“RAHAL RANDARU” SCHOLARSHIP FUND APPLICATION FORM

Written under: Rahal Randaru by Thambaru Wijesekara on February 3, 2011
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1. Full Name :
2. Date of Birth :
3. Permanent address of the Residence :
4. • Name of Father :
   • Age :
   • Occupation :
5. • Name of Mother :
   • Age :
   • Occupation :
6. Loss of either mother or father :
7. Other special references :
8. Monthly income of the family(A letter signed by Assistant Government Agent via “Gramasevaka” is required for the purpose)
9. 1. The mean attendance in grade 10 and 11 :
   2. The mean attendance in grade 12 and 13 :
10. The Name of the Dharma school attending(Required only if attending)
11. The latest Certificate received
12. Results of the GCE Ordinary Level/GCE Advance Level(First Certificates should be submitted at the interview)
13. • The Stream of subjects following for A/Levels
    • The Stream of subjects that you have chosen to study in the University

All above mentioned information and statistics are true and correct to the best of my knowledge.