S.

No: ___________

KPK-Educational Testing and Evaluation Agency (ETEA)

Paste one
Recent
Photograph
without
Attestation
Here

APPLICATION FORM FOR AWARD OF SCHOLARSHIP AND ADMISSION TO

CENTRES OF EXCELLENCE FOR THE POOR & DESERVING CANDIDATES

NOTE: No application Form will be accepted at ETEA Office.

Clip/Staple
Two Recent
Photographs
Attested
Backside
Here

Roll Number:

Gender:

Male

Female

(To be filled in by ETEA)

1.

Name of student____________________________________________________
(Use Capital Letters)

2.

Fathers Name______________________________________________________

3.

Domicile______________________________________

4.

Date of Birth (in figures) ______/______/_________ (01/04/2001 01/04/2003)

(in words) _____________________________________________

5.

Educational Institution last attended____________________________________

6.

Class in which studying______________________________________________

7.

Desired institution: (Please indicate the corresponding NUMBER of any

institution, given in the advertisement, in order of preference):
i. __________ ii. ___________ iii.__________
iv. ___________
v. __________

8.

vi. __________

vii. __________ viii. ___________

Permanent Address__________________________________________________
_______________________________________(Phone)____________________

9.

Present Address____________________________________________________
_______________________________________(Phone)____________________

10.

i)

Certified that the applicant has been studying in Government School

at least for the last one year.

ii)

Entries in columns 4-6 (without any cutting/overwriting) verified:

Name of the Principal _________________________ Signature: ___________

(with office seal)

Name of the EDO E&SE _______________________ Signature: ___________

(with office seal)

11.

Undertaking by the Candidate and his/her Parent

I____________________________S/D/O _______________________________

do certify that I have personally filled out this form and the information is correct to the
best of my knowledge and belief. If the information is found incorrect, the award of
scholarship/Admission may be cancelled at any stage after selection and amount incurred
will be recovered from my parents through District Administration.

Signature of Student ______________ Signature of Parent ________________

CNIC No. of Father/
Guardian: