Form Number: (For Official use only) Prime Minister s National ICT Scholarship Program 2012 (PMNICTSP 2012) National ICT R&D Fund, Ministry of Information Technology Government of Pakistan Scholarship Application Form for Fall 2012 & Spring 2013 Intakes IMPORTANT INSTRUCTIONS: 1. Use CAPITAL letters and leave spaces between words. 2. Write details exactly as they appear in your academic records and do not use abbreviations. 3. Incomplete, illegible or improperly filled application forms shall not be processed. 4. Applicant must fulfill both Academic & Financial Eligibility Criteria to be potentially eligible for the scholarship. 5. NICTSP scholarship holders and awardees of previous years are not eligible to apply for PMNICTSP 2012. 6. Only this form is valid as the Scholarship Application Form for PMNICTSP 2012. ATTACHMENTS: Applicants are required to attach following documents with this Scholarship Application Form. 1. Attested copies of Matriculation & F. Sc. Part I & Part II mark sheets. 2. Applicants whose F. Sc. Part I & Part II mark sheets do not have the name of their respective school/college must submit a school/college certificate affirming that they were regular students of the said school/college. 3. One (01) recent passport size colour photograph. 4. Proof of income; salary slips are required in case of salaried family members, otherwise Affidivit (Attested by Notary Public) of total family income should be submitted. 5. Attested copy of valid admission letter issued by the University OR Certificate specifying that the applicant is a bonafide student of the university, and he/she has secured admission in Fall 2012 Intake or Spring 2013 Intake. GENERAL INSTRUCTIONS: Please read all instructions carefully and in their entirety before filling out and submitting this form. 1. Applicant is required to submit duly filled Scholarship Application Form directly by registered mail/courier to the following address not later than 21 February 2013. Manager PMNICTSP 2012 National Testing Service (NTS) 96, Street No. 4, Sector H 8/1 Islamabad (Don t Staple) Affix recent passport size colour photograph with glue 2. It is the sole responsibility of applicant to ensure timely delivery of Scholarship Application Form to the address given above through registered mail/courier. Applicant is required to keep the registered mail/courier slip for any further reference. 3. Each envelop to be dispatched must contain ONLY one Scholarship Application Form. Multiple Scholarship Application Forms in one envelop may result in cancellation of application. 4. Forms can be photocopied or may be downloaded from www.ictrdf.org.pk/scholarship 5. Applicant is instructed to submit only one (01) Scholarship Application Form for PMNICTSP 2012. Submission of multiple forms from a single applicant shall not be entertained and could result in cancellation of application. 6. Applicant can either apply for Fall 2012 Intake or Spring 2013 Intake under PMNICTSP 2012. Submission of multiple forms from a single applicant for both Intakes may result in cancellation of application. 7. Applicant must have secured admission in Fall 2012 Intake or Spring 2013 Intake in one of the participating universities to be potentially eligible for the scholarship. List of participating universities is available at www.ictrdf.org.pk/scholarship 8. The contact details as filled in the Scholarship Application Form will be used for future correspondence. It is advised that the contact numbers (Landline/Mobile) should not be changed during the registration & selection phase of Prime Minister s National ICT Scholarship Program 2012. 9. Any queries pertaining to the Scholarship Program may be forwarded to nictsp@ictrdf.org.pk. For further information applicant may also contact at 0304 899 1341, 0304 899 1342, 0305 588 4499, 0341 517 8798 10. Applicant should visit www.ictrdf.org.pk/scholarship for important information and regular updates. 11. All instructions provided in this Scholarship Application Form are exclusively for Prime Minister s National ICT Scholarship Program 2012. 12. Merit for PMNICTSP 2012 (Fall 2012 Intake) & PMNICTSP 2012 (Spring 2013 Intake) will be determined separately. Page [1] of [5]
Section 1: ACADEMIC ELIGIBILITY CRITERIA: Please read the following statements carefully and tick ( ) the appropriate box. Do not leave any of the following checkbox blank, otherwise your application may not be considered. a) Have you passed F. Sc. Examination with Mathematics & Physics in 2011 or 2012 as a regular student from a school/college registered with National ICT R&D Fund (list of registered schools/colleges is available at www.ictrdf.org.pk/scholarship)? Yes No b) Have you obtained 60% or above marks in your Matriculation (Science Group) exam? Yes No c) Have you secured admission in ICT related undergraduate degree program in one of the Participating Universities in Fall 2012 or Spring 2013 semester (list of Participating Universities is available at www.ictrdf.org.pk/scholarship)? Yes No Please correctly tick ( ) your semester of enrolment/admission Fall 2012 Intake Spring 2013 Intake If your reply for statements a, b & c above is Yes, then proceed further. Otherwise, you are not eligible to apply for the scholarship. SECTION 2: FINANCIAL ELIGIBILITY CRITERIA: Definition of Family : Individuals belonging to a household, who are living under the same roof and their sustainability depends on the total household income, shall be considered a family. 1. Applicant, belonging to a family earning less than Rs.30,000 per month, shall be eligible to apply for the Prime Minister s National ICT Scholarship Program 2012, regardless of the total number of family members. 2. Applicant, belonging to a family earning more than Rs.60,000 per month shall not be eligible to apply for the Prime Minister s National ICT Scholarship Program 2012, regardless of the total number of family members. 3. Financial eligibility of the applicant shall be calculated based on the following table: Total Family Members Total Monthly Income (Rs.) Total Family Members Total Monthly Income (Rs.) 3 or Less Less than or equal to 30,000 7 Less than or equal to 50,000 4 Less than or equal to 35,000 8 Less than or equal to 55,000 5 Less than or equal to 40,000 9 or more Less than or equal to 60,000 6 Less than or equal to 45,000 Please read financial eligibility criteria as given above and provide requisite information below. a) Source of Family Income: Salaried Non Salaried Both b) Total Family Members: c) Total Monthly Income of the Family (Rs.): d) Do you satisfy Financial Eligibility Criteria as given above? Yes No Page [2] of [5]
