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UNIVERSITY OF CALICUT

for office use only
Calicut University Teacher Education Centres
1. Vatakara
2. Chakkittapara
3. Calicut
4. Kaniyambetta
5. Sulthan Bathery
6. Manjeri
7. Malappuram
8. Koduvayur
9. Aranattukara
10. Valapad
11. Nattika
Degree (Part III
Main)

PG-optional
subject


APPLICATION FOR ADMISSION TO B.Ed COURSE FOR THE YEAR 2014-15
(Please read the prospectus carefully before filling the Application form)


1. Optional Subject selected for B.Ed

2. Name of the Applicant in English (in Block letters)
in Mother tongue


3. Name of the Parent/Guardian


4. Sex M / F


5. Address to which communications are to be sent (in capital) Permanent Address












6. Marks obtained for the qualifying examination

(Part III /Double Main/Triple Main/M.Com).
OR

Grade obtained for the qualifying examination
(Part III /Double Main/Triple Main/M.Com).



Secured Percentage Maximum

Course CGPA Percentage
Core Course
Complementary Course-I
Complementary Course-II


Space for
affixing
Photograph








E-mail
Phone No
Mobile No: Pin






Phone No
Mobile No: Pin
Details of fee paid
Chalan No.
Date
Treasury




1. Percentage of marks
B.A/B.Sc.(Part III)/M.com



2. Nativity


3. Degree from University of
Calicut



4. Weightage of marks for
M.A./M.Sc. in the same
subject



5. Teaching Experience



6. N. C. C.



Total for 1 to 6




7. Number of chances (01, 02 etc.)


8. Marks secured for Post graduation in the same subject

OR
Grade secured for Post graduation in the same subject



9.. Nationality/Religion/Caste/Community


10. Quotas under which applications are to be
considered (enter code(s))








11. Whether the candidate is a Permanent Teacher
in an Aided/Govt.School. : Yes / No


12. Teaching Experience (as on date of notification)



13. Whether you belong to the District under the Yes / No
University of Calicut jurisdiction.

14. Whether you have graduated from Yes / No
University of Calicut

15. Whether claiming weightage for PG in the Yes / No
same subject.

16. If Double/Tripple Main, maximum marks/grade
obtained in the main subject applying now. Yes / No

17. Annual Family Income Rs.


18.. Do you belong to SC/ST/ETB/Muslim/OBH/LC/SIUC/OEC if so, state
the community and attach attested copies of Community and Income
Certificates.

19. Name of the District to which you belong (Attach Nativity Certificate for
claiming Nativity weightage) Residential Certificate is not acceptable.

20. Whether applying for the quota of Ex-Service men/Dependant of Ex-
service men/Dependants of Serving personnel. (Attested copies of
certificates stating relationship with the personnel should be
produced.)

21. Specify whether applying for Teachers/ Linguistic/
Minority/Lakshadweep/Sports/Handicapped (Visually/ Orthopeadically).
Attested copies of certificates should be attached.

22. Teaching experience in Govt. School/Aided School
(In case of candidates applying under Teacher’s quota and those
applying under general merit claiming weightage for teaching
experience, certificate countersigned by the A.E.O./D.E.O./R.D.D
should be produced in the form IV of KER)

23

Whether claiming weightage for NCC
(If so, attach copy of the certificate from the competent authority)



Secured Percentage

Gen.Merit Teacher

Ex-service/Serving Personnel
Handicapped Native of Lakshadweep
Linguistic Minority

Sports
Years Months Days



24. Educational Qualification (Self attested copies of mark lists/consolidated grade cards should be enclosed)
Details of qualifying
examinations
University Subject
Reg.
No.
Year of
passing
Marks
Class
obtained
with % of
marks
Chances
taken
Awarded Maximum
BA/
B.Sc
Part III Main
and Sub.



Double
Main
/Triple
Main
Main-I
Main-II
Main-III

MA/M.Sc/
M.Com



GRADING SYSTEM

Grade

CGPA secured
% of
marks

BA/
B.Sc
Core Course or
Main-I

Complementary
Course-I or
Main-II



Complementary
Course-II or
Main-III

MA/M.Sc/
M.Com



List of enclosures

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8.



DECLARATION
I do hereby declare that the details given above are true and correct and that I will obey all the rules and
regulations of the University and the Teacher Education Centre.

Place:

Date:



Signature of the Applicant