LLEGE OF E

CO
D.B.M.S COLLEGE OF EDUCATION

DU
S
D.B.M.

CATI N
O
(Recognized by NCTE, Bhubaneshwar)
and
Afliated to Kolhan University , Chaibasa, Jharkhand
and Jharkhand Academic Council, Ranchi
Road No. 23, Farm Area, Kadma , Jamshedpur -831005
District – East Singhbhum, Jharkhand
E-mail- dbms.edu23@gmail.com
Phone- 0657-2309095

APPLICATION FORM FOR ADMISSION IN B.Ed. / D.EL .Ed COURSES

Applica on Form No. : _____________ Course Applied for :- B.Ed D.EL.Ed
All entries must be filled in by the candidate in his/her own handwri ng. Incomplete Form shall not be entertained.

1. Name of the Applicant :

(IN BLOCK LETTERS)

2. Gender : Male Female 3. Date of Birth D D M M Y Y Y Y

4. Father's/Guardian's Name :

5. Father's /Guardian's Profession :

6. Mother's Name :

7. Mother's Profession :

8. Marital Status :

9. Husband's Name :

10. Husband's Profession :

11. Mailing Address :

12. Pin Code :

13. Permanent Address :

11. Pin Code :

12. Phone Number : Student Guardian :

13. Email ID :

14. Aadhar No. :

15. Do you belong to : SC / ST / BC / OBC / GENERAL 16. Physically Challenged

17. Is Jharkhand your State of Domicile? : Yes No

18. Na onality : Religion :

19. Approximate annual Income of the Family :

20. Educa onal Qualifica on :
Name of the Name of the Roll Reg. Year/ Marks Total %age Stream
Examina on University/Board No, No. Session Obtained Marks
With State

21. Employment Experience / Teaching Experience (if Any) :

Name of the Employer From / To Subject Taught Level of Teaching
Primary / Secondary /
Higher Secondary

22. Sports Achievements / Extra Curricular Ac vi es if any ..................................................................................................................

23. Language Known : Language …………………….Read ……………Write……………. Speak
: Language …………………….Read …………… Write …………… Speak
: Language ……………………. Read …………… Write ………….. Speak
24. Fluency in English : Yes No
25. Men on two method subjects, which you have read and want to offer, and college has provision for teaching
1 …………………………………………………………………….. 2 ……………………………………………………………………………………………
26. Kolhan University Registra on No. If any
27. If Migrated, name of University ……………………………………………………………………………………………………………………

Declara on:
I declare that the par culars given in the applica on form are correct and I shall produce original cer ficate, tes monials or other
evidence in support thereof as required. If any informa on is subsequently found to be incorrect, my admission may be cancelled and
shall be liable for any further ac on as the University may deem fit
Place: ……………………………

Date: …………………………… Signature of the Applicant Signature of the parent / Guardian

LIST OF ENCLOSURES: Please ck ( ) 'YES' against enclosure

i. Matricula on Cer ficate & Mark sheet viii. A Cer ficate of Reserved Category
ii. Intermediate Cer ficate & Mark sheet ix. Cer ficates in Sports / Extra Curricular Ac vi es
iii. Bachelor's Degree Cer ficate & Mark sheet x. Work Experience Cer ficate (if any)
iv. Marks Cer ficate of Bridge Course ( if any) xi. Four Passport size Recent color Photographs
v. Character Cer ficate xii. Affidavit verified by Notary Public
vi. College Leaving Cer ficate xiii. No objec on cer ficate from the employer if in Service
vii. Migra on Cer ficate

Total number of enclosures (in figures) _________________________________________________

(In words) _________________________________________________________________________

 D.B.M.S. COLLEGE OF EDUCATION
LLEGE OF E
CO

DU
S
D.B.M.

CATI N
O
Road No. 23, Farm Area, Kadma - 831005

No : ........................... Date :..............................

Received with thanks from ___________________________________________

a sum of Rupees ______________________________________________________

By Cash / DD/ Pay Order _________________________________________________

Payment against ________________________________________________________

` For D.B.M.S. COLLEGE OF EDUCATION