.

Resistration No

I7 Lrnormotf ueufl GlrrmurL_mb euguq Glung$ GpriogeitGpriodl Glrpp g$6rn@ / ,51"1 ermor year andRegister number of Passing 12th publicExamination.

eJ6m.r6lYear

u$lq nerur.

Resistration No.

t

18 rnn-6uur6'uf uLL-ruuugu$eil Gpf&dl Glrpp gbrun@l /u$q erarur. Year and Register number ofPassing Diplamo Public Examination.

eJsrnOYear

u$q ernnr.

Reeistration No.

19 ! GleuiuniLir)

B) o9l@$utleir pradl uuflfizuri

Hostelier

uncuurerf uu$lgLir U6Dp / Category of Study (9&A) on@)6un6il geireunLoeb Glu$Gpnri

gleilzug1 ungoner:suri e*L-ddr prildl | |

uurdDuoln I uav Scholar L--J D20 u$pnLi euguqBlgu r9lcil-6nri uLr9|oi'rp ugurloerflew erflerrlLi: / GlupuurL- ootoft o-perfl$Glpnnlo oglzurrri: /

6l-t $lEpptb $lgur9ntr glp6tr oflorri: Detaiis of postmatric Courses a-fter X standard inwhich applicant studied - Scholarship Details / If break of study details should befurnished

uu9leirp g5srrr@ mpgl6ugriq nflerryrh / Detailsof study undergonetogether with year

of studv

oeilo9 rf,lm reran&6'l6n

Gluuri / Name ofthe institution

oei:ofl e-pofl$GlpneooGlupuuLL-pn / Whetherobtained Scholarship

(Yes / No)

GlupuuL-L- oei:nfl

o-po9l$Glpnroo /Amount of

Scholarship received

21 (gp6opul seilo9ulnarur@oerflei: unermn&sf uufl6np zugLiqCInfleil

$)OGrE aobafl o-pofl$Gtpneoo $lL-L-nonflan$$ ofleuurrmrnr$$gorira5l o-po9l$Glpneoo Glu$peum Z (+6 o-rerfleir (qdop6ur5-6f uur6np196aeiro9 o-pofl$Glpnnno $h-l$$sur 61j1 Glurhm oeirer9

o-perfl $Gl pncnsufl en en grla& seow&dleir 6lO,nu G*glp$l, 6tegr$gl&dL-geir F66Deu $)errerm&ouuL- GerLrour@Lb). Whether the applicantis in receipt of more than two scholarship including thisone? If yes, he should return the scholarship to Govt.,which is less beneficial to him as per his choice andchellan copy should be enclosed.

Glegl$g&dL-gem nmor LofELb pnrirChalien Number and Date

(ii)

22 FLUI-.1 oebei9unarurgoi: rnneumn6sri GunoruL- GILoL-fl6oeilo9o-pn9$Glpncoo $luL-$cop Ferftr CIprl sotofl rpnfl$Gtpnroo$lL-L-riroerflsir d$ uueirGlup o9murrrmuL9$gehenryn? Srn ereufl eil glpdor

nflcurlLi:.Whether the student has applied for any otherscholarship scheme other. than this scheme? lf, yesprovide the details of the scheme.

(ebb 6r6uR6fu o-rflur g4rrdonryLi zugngrb FrE,orppnoir cupni.rofrur]r_oeirnfl gtEoerr g4ri.rsonry& onrirE i ,9nq,i-,srF-q 6l#ri]i; onetrE6r'r rrrl,ro $rcoeuin&ouur- Gn"ranr6rrh. whehtlr the studentbelongs to the domicile state of Tarir'nadu and studying inother il."t9"? If yes, enclose Insitution,s latest-a;;rovaland aJfiliation orders issued by the .ppropri"i.

"",TJriivi"flttT gaa 9"ry'&rq "n',rer:mLdlu9leir Gluuri I wa-. of tt. g"rrk

Name of the Branchoeun$lg cremn.

