[ESP Merit and Needs based Scholarship Program ]

INSTRUCTIONS FOR FILLING OUT THE SCHOLARSHIP APPLICATION FORM:

1. Fill in the form using black ball point pen and write in 7. Check your application for spellings, grammatical errors
capital letters and leave space between words and factual oversight
2. Read the application form carefully 8. Keep a photocopy of the filled-in original application
3. Before filling the original form make photocopy and fill it form for your record
first 9. Ensure that you have attached all the required
4. Submit duly completed application form to the Financial documents by putting a tick mark in checklist
Aid Office along with supporting documents 10. Answer all questions. Those not applicable should be
5. Furnish factual, comprehensive and authentic marked “N/A”
information in the form 11. Affidavit Needs to be submitted after final selection of
6. Whenever in doubt or lost, seek help from the Financial the candidate. For family financial reporting
Aid Office parents/guardian may be consulted for guidance

Scholarship is based on assessment of need and merit as well as availability of funds. Selection will be decided on the
basis of information provided in this form and investigations for the authentication of provided information. Candidate
may be required to appear for interview(s).

Definitions

Family: Father, mother(s), brother(s), sisters(s), Self, Grandparents etc.

Pucca House: A pucca house is one, which has walls and roof made of the following material.

Wall material: Burnt bricks, stones (packed with lime or cement), cement concrete, timber, ekra etc

Roof Material: Tiles, GCI (Galvanised Corrugated Iron) sheets, asbestos cement sheet, RBC,(Reinforced Brick
Concrete), RCC ( Reinforced Cement Concrete) and timber etc.

Kutcha House:

The walls and/or roof of which are made of material other than those mentioned above, such as un-burnt bricks, ,
mud, grass, reeds, thatch, loosely packed stones, etc. are treated as kutcha house.
Semi -Pucca house:
A family member is dependent if, he/she dependent s upon applicant father/guardian to meet his/her basic needs
(food, clothing and shelter etc)

Dependent Family Member:

A house that has fixed walls made up of pucca material but roof is made up of the material other than those used for
pucca house.

Do Don’t

1. Send your application by post or submit by hand to the 1. Provide False/vague/ incomplete information.
admission office or focal person. 2. Don’t overwrite/ scratch on the form.
2. Arrange supporting documents as per Checklist 3. Don’t send scholarship application directly to HEC or
sequence .Put all amounts in Pak Rs. ESP
3. Do consult with parent(s)/guardian(s) for financial data
accuracy & reliability
4. For the information not present/relevant write in capital
letters ‘N/A’
Ehsaas Scholarship Program

Reference Number: HEC/HRD/ESP/2021/688560

1. General Information
University of Health Sciences,
University Name: Degree: Undergraduate
Lahore

Campus:

Discipline: Medical Sciences

Sub Discipline: Medical Sciences University Reg. No:

Program Duration: 5 years Current Semester: 1

2. Applicant information

Name: Mr. Usama Khulaid Gender: Male

Father Name: Muhammad Riaz Guardian Name:

CNIC: 3820172461831 Marital Status: Single

Date of Birth: 21-Oct-2001 Age: 20

Nationality: Pakistan Domicile: Punjab

Tehsil: Khushab Mobile No: +923225416597

Email: ukhulaid4@gmail.com
3. Address

Address Type Address

Mailing Mohallah Shaday Khan Hadali (Khushab)

4. Previous Education of the Applicant .

LEVEL INSTITUTE PASSING PER MONTH TOTAL OBTAINED
YEAR FEE MARKS/CGPA MARKS/CGPA
Secondary School Certificate / DPS and IC 2018 2500 1100.00 1019.00
Matriculation / O – level Jauharabad
Intermediate/Shahadatnama/O-A DPS and IC 2020 3500 1100.00 1007.00
Levels (12 year Education) Jauharabad

5. Family information

Father Status: Alive Earning Status: Earning

If not Earning:

Father CNIC: 3820110481739 Profession: Pensionable Retired

Father/Guardian’s
Government of Punjab Address of Employer: CEO(EDU) Khushab
Employer Name:

Father/Guardian Financial Support other

Retired Not Applicable
Designation: than father Income :

Father/Guardian NTN
Mother Status: Alive
Number and Tax paid:

Mother Profession: Professional Status: House Wife

Parent’s Marriage
Combined Mobile Number: 03216071301
Relationship :

Telephone Number: 092454920125

6. Family Members

Dependent Family
Total Family Members: 5 4
Members:

Total Earning Family Member(s)

1 3
Member(s): Studying:

No of Brother(s): 0 No of Sister(s): 2

7. Family Income
Financially Gross
Name of earning Relationship with Net Income
Profession supporting Income (Rs.)
person Applicant (Rs.)
the family

