DIRECTORATE OF TEACHER EDUCATION AND SCERT, ORISSA, BHUBANESWAR

ADMISSION TO B.H.Ed. COURSE, 2011-2012

Applications are invited in the prescribed form for Admission to One Year Bachelor in Hindi Education (B.H.Ed.) Course to be imparted in Hindi Teachers' Training Institute, Cuttack for the session, 20112012. 1.0 Category of Candidates eligible to apply : The applicants in general category must have passed Graduation having at least 50% of marks and 45% of marks in case of SC, ST, OBC / SEBC candidates, in aggregate, at the Bachelor's Degree Examination with Hindi as an elective subject or Honours or Graduation (without Hindi) with Rastra Bhasa Ratna from Rastra Bhasa Prachar Samiti, Wardha or with a Shastri from Orissa Rastra Bhasa Parishad, Puri or with Snatak (up to June, 2005, the date up to which temporary recognition has been granted). The PH candidates with disability of minimum 40% are eligible to apply. In case of Green Card holders, Green Card of Health and Family Welfare Department, Government of Orissa issued in favour of their parents, spouse or self by the concerned CDMO must be submitted with the application form. In case of Ex-serviceman, the Ex-serviceman Certificate issued in favour of their parents, spouse or self by the respective Defence Headquarters / Rajya Sainik Board / Zilla Sainik Board must be submitted with the application form. The Outlying Oriya Tract candidates of Jharkhand, West Bengal, Andhra Pradesh and Chhatisgarh only can apply who have prosecuted their studies up to High School Certificate in the respective state will be considered for selection under OOT. They should have passed Oriya as a subject of study in HSC Examination or any such equivalent higher examination or passed Oriya as a subject in special examination conducted by BSE, Orissa. Age Limit as on 30.06.2011 : For SC / ST candidates : 35 years For Women candidates of all categories : 35 years For Male OBC / SEBC candidates : 35 years For Male General Category : 30 years For PH Category : 40 years Application Form and Information Brochure : 3.1 Application Forms and Information Brochure can be obtained from the SCERT web-site with effect from 26.10.2011. Candidates are required to download the Application Form and Information Brochure from the web-site ( www.scertorissa.org) and submit the same as detailed below. Application Fees : For General and OBC / SEBC : Rs. 200.00 For SC / ST : Rs. 40.00 For Disabled candidates : Free of Cost (provided they fulfill the following criterias) Blind students who have used Braille for studies. Hearing impaired and dumb students. Orthopedically handicapped students with disability of more than 75%. All the candidates (except disabled candidates) are required to submit the Bank Draft issued by any branch of State Bank of India (not before 26.10.2011) drawn in favour of Director, TE and SCERT-cum-Chairman, B.H.Ed., CSB payable at Bhubaneswar and deposit the same in the Office of the Principal, HTTI, Cuttack along with the Application Form. 3.2 The inservice teachers should submit their Application Form to their respective Circle Inspector of Schools within the stipulated date. Their applications will be forwarded to the Director, Secondary Education by Inspector of Schools. a) b)

2.0

3.0

Download of Application Form and Information Brochure : 26.10.2011 Last Date of Receipt of filled in Application Form by Speed Post / Registered Post : 10.11.2011 c) Last Date of Receipt of filled in Application Form by the Inspector of Schools (Inservice) : 10.11.2011 3.3 There is no provision for supply of Application Form and Information Brochure by post or any other mode. 3.0 Submission of Application Forms : Filled in application forms are to be sent to the Principal, Hindi Teachers' Training Institute, Block - 29, Old Secretariat, Cuttack - 753001 by Registered Post / Speed Post so as to reach on or before 10.11.2011. Application Form received through any other mode shall not be entertained. (For details, Information Brochure may be referred to) Director Teacher Education and SCERT, -cum-Chairman, B.H.Ed. Central Selection Board, Orissa, Bhubaneswar- 751001

INFORMATION BROCHURE FOR ADMISSION TO BACHELOR IN HINDI EDUCATION (B.H.ED) COURSE FOR THE SESSION, 2011-2012
1.0 Institution and Intake :

Admission will be made for the session, 2011-2012 for one year Bachelor in Hindi (B.H.Ed) Course in Hindi Teacher Training Institute, Cuttack located at block-29, Old Secretariat, Cuttack 753001 as per the distribution of seats among various categories keeping reservation for UR 50% and reserved category 50% as mentioned below. 2.0 Sl. No. 1. 2. 3. 4. Category of Candidates and Distribution of Seats : Seats to ExGreen % of PH Category be serviceman Card Reservation (03%) allotted (03%) (03%) SC ST OBC SEBC / 16% 23% 11% 50% 100% 16 23 11 50 100 01 01 01 03 01 01 01 03 01 01

