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Affix Passport size photograph attested by the Head of the School
APPLICATION FORM
State Level 12 digit Roll Number Scheme Code State Code Year
Class
Date of birth
] CD CDITTIJ
Date Month Year
~. Father's
3. Sex
6. Disability Status of Candidate Oth-2 Ortho- Hearing Blind Low None pedic vision
General SC .'
CCJ0QJQJO
8. Name and address of the institution in which studying at Class VIII ]evel
9. Type of the institution in which studying at Class VIII level (see definition overleaf*)
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Govt.
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Local
Private
Private
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(b) at the NCERT Level ]'5. Mother's occupation
m
Rural L2.J Urban
Body L2..JAided ~
Unaided
II.Medium
.
.
CD
.
14. Mother's
education
CD
CD
CD
CD
CD
],50,00] to 2,00,000 Phone
19. At what number is the candidate among his/her brothers and sisters. .
D D CD
[2]
QJ
up to 50,000
21. Telephone:
OJ
1,00,001 to 1,50,000
CD
2,00,00 I to 2,50,000
[I]
2,50,001 to 5,00,000
o=rco
STD Code
50,00I to 1,00,000'
To be tilled
Certified that:
in by the Head
(I)
Master/Miss is a regular student of this School/Institution and he/she has secured % marks in the class-VII annual examination i.e. when he/she was promoted ITomClass VII to class VIII He/She has secured ' % marks in six main subjects.
(Candidate must fulfill the criteria announced by State/UT). Master/Miss belongs to ScheduledCaste/Tribe category /Disability Category as per the records maintained in the Illstituion.
in the application
(iii) Marksheet
Signature
of Centre Suprintendent
(See Instruction
over leaf)
Coding Plan
Read Instructions carefully before filling the Application Form./~-'f.f
(I) (2) ~ ~/'1>TO\T 'J"["M 'liT~ q" <R I Wff{[ r@f<if~ it;-~ ~
'R'f -'!'f ff~TI<liT'ffiC!~~Do not mark or write outside the boxes. >f <R I 'If<ffi it;-'ITI;<Ofm fo\& Ofjft
Use only Blue or Black Ball Point Pen, WRITE IN CAPITAL LETTERS.
f.r~TR
Leave one box blank between two words. Limit your name and/or address within the space provided example as given below. <it ~ it;-oftq ~ 'If<rn ~
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(3)
(4)
Cross (x) only one of the appropriate boxes in item nos.,.3, 4; 5, 6, 9, 10 and 20. ~ 'f.f >f 3ifiIiq <Ii"'! ~ 3,4, 5, 6, 9, '10 ~ 20 >f~ ~ 'If<rn1Rsnfu(x) <RI Please write code number in item no. 11, 12, 13, 14 and]5 Sfi"lOC1T11, 12, 13, 14~ 15>f~foJ&31:!'1"N'I'fqfl>f'1>T;s~1 as given below.
(5)
It is the responsibility of the candidate and the Principal of the school to deposit the filled in form with the State concerned Office before the last date. No request for condoning delay in submission will be entertained whether it is due to the fault of the Candidate or the Headmaster/Principal' of his/her institution. 3ifWr ~ - '!'f ~ 'f.f ~ ~Iffi ~ 1R ~ <!it~ <!it>It 'IOKfi1R 3ifWr ~ it;-"ijj"q ~ 'f.f "'fjftfomT' ~ \JfT fcrmeff3ii< ~ ~ JfIOfR <!it6'rft I fcrmeff"lIT ~ JfIOfR mft
(6)
The student
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(7)
Incomplete
or defective applications
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The students who have secured mjnimum 55% of the total in class VII with the subjects Hindi, English, Maths, Science, Social Science and third language/Sanskrit will be eligible. Relaxation of 5% will be giv~n to S.C./S.T. Candidates.
qi'1ffi-7 >f~ ~~, ~, 'TfUrQ,crffi;j, ~ f ~ 61, '&jft 'Iff ~Iffi >f~ 6Ft it;-'ff/6T'T1 SC/ST <rf~ 'IT'f~ 'lOT ~ it;-fO\t; ~ ~ 'liT'IT'f-
55% mIi<P3!ftf<r
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Medium of Examination (Refer to item 11) Medium of Examination Code 13 English Hindi 15
Education of Father or Mother (Refer to item Nos. 12 & ]4) Education Code Up to Primary Upper Primary Secondary Senior Secondary Graduation Post graduation Doctoral Professional degree (Engineering, Medicine, MCA, MBA, etc.) Any Other I 2 3 4 5 6 7 8
Father's/Mother's Occupation (Refer to item Nos. 13 & IS) Code Occupation Professional, Technical and Related Worker Admimstrative, Executive and Managerial Worker Clerical and Related Worker Sales/Service Worker Farmer, Fisherman and Related Worker Production and Related Worker, Transport Operators and Labourer Worker not classified by the above occupations Not employed I 2 3 4 5 6 7
.TYPE
OF SCHOOL/INSTITUTION
GOVERNMENT: A Governmellt School is that which is run by the State Government or Central Government or Public Sector Underlaking or an Autonomous Organization completely financed by the Government. LOCAL BODY: A Local Body School is that which is run by Panchayati Raj and local body institutions such as Zila Parishad, Municipal Corporation, Municipal Committee, Notified Area Committee and Cantonment Board. PRIVATE AIDED: A Private Aided School is that which is run by an individual or a private organization and receives grant from government or local body. PRIVATE UNAIDED: Private Unaided School is that which is managed by an individual or a private organization and does not receive any grant either fi'om government or local body.
ADMISSION CARD
To be filled in by the applicant Master/Miss.
s/o/D/o Sri of (School)
Affix Passport size photograph attested by the Head of the School
or ( District/Centre) -_U-
__uh__-
--------
is permitted to appear for the above said eX8;mination. Full Postal Address:
OJ
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Time: 9.00 a.m. to 12.30 p.m.
Office Seal
Signature of Liaison Officer/District Nodel Officer (DEO) (Sec.) (Authorized for State Level NTS Examination) Signature of the Candidate in the Presence of Invigilator
MAT: SAT: ............................................ ............................................
Pin Code
8- Write your Roll Number, as given in the admission Card, on the Answer sheet and on the cover page of the question booklet. 9- All questions in the booklets are objective type , for each question FOUR possible answers are given, but one is correct. You task is to fmd out the correct answer and mark your choice in the Answer Sheet. 10- During the examination follow the instructions ofthe Invigilator strictly. 11- Hand over your admission Card Answer Sheet to the Invigilator before your leave the Examination hall. 12- You can keep photo copy of admission Card. 13- The student will only be responsible for any wrong information 14- The Caste certificate is attached then the student will be beneficiated as per rules
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