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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 (√) in the box. Point to be noted that an applicant can apply for only one Scholarship.
A.F. Mujibur Rahman Foundation Scholarship-(i) A.F. Mujibur Rahman Foundation Scholarship-(ii) Al-Haj Tofazuddin & Golapjan Memorial (ICMAB) Trust Syed Manjur Elahi Scholarship
1. Name of student (In Block Letter):________________________________________________
2. Father’s Name:_____________________________________________________________________
3. Address: a) Present: ______________________________________________________________
_________________________________________________
b) Permanent: __________________________________________________________
___________________________________________________________
4. Date of Birth: _________________ 5. Father’s Occupation: ________________________
6. Mobile No: __________________ 7. Email address: _______________________________
8. Father’s 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.
Page 2 of 2 10. CMA performance/ part qualification:
Sl . No. Level Session Year Subjects passed
*11. Total family income (Annual): Tk.= ___________
12. Number of family members: ______________
13. No of brothers’ 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.
