Beneficiary Registration

Beneficiary Registration for Financial Assistance

Your Picture*

Financial Assistance Request For *

How many years of Financial Assistance you are looking for? *

Estimated Annual Fees*

Personal Information

First Name *

Last Name: *

Email: *

Telephone Number:

Mobile Number:*

Gender *

State: *

Note: (Financial assistance program is available only in the states mentioned in the drop down menu. If you live in a state not listed here, please contact aaghaz.foundation@gmail.com to speak to us)

City: *

Note (If your home district is not listed then it means Aaghaz is yet to start its operations there. Please contact us at aaghaz.foundation@gmail.com to speak to us)

Date Of Birth: *

Address: *

Aadhar Card No. *

Aadhar Card Document. *

Family Information

Father name: *

Mother name: *

Parents Alive/Deceased/Divorced: *

Father Phone Number:*

Mother Phone Number:

Guardian Name:

Guardian Relation:

Guardian Phone Number:

Father Age: *

Mother Age:*

Father Profession: *

Mother Profession:

Monthly Family Income: *

Number of Brothers and Sisters:

Why do you need Financial Assistance? Tell us in detail(Minimum 100 words):

Academic Information

Academic Level: *

Grade: *

Enter name of Course/Degree if Academic level is Post Secondary:

Institute Name: *

Other Institute:

Institute Phone Number:*

State : *

City: *

Institute Address:

Enter Last Academic Year Performance Score/Percentage : *

Upload your last Marksheet or Scorecard: *

Personal and Professional Reference

Reference One *

Should be your past or current school/college/university teacher

Full Name*

Phone Number*

Home Address*

School/College/University name where employed*

Reference Two *

Should be a prominent/Known/Respected person from your locality

Full Name*

Phone Number*

Home Address*

Employed at*

Note* Aaghaz will speak to the references about your application

Are you referred to Aaghaz Foundation by an existing Aaghaz Member?*

Enter Name of Aaghaz Member *

Enter Contact Number of Aaghaz Member *