• Year: Select 2022-2023

• Title:   Shri.          Smt.  
• Permanent Address:
• First Name:

  Middle Name:

  Last Name:
• Date of Birth (Minimum age for eligibility-21 years):
  
  Age as on 1 st January 2021: (Note: Applicant must not have completed 35 years on 1 st January 2021)
  
• Marital Status:
  Select Single Maried

  • Physically Challenged:Yes          No  
• Address for Communication:
• Telephone No:

  Fax No:

  Email Address (if any):
• Educational/ Art Qualification (Ref. Condition of Eligibility Rule 2): (Note: Those undergoing regular studies are not eligible for scholarship)
• Present monthly income and source of income:
  

  Value of artworks or publications sold during the last three years and approximate income from sale proceeds or publications:
  
• Foreign countries visited in the last 5 years and the purpose of visit:
  

  Exhibition in which works exhibited: (attach list if necessary)
  
• Awards, Recognition and Distinction received:
  

  Particulars of any Scholarship/Fellowship received in the past and its duration/amount:
  
• Particulars of financial aid other than scholarship/fellowship received from other agencies including foreign agencies during the last five years & the purpose for which received:
  

  Number of years for which working as an artist:
  
• Any other relevant information not covered above, including whether belonging to Scheduled Caste/Tribe or Backward Classes:
  

  Discipline under which Scholarship is applied for:
  

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• Titles or details of maximum five photographs of artworks or one published article (1000 to 1500 words) executed or published after 1st July 2020, may be enclosed along with the Application Form:

• Sr. No.	Title of the Exhibit/Article	Medium	Image Upload
  1
  2
  3
  4
  5

• (Note: The photographs of exhibits or prints of published articles will get merit. Do not forget to mark your name and details on photographs or articles for verification. The documents are subject to non-returnable basis and will be retained by the Akademi for future reference.)
• I agree to abide by the conditions of the scholarship and the facts stated above are correct.

Date: