For office use only

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Instructions for filling the application form

1. Do not leave any field vacant in the form. : Mention NA or ‘same as’ as the case may be.

2. All information that needs to be presented in boxes should be written in upper case (capital letters).

3. For questions/essays that require descriptive answers:

a. Please attach a separate, good quality A4 sheet with your answers/ essays within the prescribed word limit. (Applicable only if you are not applying online)

b. Identify your answers/essays by specifying the following for each essay: question, section name, sub-section name and page and number of the question. e.g. What have you accomplished in your engagement in the mentioned extracurricular ac-tivity?/ Extra-curricular activity/ Page 11

c. You could either type and print your essays, or write by hand using a pen (Please do not use pencil).

4. Application fee:

a. There is no application fee for the program. You can access the forms either by downloading it from the website or collecting it directly from the YIF office.

Please send the complete application form and recommendation to the following address:

Young India FellowshipB-118 Sector 2Noida - 201 301Uttar Pradesh

Please note that you should not make photocopies of the application or recommendation form because each form is tracked with a unique form ID.

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DAP-2014-000338

Important note: Please read the instructions on Page 1 carefully before starting to fill the application form.

Contact Details

PERMANENT ADDRESS

CITY

STATE

COUNTRY COUNTRY

PRIMARY EMAIL ID

ALTERNATE EMAIL ADD

Personal Details

FIRST NAME TITLE (Mr. / Ms.)

GENDER: MALE FEMALEMIDDLE NAME

SURNAME DATE OF BIRTH: day _ _ / month _ _ / year _ _ _ _

CORRESPONDENCE ADDRESS

CITY

STATE

TEL. RES

OFFICE

MOBILE

FAX

2

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Academic Record

(I) HIGHER SECONDARY (CLASS X)

SCHOOL NAME

STATE

COUNTRY

LOCATION(CITY/TOWN)

(a) AGGREGATE SCORE

(e) What was your most preferred subject during your higher secondary and why? (Maximum limit – 100 words.)

(d) Distinction received

(b) YOUR APPROXIMATE RANK IN YOUR CLASS (e.g. all students appearing in the board exam from your school)

(mention what you scored in reference to the maximum marks possible, e.g. 440/500)

(c) Top three subjects in terms of score. Convert your grades to percentage.

Subject Score (in %)

1. Top 5%

2. Top 15%

3. Top 30 %

4. Top 50%

5. Below 50%

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________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Academic Record

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(II) SENIOR SECONDARY (CLASS XII)

SCHOOL NAME

STATE

COUNTRY

LOCATION(CITY/TOWN)

(a) AGGREGATE SCORE

(e) What was your most preferred subject during your senior secondary and why? (Maximum limit – 100 words.)

(d) Distinction received

(b) YOUR APPROXIMATE RANK IN YOUR CLASS ( e.g. all students appearing in the board exam from your school)

(mention what you scored in reference to the maximum marks possible, e.g. 440/500)

(c) Top three subjects in terms of score. Convert your grades to percentage.

Subject Score (in %)

1. Top 5%

2. Top 15%

3. Top 30 %

4. Top 50%

5. Below 50%

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Academic Record

(III) UNDERGRADUATE

COLLEGE NAME

DEGREE

ATTENDED

UNIVERSITY

(MENTION AUTONOMOUS IN CASE IT IS NOT Affiliated)

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From To

MAJOR FIELD OF STUDY

SCORE

(a) Aggregate (over all semesters completed so far)

Convert your grades/points into percentage in case your college does not use percentage

(b) 1st year, 2nd year 3rd year 4th year 5th year (if applicable)

(d) Distinctions received

(e) What is your most preferred subject and why ? (Maximum limit - 100 words)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

(c) Top three subjects in terms of score. Convert your grades to percentage.

Subject Score (in %)

STATE

COUNTRY

LOCATION(CITY/TOWN)

(f) What did you enjoy most in your undergraduate academic experience? (Maximum limit - 200 words)

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Employment Details (If applicable)

(I) CURRENT EMPLOYER/SELF-EMPLOYED

ORGANIZATION

LOCATION

INDUSTRY

CURRENT DESIGNATION

COMPANY TURNOVER

DURATION WORKED FOR

NO. OF EMPLOYEES

From To

(choose one: less than 1 cr, 1 cr – 5 cr, 5 cr – 20 cr, 20 cr – 100 cr, 100 cr – 500 cr, 500 cr – 1000 cr, greater than 1000 cr)

FUNCTION

(mention key area of involvement e.g. sales/business development/mar-keting/research/ HR/ client servicing/ finance/accounts/creative etc.)

Please answer the following questions:

(1) What are your main responsibilities in this position? (Maximum limit - 100 words)

(2) What have been the biggest challenges you have faced in this position and how did you tackle them? (Maximum limit - 200 words)

(3) Awards/accomplishments (Maximum limit - 100 words)

Employment Details (If applicable)

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(II) PREVIOUS EMPLOYER/SELF-EMPLOYED (If applicable)

Please answer the following questions:

ORGANIZATION

LOCATION

INDUSTRY

DESIGNATION (MOST RECENT)

COMPANY TURNOVER

DURATION

NO. OF EMPLOYEES

From To

(choose one: less than 1 cr, 1 cr – 5 cr, 5 cr – 20 cr, 20 cr – 100 cr, 100 cr – 500 cr, 500 cr – 1000 cr, greater than 1000 cr)

FUNCTION

(mention key area of involvement e.g. sales/business development/mar-keting/research/ HR/ client servicing/ finance/accounts/creative etc.)

(1) What are your main responsibilities in this position? (Maximum limit - 100 words)

(2) What have been the biggest challenges you have faced in this position and how did you tackle them? (Maxi-mum limit - 200 words)

(3) Awards/accomplishments (Maximum limit - 100 words)

Extracurricular Activities

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(I) ACTIVITY 1

ACTIVITY

DURATION

LEVEL OF PARTICIPATION

1. School level

From To

2. District Level

3. State Level

4. National

(II) ACTIVITY 2

ACTIVITY

DURATION

LEVEL OF PARTICIPATION

1. School level

2. District Level

3. State Level

4. National

From To

• What have you accomplished in your engagement in the mentioned extracurricular activity (Maximum 100 - words)

• What have you accomplished in your engagement in the mentioned extracurricular activity (Maximum 100 words)

• What have you accomplished in your engagement in the mentioned extracurricular activity (Maximum limit - 100 words)

(III) ACTIVITY 3

NAME OF ACTIVITY

DONE

LEVEL OF PARTICIPATION

1. School level

2. District Level

3. State Level

4. National

From To

Extracurricular Activities

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________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

(IV) Please share your other hobbies (Maximum limit - 50 words)

Parents/Guardian Details

FATHER’S / GUARDIAN’S NAME

ACADEMIC QUALIFICATIONS(list all)

GROSS INCOME

OCCUPATION

TURNOVER

(less than 1 cr, 1 cr - 5 cr, 5 cr – 20 cr, 20 cr – 100 cr, 100 cr – 500 cr, 500 cr – 1000 cr, greater than 1000 cr)

(less than 2 lacs pa, 2 – 5 lacs, 5-10 lacs, 10-25 lacs, 25 – 50 lacs, 50 – 1 cr, greater than 1 cr pa)

OFFICE ADDRESS

RESIDENCE ADDRESS

ORGANIZATION (If applicable)

NO. OF EMPLOYEES

CONTACT NO. (RESIDENCE)

MOBILE

Parents / Guardian Details

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MOTHER’S NAME

ACADEMIC QUALIFICATIONS(list all)

GROSS INCOME

OCCUPATION

TURNOVER

(less than 1 cr, 1 cr - 5 cr, 5 cr – 20 cr, 20 cr – 100 cr, 100 cr – 500 cr, 500 cr – 1000 cr, greater than 1000 cr)

(less than 2 lacs pa, 2 – 5 lacs, 5-10 lacs, 10-25 lacs, 25 – 50 lacs, 50 – 1 cr, greater than 1 cr pa)

OFFICE ADDRESS

RESIDENCE ADDRESS

NO. OF EMPLOYEES

CONTACT NO. (RESIDENCE)

MOBILE

ORGANIZATION (If applicable)

Essays

Please read the following instructions carefully before writing your essays.

