VIDYARTHI SETU PROJECT

Student Registration & Assistance Application Form

Fields marked * are mandatory. Please keep your Aadhaar/ID, marksheet, income certificate and bank details ready before you begin.

1. Student Personal Details

Full Name of Student *

Date of Birth *

Gender *

Male Female Other

Aadhaar / Government ID No.

Student Mobile No. *

Student Email ID

Category *

Disability, if any

No Yes

If Yes, Details

2. Parent / Guardian Details

Father's Name *

Mother's Name *

Guardian's Name (if applicable)

Relationship with Student

Parent/Guardian Mobile No. *

Alternative Contact No.

Parent/Guardian Occupation

Annual Family Income (₹)

Income Certificate Available

Yes No

3. Residential Address

Village / Ward *

Post Office

Block / Municipality *

District *

PIN Code

State

Residential Address *

4. Educational Details

Name of School / College / Institution *

Institution Type *

Class / Course *

Stream / Subject

Academic Year

Roll No. / Registration No.

Board / University

Previous Academic Result / Percentage

Current Academic Status

If "Other" Academic Status, please specify

5. Vidyarthi Setu Assistance Required

Please select the assistance required

Scholarship / Financial Assistance Mobile / Laptop Digital Education Assistance Transport Material (Two Wheeler)

Other (please specify)

Briefly describe the assistance required

Product / Item Details (if assistance involves a physical item, e.g. mobile, laptop, two-wheeler)

Product / Item Name *

Product Model No. / Model Name *

Brand / Manufacturer

Estimated Unit Cost (₹)

Product Specification / Configuration *

6. Family & Economic Information

Total Family Members

Earning Members

Monthly Family Income (₹)

Type of House

Kutcha Semi-Pucca Pucca

Family currently receiving any Government assistance

Yes No

If Yes, details

Any other scholarship / educational assistance received

Yes No

Details

8. Document Checklist (Upload)

Accepted formats: JPG, PNG, PDF — max 2MB per file. Items 1–4 are mandatory; the rest are optional and may be submitted in person later.

1. Student Photograph *

2. Aadhaar / Government ID *

3. Parent / Guardian ID *

4. School / College ID *

5. Admission / Bonafide Certificate

6. Previous Marksheet

7. Income Certificate / Income Proof

8. Bank Passbook / Cancelled Cheque

9. Address Proof

10. Other Supporting Document

9. Declaration by Student / Parent / Guardian

I/We hereby declare that the information provided in this registration form is true and correct to the best of my/our knowledge. I/We understand that the Vidyarthi Setu Project assistance is subject to eligibility, verification, availability of resources and the rules/policies of Moon Light Charitable Trust.

I/We authorize Moon Light Charitable Trust and its authorized representatives to verify the information and supporting documents submitted with this application for the purpose of processing the application.

I/We understand that submission of this form does not automatically guarantee assistance under the project.

Place *

Date *

Signature of Student (type full name) *

Signature of Parent / Guardian (type full name)