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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

Serial No. Center Code
(Office!o fill)

Class

Date of birth

w [ili] [iE] DIIJ[IT]
Name (Do not write Mr.lDr.lProf.)

§] CD CDITTIJ
Date Month Year

I. Name of the Candidate (Do not write Miss/ Master)

~. Father's

3. Sex

4. Area towhichandidate c resides5. Caste category of candidat~

6. Disability Status of Candidate Oth-2 Ortho- Hearing Blind Low None pedic vision

LJ[2J LJ QJ Male Female Rural Urban

.

General SC .'

LJ0QJQ]QJQ] ST OBC Oth-I

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*)

m ~

Govt.

m ~

Local

m

Private

m

Private

m
~
(b) at the NCERT Level ]'5. Mother's occupation

m
Rural L2.J Urban

Body L2..JAided ~

Unaided

II.Medium

of examination (a) at the State level:

13. Father's occupation

.
.

D

CD
.

14. Mother's

education

D

CD

12. Father's education

0

16. ~<? o~family members hVll1g 111 house. the

17. Number of brothers

CD
CD

18. Number of sisters
.

CD
CD
],50,00] to 2,00,000 Phone

20. Parental annual income

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'

More than 5,00,000

22. E-mailaddress of Institution

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.

I

I

I

(2) (3) (4)

(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.

.

The particulars given by him/her

in the application

form have been verified (i) Caste (ii) Disability

and found in order. of class VII.

Attached attested copies of following certificates.......................................... Date ...........................................

(iii) Marksheet

.............................................. Signature ........................................... of the Headmaster/Headmistress With Seal ..............................................

Signature of the cand idate

Signature

of Centre Suprintendent

Signature of DEO (Sec.) & Nodel Officer
...............................................

(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 f¥f~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.

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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 ~

for it. Please see <liT ~ I

~

I 31I'F/iT 'IT'f/Iffil ;;ITii!'l6"<ft ~ ~ i3<fi >f ~

<R I 'J"WT~

fur 'Il{ ~

(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"lOC«1T11, 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

I

(6)

The student
tfil1f if <IT

will only be responsib,le
'l""ffif WAT it;- fO><:I~

for any wrong infOl'mation,
1IT<IT1

~

ift'~

(7)

Incomplete

or defective applications

arc liable to be rejected, I

-

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(8) fcrmeff ~

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'1'1 <liT f.rffif f<I>"lIT ~ un

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-

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fcrffi;j ~ ~ '1I'!T/~ >f~ 5% <!itrg:c ~ tl

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55% m«Ii<P3!ftf<r

'1'1 ~

'liTIffiI-

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$[ Jf"lITfI "'fjft<iRI ~

fur 'Il{ ~

it;-3TjfIR 3IWI-3IWI fW'1

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

9

8

.TYPE

OF SCHOOL/INSTITUTION

(Refer to Item No.9)

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.

National Talent Search (First Level) Examination - 2012
Name of the State - Rajasthan
(Which will conduct the Examination)

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:

PIN Code She/He is allotted 12 digit Roll Number:
Scheme Code State Code Year Center Code Serial No. (to be filled by the Office)

OJ

0:Q]

[ill]

ITIIJ

[[]]
Time: 9.00 a.m. to 12.30 p.m.

Date of Examination' Venue of Examination Centre
_0.0_-

Signature of Centre Suprintendent with office seal

Signature of the Head of the School with office seal

Scrutinized by (Office Staff)

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: ............................................ ............................................

Signature of the Invigilator at the examination Centre

--------------------------------------Full Postal Address of the Candidate for despatch of admission letter.

Pin Code

3

INSTRCTION TO THE CANDIDATE
12345~ ~ 6(For the students studying in the class VIII) Make sure that the admission Card is not detached from the application form, Candidate can collect the admission Card from the head of the instruction at least days before the examination. Reach the examination Centre at least an hour before the commencement of the examination and occupy the seat that bears your Roll Number. Do not take' calculator, Mathematical & physical table or any other kind' of ready reckoner to the examination hall. The examination will be conducted in two sessions on the same day. You have to take the' examination in TWO PART: part -I: part -I is confmed to Mental Ability Test (MAT) consisting 90 compulsory question part -II: part -II is confined to Scholastic Ability Test (SAT) consisting 90 compulsory question, 35 from science, 35 from Social study, and 20 from Mathematics. Time for part -I is 90 minutes and part -II s 90 minutes
0,

7- Each questioncarries l(one) mark.

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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