1

SXC B.ED. APPLICATION FORM 2015-20

2016.

Application received on

Application Number

Qualification

Category

RC
XT
GEN
PH
CU

SC
ST
OBC
OTHER

University

T. XAVIERS COLLEGE
ST.

Deputed /
Fresher

30, MOTHER TERESA SARANI, KOLKATA 700 016

[AUTONOMOUS]

If Deputed,
Teaching
Experience
till 31/01/15

DEPARTMENT OF EDUCATION
Affiliated to Calcutta University,
Recognised by N.C.T.E.
&
Accredited by NAAC

Affix a recent passport

size photograph, and
get it attested by the
principal / headmaster
of school / college or
a gazetted officer.

APPLICATION FOR ADMISSION TO THE B. ED. COURSE

The Application Form has two sections A & B. Deputed-Teachers

Deputed Teachers have to fill in both
Sections A & B. Others need to fill in only Section A.
PLEASE NOTE (a)

Before filling in this form, every candidate is advised to read the prospectus carefully.

(b)

This form, duly filled in, should be submitted to St. Xaviers College from 02-02-2015
02
to 06-02-201
2015 between 9:30 am and 12:00 noon.

(c)

Recognised by NCTE, accredited by NAAC and affiliated to CU, guidelines of NCTE

will be adhered to for selection.

Documents required at the time of submission of filled in application form (duly

duly attested Xerox copies to be
submitted and originals to be presented for verification):
a. Mark sheets for all stages of examinations passed.
b. Age verification certificate.
c. University registration certificate.
d. Certificate for reserved category.
e. Baptism certificate
ficate for Christian candidates and approval letter from the local Parish Priest.
f.

Approval of DI of schools for deputed candidates.

g. Xerox Copy of M. C. Resolution for deputed candidates countersigned by DI/ADI of school.

SXC B.ED. APPLICATION FORM 2015-2016.

Section A (To be filled in by all applicants).

I : Personal.
1. Name of candidate in full _____________________________________________________________
(in Block Letters)

Title / Surname

Middle Name

Name

2. Male /Female/Transgender (Please Tick)

3. Date of Birth ________________________________ Age on 1st July, 2015 ___________________

4. Address for correspondence (in Block Letters).

Permanent home address________________________________________________________________

(in Block letters)

Post Office:
Pin Code:
Rural

State:
Urban

District:
Country:

Place a tick

Kolkata address______________________________________________________________________
(in Block letters)

___________________________________________________________________________________
Phone : _________________ Mobile ______________ E-mail _________________________________
5. Whether domiciled in West Bengal? ________________________ Married / Single_____________
6. Fathers / Mothers Name ___________________ Spouses Name __________________________
7. Fathers / Mothers / Spouses Occupation ______________________________________________
8. Family Income __________________________ per month
9. Nationality __________________________ Religion (RC/XT/OTHER) _______________________
10. Category (SC/ST/OBC/PH/GENERAL)________________________________________________
11. Medium of instruction preferred in teaching (English / Bengali) _____________________________
II : Academic & Professional.
12. Academic record (cancel which are not applicable)
a) Passed MADHYAMIK/ICSE/CBSE(X) or Equivalent Examination
in the __________________ Division from _______________ School in the year_____________
b) Passed HS/ISC/CBSE(XII) or Equivalent Examination in the ______________________Division
from _________________________ in the year _________________ with the following Subjects
______________________________________________________________________________

SXC B.ED. APPLICATION FORM 2015-2016.

c) Passed B.A. / B.Sc. Examination of _________________________________________ University

from ___________________________________________________________________ College,
in the year ____________________________ with ________________________________ Class
Honours in _____________________

Pass Subjects___________________________________

d) University Roll No. of B.A. /B.Sc. ___________________________________________________

e) Passed M.A./M.Sc. Examination of ___________________________________________________
University with __________________ Class, in the year ________________ Subject ___________
f) Other Examination or Course of study followed since ____________________________________
_______________________________________________________________________________
g) Prizes, Merit scholarships or other distinctions _________________________________________
_______________________________________________________________________________
h) Name and Registration No. of last University attended with year ___________________________
i) Roll No. of last Examination: _______________________________________________________
13. If employed, since leaving College,
a) in teaching post, details of employment ______________________________________________
_________________________________________________________________________________
b) in non-teaching post, details of employment ___________________________________________

14. Write two method subjects studied at Graduation level (refer to combination of subjects given in the
prospectus) : Subjects will be finalised at the time of interview.
1. _________________________________ 2. ____________________________________
15. Compulsory Elective Paper (tick the appropriate box) :
Guidance and Counseling.

Measurement and Evaluation in Education.

16. Did you apply for admission to B. Ed. Course at St. Xaviers earlier ?
If yes, mention year and application number.
1. _______________________________________
2. _______________________________________

SXC B.ED. APPLICATION FORM 2015-2016.

17. For 2015-2016, have you applied elsewhere for B.Ed.? Yes / No
If yes, Name of the Colleges : 1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________
18. Academic Record
Exam. Passed.

Board/Univ.

Subjs. taken

Marks obtd.
Total Marks

Percentage
of Marks

Madhyamik / ICSE
or equivalent
H.S. / I.S.C.
or equivalent
Degree Hons.

Pass Subjects

1.
2.

Post Graduate
M. Phil / Ph. D
NET/SET
SSC
Degree/Diploma in
Computer

19. Academic Achievements (University/State/National level) : ________________________________

___________________________________________________________________________________
20. Co-curricular Achievements (University/State/National level) : _____________________________
___________________________________________________________________________________
21. Special Achievements and Hobbies (if any) :____________________________________________
___________________________________________________________________________________
22. For Priests, Religious or Seminarians: Name and address of Bishop / Superior :

I declare that information given above are true to the best of my knowledge. I am aware that if found
incomplete / untrue / incorrect, my application is liable to be cancelled.

Date

Signature of the Candidate

SXC B.ED. APPLICATION FORM 2015-2016.

Section B (To be filled in by Deputed Teachers only and submitted.)

Particulars to be furnished by the Headmaster of the School Or the Secretary if the Candidate is Headmaster

1. Designation : Headmaster / Headmistress / Assistant Teacher

2. Name and full postal address of the School where the candidate is now serving :

3. Date of appointment of permanent post in this School: Subjects taught and classes:

4. Teaching Experience as a permanent teacher as on 31-01-2015:______________________________

5.

Previous teaching experience, if any: (mention School or Schools, year of service, dates of
appointment.)

6. Whether deputed by the school for undergoing training ____________________________________

7. Number of teachers from the School seeking admission to training College this year ? ____________
8. Number of teachers from the School seeking admission to St. Xaviers College this year ? _________

Certified that the above statements are true.

Date:

Seal of the School

Signature of the Head of the Institution.

SXC B.ED. APPLICATION FORM 2015-20

2016.

ST. XAVIERS COLLEGE

[AUTONOMOUS]
30, MOTHER TERESA SARANI (PARK STREET), KOLKATA 700 016

DEPARTMENT OF EDUCATION
ADMIT CARD FOR INTERVIEW
(To be collected by the candidate at the time of form submission)

Affix a recent passport

size photograph, and get it
attested by the principal /
headmaster of school /
college or a gazetted
officer.

Application Number
Name
Address

Phone No :
Mobile :
Email :
Method Subjects :

Compulsory Elective Paper :

Date:

Signature of candidate