Application Form for Undergraduate Program-Batch-IV

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HIGHER EDUCATION COMMISSION H-9, ISLAMABAD (PAKISTAN) Attach Photograph here (2-Photos, Put Name and Attestation at the back) PROVISION OF HIGHER EDUCATION OPPORTUNITIES FOR STUDENTS OF BALOCHISTAN AND FATA APPLICATION FORM FOR 4-YEARS UNDERGRADUATE PROGRAM (2011) (i.e. B.E/B.Sc (Engineering), MBBS, BDS, BBA, B.Com (Hons), B. Pharmacy, BCS, BSc (Hons), LLB etc.) Instructions to fill the form: 1. Please ensure before filling the application form; that you have
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  Page 1 of  5   APPLICATION FORM FOR 4-YEARS UNDERGRADUATE PROGRAM (2011) (i.e. B.E/B.Sc (Engineering), MBBS, BDS, BBA, B.Com (Hons), B. Pharmacy, BCS, BSc (Hons), LLB etc.) Instructions to fill the form: 1. Please ensure before filling the application form; that you have carefully read the application form and all thedetails of scholarship program published in advertisement and on HEC website.2. Fill the Application Form in CAPITAL LETTERS using Black ink.3. Incomplete Form will not be considered.4. Do not leave any colum n blank, if Not Applicable please write “N/A”.  5. Do not overwrite or cross any information on the form.6. Attach attested photocopies of all required documents with the form. (Details at page 5)7. An amount of Rs. 600/- as application processing and test fee (non refundable) may be deposited in the HECOnline A/C No. 17427900133401 in Habib Bank Limited, Shalimar Recording Company Branch, H-9,Islamabad.8. Send us srcinal bank receipt. (Photocopy of the bank receipt or any other form of payment is not acceptable).   Eligibility Criteria aIs your age less than or equal to 22 Years on 18 th July 2011   Yes No bHave you obtained 60% Marks in F.A/F.Sc/A-Level/Equivalent Yes No If a and b, both are Yes then proceed further Bank Slip Details   Original Bank Slip worth Rs . 600/- No: ____________________ Date:________________________________ Drawn on Bank: Branch: Choice of Test Centre   Select centre where you will take NTS test (Tick (  one of the following): Islamabad Peshawar Quetta Karachi Lahore D.G. Khan (  Conduction of test in Lahore and D.G. Khan is subject to minimum of 300 candidates, otherwise candidates will be assigned next nearest test city. Request for change of center will not be entertained once choice is exercised. In case candidate does not tick the choice of center for NTS test he/she will be placed as per his /her domicile.) Admission I intend to get admission in 4-years undergraduate program in the discipline given below in order of preference: i) ________________ ii) ____________________ iii) ________________ iv) ____________________  (  It is not necessary to recommend the candidate for admission as per his/her choice. It depends on the availability of seats in  HH IIGGHHEERR  EE DDUUCCAATTIIOONN  CC OOMMMMIISSSSIIOONN   HH--99,,   II SSLLAAMMAABBAADD  ((PP AAKKIISSTTAANN )) PROVISION OF HIGHER EDUCATIONOPPORTUNITIES FOR STUDENTS OFBALOCHISTAN AND FATA Attach Photograph here(2-Photos, Put Nameand Attestation at theback)  Page 2 of  5   Important Note: The application form for Scholarship Program is free of cost. the Institutions/ Universities and the candidate  ’  s merit. HEC will facilitate the students for admission but the final responsibility to secure admission at any Public Sector University/Degree awarding Institute or Private Sector Universities, (fall in W-Category: list available at HEC website ENUDAI/Documents/Categorization%20of%20Private%20Sector%20Universities%20and%20DAIs-27-12-10.pdf) lies at the candidate.   The main objective of this project is to provide scholarship (financial benefits). However, HEC has limited reserved seats in various disciplines in Public Sector Universities/Institutes for HEC scholars of Balochistan and FATA. Those candidates,who failed to get admission in Public Sector Universities through normal channel (open merit / any other reserved seat) will be considered for nomination against reserved seats. It is obligatory that the candidate has tried to get admission through normal channel (open merit / any other reserved seat) before submitting a request for placement against reserved seat   )    Personal Details   Full Name : (As given in Matriculation / S.S.Certificate) Father’s Name : Guardian Name:   (In case of death of father) Relationship with Guardian: Applicant’s CNIC/Form-B No: (Attach Attested Photocopy of CNIC or Form „B‟)   Father’s/Guardian’s CNIC No : __________________________ (Attach Attested Photocopy) Date of Birth: Gender: Male Female  Day Month Year  Age as on (18-07-2011) Day Month Year (  Age should be less than or equal to 22 years at the time of closing date of receipt of application i.e. 18-07-2011)  Address   i) Postal Address   ( Where you want to receive letters from HEC  ):    ____________________________________________________________________________________________  _____________________________________________ City  _   _________________________________________ District/Agency/FR______________________________ Province _______________________________________  (Please note: Postal address should be of major city for timely receipt of letters from HEC) ii) Permanent Address (if different from the above postal address):    ____________________________________________________________________________________________  _________________________________________________________ City  _   ______________________________ District/Agency/FR_________________________________ Province: ___________________________________  Phone No: (Compulsory)   i) Residence (with city code):   ______________________________  ii) Mobile Number :  _________________________________  iii) Father‟s  / Guardian Office Number (with city code): _________________ Mobile No: ______________   Page 3 of  5   iv) Any other contact Number (with city code): _____________________  E-mail Address :  (Compulsory)   Email *:  _________________________________________________________  * It is mandatory for you to have a valid email address otherwise your form can be considered INCOPMLETE. In case you don‟t have email account, please create immediately on yahoo/gmail/hotmail (this facility is free of cost). Most of the futurecorrespondence will be done through email. Do not change your E-mail address and frequently check your emails. Sometimesemails are transferred to Junk/Bulk Mail folders; therefore check these folders as well. Domicile: Candidate’s Domicile ( Tick (  one of the following and attach attested photocopy)i. FATA:Name of Agency/FR ________________________  Bajaur Khyber Kurram Mohmand OrakzaiNorth Waziristan South Waziristan FR Peshawar FR Kohat FR BannuFR Lakki FR D.I.Khan FR Tank ii. Balochistan:Name of District    ___________________________  Kalat Mastung Khuzdar Awaran WashukKharan Lasbela Ketch Gawadar PanjgurNaseerabad Jaffarabad Jhal Magsi Bolan BarkhanPishin Loralai Chagi/Dalbadin Nushki SibiHarnai Ziarat Kohlu Sherani ZhobDera Bugti Killa Abdullah Musa Khail Killa Saifullah Quetta** Urban   Rural ** The candidates belong to Quetta (urban/rural) should provide the certificate of their residency from Local Government Office. Father’s Domicile : (Tick (  one of the following and attach attested photocopy) i) FATA Name of Agency/FR ________________________ ii) Balochistan Name of District ___________________________  To Be Filled by Already Enrolled Students in Public Sector Universities/Private SectorUniversities (w-category only):   Name of Institution/University____________________________________________________________________ Program Name _____________________________ Subject/Discipline ___________________________________ Duration of Program___________________________ Date of Enrollment_________________________________ Total Semester/Years Attended_______________________ Current Semester/Year of Study__________________________________________________________________  (  Please attach copy of Reference Letter of your Institution showing that you are a full time student)  Page 4 of  5   Educational Details   EducationalLevelName ofCertificate  (Give ExactTitle, as writtenin thetestimonial) Year ofPassingMarks obtained  (as mentioned inyour final yearMarks Sheet ) TotalMarksName ofInstitution/SchoolName ofBoard/University SSC OREquivalentHSSC OREquivalent *** O-level  and  A- level  applicants will have to provide equivalence of grades/percentages and attestation from IBCC (Inter Board Committee of Chairmen) without which applications will not be processed. *** The candidate whose 12th Class result is awaited may give the detail of 11th Class result with at least 60% marks and hope certificate from Head of Institute/College. What is your major subject in Intermediate? Please tick  one of the following:Subject Pre-Medical Pre-Engineering ICS General Science Arts/Commerce Place of Study:  The candidates who have studied in the Institutions located in the districts of Balochistan or Agency or FRs in FATA fall under the category  BALOCHISTAN IN  and  FATA IN  category. Those who have studied in the Institutions outside Balochistan and FATA/FRs fall under  BALOCHISTAN OUT  and  FATA OUT  category.Please tick the relevant box. Degree Balochistan In Balochistan Out FATA In FATA Out SSCHSSC The  students who fall in the ‘FATA -In/Balochistan-  In’ category  should provide the Provisional/Character Certificate of HSSC duly signed and stamped by the Principal of the college. Undertaking given by Father/Guardian: I solemnly verify that the particulars stated above are correct to the best of my knowledge and belief. In case anydiscrepancy is identified by HEC at any stage, the scholarship of my Son/daughter/ward can be immediatelyterminated and I will have no right of appeal or seek relief from any court of law. Consequently I will be liable to payback the entire amount, released by HEC under various expenditure heads, against the scholarship.Name: ___________________________________ CNIC Number: ___________________________________ Signature: ___________________________________ Date: ___________________________________ 
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