The Institute of Cost and Management Accountants of Bangladesh
ICMA Bhaban, Nilkhet, Dhaka-1205.
Scholarship Application Form
Instructions: Please fill up the form meticulously & select the Scholarship option from the following list by giving Tick mark (β) in the box. Point to be noted that an applicant can apply for only one Scholarship.
1. Name of student (In Block Letter):________________________________________________
2. Fatherβs Name:_____________________________________________________________________
3. Address : a) Present: ______________________________________________________________
_________________________________________________
b) Permanent: __________________________________________________________
___________________________________________________________
4. Date of Birth: _________________ 5. Fatherβs Occupation: ________________________
6. Mobile No: __________________ 7. Email address: _______________________________
8. Fatherβs present address: _________________________________________________________
____________________________________________________________
9. Educational Qualification (Marks Certificates/ Mark Sheet to be attached):
Sl.
No.
Name of Examination
Passing year
Div./ Class or GPA/
CGPA
Marks Board/ University 1.
2.
3.
4.
5.
10. CMA performance/ part qualification:
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Sl . No.
Level Session Year Subjects passed
*10. Total family income (Annual): Tk.= ___________
12. Number of family members: ______________
13. No of brothersβ and sisters with their ages and occupations, (if any) _________________
___________________________________________________________________________
14. Other scholarship(s) (if any) currently enjoying: _________________________________
_____________________________________
Signature of Applicant (Student)
Date: ___________
Level: __________, Roll No. _____________, Reg. No._________, Section ______, Session ___________
*Guardians income certificate from Union Parishad/ Word Commissioner for agriculture and business man and salary certificate for service holder to be attached.
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