SECTION 3: PERSONAL INFORMATION: a) Name in Full: b) CNIC #: (Write your own CNIC No. or B Form No.) c) Father s Name: d) Father s CNIC #: (Write your father s or guardian s CNIC Number) e) Father s /Guardian s Occupation: d d m m y y y y f) Date of Birth: g) Gender: Male Female (Area Code Tel. Number for example 0157 2919456) (Keep this number active for correspondence) h) Telephone No.: Mobile: i) Email: j) Postal Address: k) Union Council: l) City/Town/Village: m) Tehsil/Taluka: n) District/Agency: (Provide Agency Name in case of FATA) o) Province/Region: Punjab Balochistan Islamabad(Rural) Sindh FATA AJ&K Khyber Pakhtunkhwa Gilgit Baltistan SECTION 4: ACADEMIC INFORMATION: a) Provide six digit code of your school/college from where you attended F. Sc. classes as a regular student. Six digit code can be found in the list of registered schools/colleges available at www.ictrdf.org.pk/scholarship. For further help, dial 0304 899 1341, 0304 899 1342, 0305 588 4499, 0341 517 8798 b) School/College attended during F. Sc.: (Specify the name of school/college from where you attended F. Sc. classes as a regular student.) School/College Name: Page [3] of [5]
c) Name of Principal: d) School/College Contact No. (Area Code Telephone Number e.g. 0234 56543) e) School/College Address: f) Union Council: g) City/Town/Village: h) Tehsil/Taluka: i) District/Agency: (Provide Agency Name in case of FATA) j) Province/Region: Punjab Balochistan Islamabad(Rural) Sindh FATA AJ&K k) ACADEMIC RECORDS: Khyber Pakhtunkhwa Certificate/Degree Roll No. Year of Passing Matriculation or Equivalent (Science Group) F. Sc. Part I (With Maths & Physics as compulsory subjects) F. Sc. Part II (With Maths & Physics as compulsory subjects) Total Marks Gilgit Baltistan Obtained Marks % age Academic Board SECTION 5: ADMISSION INFORMATION OF APPLICANT IN PMNICTSP 2012 (Fall 2012 & Spring 2013 Intakes) PARTICIPATING UNIVERSITY: 1. Applicant is required to provide information about the participating university in which he/she has secured admission in ICT related discipline under Fall 2012 Intake or Spring 2013 Intake. 2. Provision of multiple ICT related disciplines, multiple Intakes or participating universities could result in cancellation of the Form. 3. Securing admission in a participating university is no guarantee of award of scholarship due to various reasons including (but not limited to) student s performance in university admission test, prior academic performance, limited number of scholarships, provision of limited number of seats by participating university/campus, university admission criteria/policy, provincial population quota, limited funds and criteria devised by National ICT R&D Fund. 4. Applicant is required to attach either of the following: a. Attested copy of valid admission letter issued by the University where applicant has secured admission in Fall 2012 Intake or Spring 2013 Intake. OR b. Certificate specifying that the applicant is a bonafide student of the university, and he/she has secured admission in Fall 2012 Intake or Spring 2013 Intake. Page [4] of [5]
Please read instructions as given above and provide admission information below: a) University Name: b) Campus: c) City: d) Discipline / Degree Title Enrolment / Admission: Fall 2012 Intake Spring 2013 Intake e) Date of Admission: e) University Registration No.: SECTION 6: ATTESTATION BY AUTHORIZED REPRESENTATIVE OF UNIVERSITY: It is certified that above information regarding admission of applicant as provided in SECTION 5 ; is correct and he/she is a bonafide student of the university. Name: Signature & Stamp: Designation: Date: University: SECTION 7: UNDERTAKING: It is solemnly affirmed that all the information provided herein this Scholarship Application Form is correct. If any information contained herein is found to be untrue, I shall be liable to any disciplinary action including rejection of this Scholarship Application Form or cancellation of Scholarship/Financial Assistance by National ICT R&D Fund for Prime Minister s National ICT Scholarship Program 2012. If approved, I shall use this Scholarship up to the best of my knowledge and abilities and after completion of studies; I shall serve my country for at least two years. I further affirm that I have read, understood and shall abide by all the instructions provided in this Scholarship Application Form. I also understand and agree that all decisions made by National ICT R&D Fund related to Prime Minister s National ICT Scholarship Program 2012 would be final and binding upon me. Applicant s Signature Name: Stamp & Signature: ATTESTATION BY GAZZETTED OFFICER CNIC Number: PLEASE NOTE: Any information by the Applicant provided in the course of obtaining Scholarship shall be accurate, without omission of any relevant facts and not misleading. If any error or omission is found in the information supplied in acquiring this Scholarship, Applicant shall not be offered a Scholarship, or he/she may have Scholarship withdrawn or terminated. For verification and other purposes pertinent to the Prime Minister s National ICT Scholarship Program 2012, Applicant s information will be shared with relevant authorities and related personnel. National ICT R&D Fund ( Company ) reserves the right to amend or alter any of the terms and conditions with respect to the Prime Minister s National ICT Scholarship Program 2012 ( Program ). Final decisions pertaining to the Program rest with the Company. Page [5] of [5]