(i) You need to answer the following questions in essay-format and within the prescribed word-limit.(ii) Please use good quality, white A-4 sized sheets to write the essays.(iii) A new essay should be started on a new A-4 sheet.(iv) Please write the topic of the essay/question at the top of the page before you write the essay/answer.(v) You can use either of the following methods to write your essays:

• Type and print your essays and then attach one copy of each essay to the form • Write by hand and attach one copy of each essay to the form• Type it online if you are using the online admission module

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(I) What matters the most to you and why? (Maximum limit – 600 words)

(II) What has been your biggest achievement so far and why do you consider it to be so?

(Maximum limit – 600 words)

(III) What do you hope to accomplish from the Young India Fellowship? (Maximum limit – 600 words)

(IV) Do share with us any other details that you think might add to your candidature for a Young India Fellowship.

(Maximum limit – 600 words)

(V) Do attach any relevant collateral that you think might add to your candidature for a Young India Fellowship. Collaterals could include videos, works, prototypes, special certificates etc. (Please note that school passing certificates, marksheets etc. are not to be sent as a part of this application and will be required only at the time of the interview.)

References

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Guidelines for students

• Every applicant has to submit one recommendation as a part of the application. • The recommendation could be from your professors or mentors in your academic context or seniors in the

professional context.• Recommendations by family members, friends and peers will not be accepted.

Guidelines for referees:

You have been chosen by a prospective Young India Fellow to recommend his/her case for the program. Please read the following instructions carefully before filling up the form.

a. What is the spark that you see in the candidate that confirms your belief in him/her as a change agent in building a great future for India?

b. Share an instance where the applicant has taken a significant initiative across any sphere of his/her life and the outcome of this efforts.

c. Are there any other details that you think could help us understand his/her candidature better for the Young India Fellowship?

Please write a recommendation essay that includes the following aspects about the candidate: (Maximum limit - 500 words)

1. In case you have directly received the form from us, you would have got the recommendation form (enclosed in a separate envelope) along with the application dossier. You are requested to hand over the form to your referee who will fill it up and hand it over to you in a sealed envelope. You will need to send this recommen-dation form along with your completed application form to us.

2. In case you are applying online, you will need to mention your referee’s email address which will allow us to send him/her the recommendation form that can be filled online.

3. In case you are downloading the recommendation form from our website, you will need to print it and pres-ent it to your referee in an envelope. The referee will fill it up and hand over the recommendation in a sealed envelope. You will need to send this recommendation along with your completed application form.

1. For your recommendation, please use a separate, good quality A4 sheet. 2. Please write within the prescribed word limit. 3. You could either type and print your recommendation, or write by hand.4. Please fill in your personal details (ref: next page) in upper case (capital) letters.5. Please attach your personal details form (ref: next page) and this page of instructions along with the recom-

mendation essay and hand it over to the applicant in a sealed envelope.

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Ref No

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Referee Details

FIRST NAME

TITLE (Mr./Ms./Dr. etc.)

MIDDLE NAME

SURNAME

DESIGNATION

DESIGNATION

NAME

ADDRESS

ORGANIZATION (If applicable)

RESIDENCE CONTACT NO

MOBILE

CONTACT NUMBERS

EMAIL ADDRESS

Your preferred time to be contacted by us (in case we need to seek any clarification for the applicant’s case)

(9 am to 12:00 noon, 12:00 noon to 3:00 pm, 3 pm to 6 pm, 6 pm to 9 pm)