OOT (02%) 01 01 02

Inservice (15%) 02 03 02 08 15

Balance 12 17 09 38 76

Unreserved Total

While distributing seats, in case of fraction, the seats will be distributed as per rule and adjustment of seats will be made within the intake capacity of the institution. In case of non-availability of eligible candidates in the categories of PH / Ex-serviceman / Green Card / OOT / Inservice candidates under the social categories i.e. ST / SC / OBC SEBC / Unreserved the vacant seats will be filled up by the candidates of the respective category. Eligibility : The candidates both fresh and Inservice must fulfill all the eligibility conditions given below. 3.1 She / he must have passed Graduation having at least 50% of marks in case of General candidates and 45% of marks in case of SC, ST, OBC / SEBC candidates in aggregate in the Bachelors Degree Examination with Hindi as an elective subject or Honours or Graduation (without Hindi) with Rastra Bhasa Ratna from Rastra Bhasa Prachar Samiti, Wardha or with a Shastri from Orissa Rastra Bhasa Parishad, Puri or with Snatak (up to June, 2005, the date up to which temporary recognition has been granted). She / he must have Oriya as MIL up to HSC level or any such equivalent or higher examination or have passed Oriya as a subject in specific examination conducted by Board of Secondary Education, Orissa of HSC standard or should have passed HSC Examination of Board of Secondary Education, Orissa on Oriya medium with MIL other than Oriya. Such candidates who have passed HSC examination of Board of Secondary Education, Orissa without Oriya as MIL should produce a certificate to the effect from the Headmaster of the concerned school that he / she has passed High School Examination in Oriya medium.

3.0

3.2

3.3

The age limit as on 30.06.2011 : 35 years before before before before before

She / he should not have born 30.06.1976 For Women Candidates of all She should not have born 35 years categories 30.06.1976 He should not have born For Male OBC / SEBC Candidates 35 years 30.06.1976 He should not have born For male General Candidates 30 years 30.06.1981 She / he should not have born For PH Candidates 40 years 30.06.1971 Note : The upper age limit is inclusive of age relaxation for relevant groups as admission under rules. For SC & ST Candidates 3.4 Residential Certificate :

The c andidates except the OOT category must be permanent residents of Orissa. To that effect each candidate shall furnish along with his / her Application Form a permanent residential certificate in the prescribed format issued in favour of him / her by the Tahasildar / Additional Tahasildar (after creation of new district) concerned. Caste Certificate :

3.5

In case of SC, ST and OBC / SEBC candidates the Caste Certificate should be issued by the concerned Tahasildar. The Caste Certificate shall be considered by virtue of birth only not by marriage or adoption. PH Certificate : The candidates with disability of minimum 40% are eligible to apply. Such candidates are required to submit PH Certificate issued in their favour in the prescribed form by Medical Board countersigned by the CDMO concerned. Candidates in possession of permanent disability certificate issued prior to 30.06.2006 shall submit their renewed certificate. The candidates cannot claim reservation in two types of disabilities to fulfill the minimum percentage of disability. Disability type-wise reservation of seats shall be made for the candidates under this category Blind : 01%, Deaf : 01% and Orthopaedically Handicapped : 01% as per the Resolution No. 15333/Gen dated 04.05.1981 of the GA Department, Orissa published in Gazette No. 1011 dated 12.08.1981. However, such candidates shall pursue their studies within the existing facilities available in the institutions.

3.6

3.7

OOT Candidates : Candidates from the Outlying Oriya speaking Tracts of Andhra Pradesh, Jharkhand, Chhatisgarh and West Bengal with required academic qualification / conditions as indicated in the Para 3.1 to 3. 2 are eligible to apply. They are required to submit permanent Residential / Certificate to that effect, issued in their favour by the competent authority of their respective state. 2

Only those candidates who have prosecuted their studies at least up to High School Certificate Examination in their respective states will be considered for selection under the OOT quota. They should have passed Oriya as a subject of study in HSC examination or any such equivalent or higher examination or have passed Oriya as a subject in special examination conducted by BSE, Orissa of HSC standard. The seats of OOT category may be allotted to the states on the basis of valid applications received from different states. The CSB may be authorized for this. Kashmir Migrant: The following type of relaxation will be admissible in case Kashmir Migrants in the matter of their admission (vide Government letter No. 6110 / SME dated 15.04.2010) Extension of date of admission by about 30 days. Relaxation in cut-off percentage up to 10% subject to minimum eligibility requirement. Increase in intake capacity up to 5% - course wise. Reservation of at least one seat in merit quota in technical / professional institutions. Waiving of domicile requirements Facilitation of migration in second and subsequent years.

3.8

Ex-servicemen Candidates : The person who has retired from Defence service is to be considered as Ex-serviceman. The son / unmarried daughter / spouse of Ex-serviceman including self are eligible to apply on submission of Certificate issued by the respective Defence Headquarters / Rajya Sainik Board / Zilla Sainik Board in favour of his / her parents / spouse. The certificates must reflect the name of ex-serviceman, the date of entry to the defence service and retirement, his relationship with the candidate, seal and signature of the concerned authority.