Bank Account NumberMICR Code of tfr.Eatrt Tzu,uAun*

orryi groLo cr11gpgl(D gdluf@l

IFSC Code / urn6|oonum6f,jF,r619glquuq gdluf@

-*geg'rulDECLARATION

- -.:--.^.. - 11 6l6iro9lerrrsrmn^u${e.u

^{QdluCIL-uui6r1n* sr-Tgg oj}c{lnro€Erb erflurnnn6r,6,, LopErLbq-'uur6nr'0urffr'Dar 11 o-guguLontidlcpq.

.ttTt*t il ga#*r,:ul cr6""ft":;-,ncurrdroeir CIanornerfleirFrugj 6l5ur aaftrL-pfluiu'-'-nr-tt*6g g,iurrne-riu@rheJrn o-paflp;GlpnnDs (gr(Bor6opqrir g4rra ogl$6gLbrr$p o$luflg2LLb $6urfl g{6rfl&o Greoencpor "r* ,*rn,y e-E6l g,{6rflii6lGpd!.r. I here by declare thata-ll the details submitted application are correct "nJ

tt r.. If any of the details submittedis found to be incorrect tatei, then I h...;; ;;if, "on*"nt to return the scholarship tosanctioned to Governr.r,! in any means prescribed by the Government.2) pL-riq aeiroguLnnnrgeir GuneruL- crLnlng r*on e-p"nii;,Gpn-rffi-- rrno-r*,:rflpg Op'LopSluj / ron$|zu gqrye^oeirofl 1ga$$Grpncoo $iunrooflem 6tg6 uuranGlup oflarbrrnrnrn$pufl6ur5loi,r,geurErti;g GLofruL-r- $lL-L-'roofla1 d$-rr,r5heup Lonnurn&sri-Gg,ir1 Cf6,bl-Cp,ionril Lonomnd'orygoflqguqrfleoLnufleirug gr4: yrrrrGuE[ 4..pS[* de "ril"fl o-pofl$Grpn6'66-oru 6u$Eti6onenn@(g6opduIr6dr uuorplgLb $lL-uraroerflor s$ crupnuO,i, Sr$qgngtcou-r 6r"ig I"n"Jg,u, $l6ua& Gr*,ppo-Et$urerfld;slGpnn' Irlthe event thatlf, r had, / rr-"r1. ippried for post-matric scholarship andany other schemes of central / state Govt. in current year / previous year and if i am/was the student is selectea ror trre award of scholarship in more than one scheme then Ihere by give my consent to return tf..

""rtot"t"ttip" "nder the schemes to Governmentand retain one schorarship of higher behefit

"" p..ily choice.

Lrlrb'urrol / Lonennoflurfleir eosCIulnrlurbSignature of Student

Place :

Date :

Glu$Gpmi / ungtonoLalrfleir eusGlu.rrrlurirSignature of parent /Guardian

6

up6lur gyfei Guneiui Gholrflrii oo'uo5l s-p6np 6Pngt GluEtrir-roreurrortoqglg TiO'lE-uoir *-fygg-6fpgt €bg66noELf I JgAfo+ufl6dni r-onarrorfoqgl;ono a'GtFtr e'gl15ut6

Additional benefils for ifr'sically aislUtea SC/ST students under Govt' of India

Postmairic Scholarship beneficiaries aione'

trttt { S'iP$l

Glofio/whether the applicant of physically disabled' If yes, tick ( 'i ; trre suitable'

urrrinnel& (gropo.l/ Low Vision

;"gl G.r$eil geoPLueireneuri i Deaf

@rieleir / Recovered from leProsY

PsYcholo gicaliY affected'

o- poflqL- eir seil Errfl & g Glsd: ueuri / Orth ope dically

handicapped going to college with the 4e1p -o! alr:e-scort"