Muhammad Riaz Retired Yes Father 34,785.00 34,785.00

Total Monthly Income 34,785.00 34,785.00

Please include all income e.g Salary, Pension, Income from Land, mortgage, lease, dividends, shares etc in Gross
income. Please attached the Latest Salary Slip\income certificate with application Form. The profession includes
Public /Government Job ,Private Sector Job , Business, Farmer , Laborer, self-employed, Other

8. Income From Other Sources

9. Current Monthly Educational Expenditure
Per Month
Relationship Type of
Name Institution Name Class Education
with Applicant Instituition Expenditure

MBBS 4th
Ammara Riaz Sister SIMS Lahore Public Sector 5,000.00
year

Tooba Riaz Sister DPS and IC Jauharabad Public Sector 10 Class 3,700.00

Total (Per Month) 8,700.00

Name Per Month Education Expenditure

Self( Please include expenditure including tuition fee and lodging charges) 8,000.00

9. Accommodation Expenditure

Type: Village House Structure of House: Pucca House

Status: Family Owned No of Rooms: 2-4

Covered Area[in Sq
Size of Home[in Sq Ft]
2000 Ft] (Sq.Ft = length x 1600
(Sq.Ft = length x width):
width):

No of Air Conditioners: 0 Number of Servants: 0

Monthly Rent Paid: 0

Address: Hadali (Khushab)

Any other house/flat owned by the Parents/Guardian (if yes please specify with location and size)
11. Monthly Family Expenditure
Detail Per Month Amount
Average Telephone bill of last Six months 500.00

Average Electricity bill of last Six months 3,497.00

Average Gas bill of last Six months 316.00

Average Water bill of last Six months 0.00

Average Monthly Mobile Bill 1,500.00

Average Family Educational Expenditure other than applicant 8,700.00

Applicant Educational Expenditure 8,000.00
Average Family Expenditure on Kitchen/Food 8,000.00

Average Family Medical Expenditure 2,000.00

Accommodation Expenditure , in case of rent 0.00

Average Family Misc. Expenditure 2,000.00

Total Monthly Expenditure 34,513.00

Detail Per Month Amount

Net Reusable Income(Total Monthly Income – Total Monthly Expenditure) 272.00

12. If the monthly Income is negative kindly explain the reasons for the gap, and the arrangements through which the
differential gap is met by the family
13. Assets
Does the family own any Transport? Yes
Type of Transport Engine Capacity CC Quantity Current Market
Value (Rs.)

Bike 70 1 60000

Total Value of Transport 60000

Does the family own any cattle? No

Other Assets
Other Assets Quantity Current Market
Value (Rs.)
Other House 0.00 0.00

Business 0.00 0.00

Agriculture Land 0.00 0.00

Bank Balance 0.00 0.00

Stocks/Prize Bond 0.00 0.00

Plot(s) 0.00 0.00

Any Other Asset 0.00 0.00

Total 0.00

Detail of Assets on Lease (Please specify)

How were the admission /first semester charges paid?

Through cash via HBL

Have you ever been awarded any other scholarship before? if yes please share the No

Statement of Purpose (attach separate sheet if required)

I need this scholarship because I don't want my financial issues to be a hurdle in my way to be a good doctor. I belong
to a middle class family of three children and all of them are studying currently. We are dependant for everything on a
small pension of our retired father. I have worked exceptionally hard to get a seat in MBBS this year and if I'm able to
get this scholarship, it would actually be a further confidence booster for me and a very big relief for me and my poor
family.

How did you know about ESP Merit and Needs-Based Scholarships Program?
University
Document Check List
Supporting Documents to be submitted to FAO along with ESAAS Undergraduate Scholarship Project
Application Form
S.NO Supporting Documents Status

1 Copy of Applicant CNIC/B.Form

2 Copy of CNIC (Father, Mother/ Guardian)

3 Salary Slip / Income Certificate (Father/Guardian, Mother)

4 Copies of last Six Month Utility Bills (Electricity, Gas, Telephone, Water) – (If applicable)

5 Copy of Rent agreement in case of Rented House

6 Copies of Last Fee Receipts of Applicant and Siblings (If applicable)

7 Copies of Medical bills/ expenditure related documents (if applicable)

8 01 Passport size Photograph of Applicant

Undertaking

1. The information given in this application is true to the best of my knowledge and I understand that any
incorrect information will result in the cancellation of this application. If any information given in this
application is found incorrect or false after grant of financial assistance, the institute will stop further
assistance and the student will have to refund all payment received and or penalty equal to total scholarship
amount.
2. HEC and University reserves the right to use information given in this form for verification and other purposes

Date Date

Father/Guardian Applicant
Signature Signature

For Official Use

Application Form Complete with
Yes No Application Case Review Dates
supporting documents

The notices furnished to the

applicant for furnishing of required
documentation

Signature of The Focal person

Date