pmdulllguuoLriooir / Physically handidcapped students

stavine in hostels attached to the ils

ens, sndrseir ea[surgpgl

I dlp''l uuSl$dl

duEusurtaeir/ Special coaching for mentally retarded

t nilLqr-eir aeirgrgrfltiqg

;FEgl Cort Name and Address

Gr66-gDJ6--G"(Deiroerflzu Glun

g4Eor:zurflur-616$gr eneirflp$ GlupE $lcorrw8a Gomror@rir' For the

Certificate issued by the Competant rnedical authority

enclosed with the aPPlication'

disabilities listed above,

should be obtained and

zu$l$groeowuLnenrfleir e'osGlulnrhuril / Escort Signature

7

66ir ofl $lnnou$ pann:arrynd 6l-pq Gleriruluu Goafurgug

TO BE FILLED BY THE HEAD OF THE INSTITUTION

/Classification of the Institution 9& (

t]D

a)Central Government

c) Government aided

b) State Government

d) Self financef Private

Dt]

en glozurfl (glOtti' gflu9u@r

Name of the Institute ald Address with Pincode

i$l eur r-6lrirerrqfu oeir

e-mail id of the Institution

1)Phone Number of the institution2)Mobile Number of the person dealing withScholarship subject

ronerrrrj;srflotr Gl uuri/Stu dent Name

ft5rurrrffiFEfiGmg oei:ofl uuflgLir ooirnflu-rn

Academic Year in which the student rs

studing on currentunr-urJlrfl eiflei. Gluu.Lri / Subj ect Name

gt rmgF"g'fql Orftonel uufl gLb 219L-Lb

Studl'rng Year of the Courseouf on $tEoueri$pnel Lnnrrmzu15&g zupruouull-

u$lG'lermur Student Register Number assignedthe Institution

Support Course

gfffl 6l6o-n6il, Lonermeuri

uullgdr urL-urflrflq elren rginfl GluErir unuir9rflerLn (grl)

au.r ggprlol unr-uflrfleun / If the Institution Govt' /Govt.aided whether the course pursued bythe student is a Regular Course or Self

fl / au$l$l ozugnrfl ereufleil,gr1ry"a e-gofl GluELb ooilg1rfl / au$l$l ozugflrll 6r5urlzu,

Lonermzuri egla gg&SL-gou GsfSrDo Glu$pruryn (Sl)

flrierno gg6$r-goir SL! Gsf&5Ds GluSpzum ?

/Mode of Admission whether Government

Quota (or) Management Quota ?

12 p r,- u q o euofl unanl g e{r mneumzuf o^r qg ri r5l eil G orip ppneir/Date in which the applicant joined theclass in current vear

13 6tpp gg*gsir Gprioi (ygujtb LnnpLb

Month in which the annual examination.incurrent vear wili be over.

I4 L-oneumouri on@Oun6b prirdlu uuflobueuryn?

Where the applicant is residing in the Hostel?o\l nflc)d;lun60r Gluuri / Nerme of the Hostel

o\leo' Lnneomqiri nfl@E;Ufl6b Geri$p pneir.

Date on which the student ioined thehostel.

tolg' nq O5l ooiln9 $)enzuu$gL-Gur $rnrunSg15iT m pn ?

Where the hostel is attached to theinstitution?

f.r. perflunri nn@$ ereuflri: g'igto6ilan 8E1.*pgearzuellqneil gqnfu Sorfl 6ouulrgn? If privateHostel whether it is recognized byeducation institution Head.

L. peufl unri nfl @$un? e-6duro1, o-nrpnfL$$S gsr-lerm6 cu@c6l&ouu@6lglpn? glei:zugt

$lzuzuolnno erprarouu@dlppn ?Whether theHostel is run by the Private managementand whether free boarding and lodgingis orovided.

15 g4rle oflG$lun? ggLir eroflsir, o5lerrrriLosir g4ofl&oqLb / Whether the student is staying inthe Govt. Hostel.If so. indicate details there for.(i) eJ$l$lrnnfl L-ri peu$goop on@Sl

Adi-Dravidar Welfare Department Hostel

(ii) L9f uL-Gr-nri Fdupglcnp nnGf SlBackward Class Welfare Department Hostel

(iii) r-6loe4Lb L5)$u@$puuuGunri LopErb dlgunsireoLou$lemri

,Ecupg1dop nn@l$ / Most Backweird Class andMinorities Welfare Denartment Hostel

(i")gtgrl nfl6t6loeir gpiluLSiL-a1Lb / Other hostelsplease indicate

T6oll (f $l oru un6nrfl6in Gl u uri LlpE 6 eo s Gl unuuLb

1gipSleorlfireir/Name and Signature of the Wardenand Sea-l

T7 (lrp6npur oeilerflunmrrgeil Lonorneuf Glu$Eeiron eir(06o6

o9qgr6or@ Percentage of Altendance obtained bythe student in last year.

.9

o6fu all $lconlru$ paooofflan e-E$lGlun$lDECLARATION OF HEAD OF THE INSTITUTION

l)Lnneco,zuri oeilog lprlg$Glpnroa Glrp GungiLnncdr il(D6n5 nflqg&on@ GluDgleirennri rr6iner60Tp6rnri6lGp6trf. Certified that, the student has secured requisite percentage ofattendance for sanction of scholarship.

2)upflu / Lor$)zu gilrenri: pr-$puu@ri peroflsearouflarGungt LnnffdrntiorJneil erflmoledilurjltiorlur-L-oflnroreruruuLi:, ong$l&oneirE , erlgLnnonrieneinE , gJlapb peurzuori / .uei:ornou6 opoLb zupr.id'luLGoritieos glgiu$l& onrrrE gg6lu66r-5x$gflsrr poefl6d,en sr'r-nuLi: sl0fi$6s o E$luLerflti;dlGper-r. Ihere by declare that documents submitted by the students will be produced for Auditconducted by the Central Government / State Government.

3)Lnnemrn6ori erfletro-rernuupSl6ir gpiln$iL- erglerrymoeh Lnpgrb oLrriurS$p qereumriroeo* gJ,i,".lGlourppsur grlgLiueoL-ufkb $lrirLnnemrn&o66g Gunerui GILoL-rflB oeilerSl o-pofl$Gtp"nmo gtr-$$#S$osi:ol e-gnflp Glpneoo Glrp pggl zuml$peuri 6166T onenpoflti;dlGpor. goipr66r nflzurmLsJneioriur$$pg ifletrrdrri oobrL-giluLiulL-neb p$Gung guuerflBouu@dr seilog oo16;o$ Glpneoo(91$du6npu.lLi: g4no&g rreuerfluflgLb innernnrisrfLLfl6$gl 6u@6t Gleu.rgi g[a& ocrn6d'loir $lgnrg&Gltgrpp o-E$|uerfl&6lGpeur. The details submitted by the student in his application areverified and post matric scholarship has been claimed based on those verifieddetails. If it is found that scholarship has been claimed by institution by submittingincorrect data, scholarship obtained so will be returned to government account inthe manner as prescribed by the government

4)pruq oeilerflunarurgsi: Loremlnr;ori GuneruL- G|LoL-rflti aoi:erfl o-pofl$Glpneno&g6 ogerureuilur5lpgGzuE ooilerfl a-pnfl$Glgneoo g$lL-rrfisofleir 6$ uueirGlup rflcrdr6rdru.gtpguffOppreb, gSgrrgglri"'St!uu"rcnclup inreuitrn&sf Gp'iq GluELb Gpringeir Lonermr&sri nfllguqrflsnLoufl#ug ,f$f" uurnrGuE[$rr-$$5ur S$ oeber9 rpofl$Glpn6n55our Glu$EriGlonortr$r 196r,pernen uuetrplgli, gt..S4rtt -S1}

Glupuu@6 E$l,rtpt$-u r.orarcrn6orflL-rfl1g$g 6u@5ir GleLlgr grrs6 ser,r&6'trir-$6nr5le C"g,pLlE$luaflrf;dGpeir.If the student has applied for more than one'.scheme including thisscheme and if the student is selected for the award of scholarship under more thanone scheme then as per the choice exercised by the stud.ent, icholarship benefitunder the schemes will be remitted to Govrnment account by recovering the student.

Place :

Date: Principal Signature with Seal

10

1 . orq8di6l glrnq qerrauuL-Lb

Passport size photo

3.on$ onrmECommunity Certificate

5.zu1gLnneoo oneinE

trncome Certificate

T.ergeoro& eneiirE1

Attendance Certificate

9.prfl$pnreorL- Gerippunemrrdjsri GlelerflLonflzu oei:nfl

$lEzuemriLoerfl oil uu5loiruzuri ereo'fl oir

soi:afl ,6U-- g4rudan[&onemE. Whehter the studentbelongs to the domicilestate of Tamilnadu andstudying in other states? Ify€S, enclose Insitution'slatest approval copy.

2 . $lernL-SlE$pLir StguL5leir $tsrnl$lE$pon6drdip$ I Break Certi{icate

4. Ln$luGl uaror eneurElorir

Mark Certificate

6.errirdl oeuntig qppo' grpe,b u&o poeilBank Pass Book First Page Copy.

8.ggprri ernror on6rfEAadhaar Card Copy

l0.GlufGpnri / ungtonzuzuf eoLnu.r

glrs, / Lnn$leu gyre / per'fluLnri

6lg1ou6fi oorfuri ocrflet,

,61E.*p9L-r-6lCI,sg1 Glupuuir-osr$lu&eneirE poeb Income asper Salary Certificateobtained from the Govt. ofIndia / State Govt. I PrivateOrganisation (SalaryCertificate is to be enclosed)

1 1. glfr,ernpu ggnrorgeil gctrrgr;g GLnfuL-L- $lrrrnioofloir S$ osbcrg o-pofl$GlpnenoGlrpp Gpriolsil (gd'Dporn6n uuetrGtuELb $lrr$$leir d$t GLpriuiL- ooirofl

o-pofl$Glpneorur gqrla&qg 6Ou$ Gleg$$up$onen Gteg$gl& dl@ poe'b. If thestudent is in receipt of Scholarship under more than one Scheme inthe previous yeurr than challeur copy for the remittance of scholarshipreceived under the scheme where the benefit is less as per the choiceexercised by the student to the government.

pdpopSlefu uu$lg1rb Lornrunr&Efoegri qg L0iGt6

gdnq :- (1) pmLoeng oei:o9 o-pafl$Glpneoo nfleiforeo.muu$$laneo'r $l$geopu.rnet pnriroeir uLrflgrir

ueirorfl / oeilgirfld;g erLpnioriuiL- $)eoernu-L eugfl uuLemi 1gdlui$l (Login ID) qg:ouLh $trnnnuruuloirunL*geb u$lGeu$pLh GleLirgt oLnrirl96orlu@Lb. g{6u6xnE e-rflu onzu$$leu pnriLoeir uuflgLb

ueirofl / oeirgrrfl (gr6urr5 prno6ng o9noro'carriu$51-* $)eursoorul o-l$lufleil u$lGzuSpLir GloriLpr$eir

pr'irogg&Glordr pffipp AO g{6DLUn6n €idluliG rmur (Scholarship Student ID)eiLprirouu@ib. gr1pdi{Lflsir ronzulr gb$grlnorflrri Ln$ELb upnugguflen'i ,gr g4gzueuri Lopgjril

GlpnL-riqroL-ul g]topp ge'oeuelriooir urfl$gleonuflrur grlgirue-ou-u9eil inneourntirsriogeorul erri:61

ocrur6s)rt oei.ln9l e-po9 $Glpneoo erqq eozutiauu@Lb.

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