3.9

Green Card Holder Candidates : The candidates under this category are eligible to apply on submission of the prescribed Green Card of Health and Family Welfare Department, Government of Orissa issued by concerned CDMO. The name and date of birth of the candidate and name of the parents written on Green Card must be same as reflected in HSC certificate of the candidate.

3.10

Inservice Candidates: Untrained teachers with Graduation appointed as Hindi Teacher on regular basis against sanctioned Hindi post in Government / Government Aided / Recognized High Schools possessing qualification as mentioned at 3.1 and continuing as such are eligible to apply provided he / she must have completed at least one year continuous service by the last date of submission of application form. All inservice candidates shall submit an undertaking at the time of admission to the effect that they shall not claim any salary / stipend during the period of their training. He / she shall have to submit an affidavit to the effect that he / she shall continue in the school, in

question, for a period of at least 10 years after completion of his / her B.H.Ed. training. 4.0 How to obtain Information Brochure and Application Form : 4.1 Application Forms and Information Brochure can be obtained from the SCERT web-site. Candidates are required to download the Application Form and Information Brochure from the web-site (www.scertorissa.org) and submit the same along with the Bank Draft for Rs.200.00 issued by any branch of State Bank of India (not before 26.10.2011) in favour of Director, TE and SCERT-cum-Chairman, B.H.Ed., CSB payable at Bhubaneswar and deposit the same in the Office of the Principal, HTTI, Cuttack. The SC and ST candidates can download a set of Application Form and Information Brochure from the SCERT web-site (www.scertorissa.org) and submit the same along with the Bank Draft for Rs.40.00 issued by any branch of State Bank of India (not before 26.10.2011) in favour of Director, TE and SCERT-cum-Chairman, B.H.Ed., CSB payable at Bhubaneswar and deposit the same in the Office of the Principal, HTTI, Cuttack. The following disabled candidates can download Application Form and Information Brochure from the SCERT web-site (www.scertorissa.org) and submit the same provided they fulfill the eligibility criteria mentioned at 3.1 to 3.4 and 3.7. Blind students who have used Braille for studies. Hearing impaired and dumb students. Orthopedically handicapped students with disability of more than 75%. All inservice teachers can download the Application Form and Information Brochure from the web-site (www.scertorissa.org) and submit the same along with the Bank Draft for Rs.200.00 issued by any branch of State Bank of India (not before 26.10.2011) in favour of Director, TE and SCERT-cum-Chairman, B.H.Ed., CSB payable at Bhubaneswar. The inservice teachers should submit their Application Form to their respective Circle Inspector of Schools within the stipulated date. Their applications will be forwarded to the Director, Secondary Education by Inspector of Schools.

4.2

4.3

4.4

5.0 5.1

Selection : Selection Criteria : 5.1.1 For Fresh Candidates :

Selection of all categories of candidates shall be made at the Institution on the basis of total percentage of marks secured from HSC to Graduation level. Career Assessment shall be made as follows. HSC Percentage of marks excluding extra / fourth optional +2 / Higher Secondary / Intermediate Percentage of marks excluding extra / fourth optional Percentage of marks in Honours +3 Degree (Honours) Percentage of marks in subjects other than Honours Hindi as Elective / Pass / Ratna / Shastri / Snatak Percentage of Marks excluding viva-voce marks (up to June, 2005)

Note : 1. It may be mentioned that +3 H onours has 800 marks as theory paper and +3 pass and Elective has 400 marks in theory paper. Rastra Bhasa Ratna / Snatak / Shastri which is equal to +3 pass and Elective only vide notification No. 22284 dated 30.04.2011 of Utkal University has 600 / 700 mark as theory paper along with 100 extra marks in viva-voce examination which is mostly equal with +3 Honours marks. So, to treat both Honours and pass students in equal footing the course may be synchronized and the method of selection should also be synchronized by excluding the viva-voce marks and considering the theory mark only. 2. In case of two Electives / Pass subjects at graduation level with Rastra Bhasha Ratna / Snatak / Shastri, the marks of one Pass / Elective subject with Higher marks and the marks of Rastra Bhasha Ratna / Snatak / Shastri be considered as the basis of selection in order to bring parity in the treatment between the Honours and Elective / pass students. This proposal will not be applicable in case of candidates with Hindi as Honours and pass at +3 level. 5.1.2 For Inservice candidates: The teachers from secondary level shall be selected by the Director, Secondary Education, Orissa as per selection criteria and the final list of 15 selected secondary teachers along with their application forms shall be submitted to Director, TE and SCERT within the stipulated date for placement of the inservice teachers in HTTI, Cuttack. Selection of candidates shall be made on the basis of recommendation by the Director, Secondary Education as per the seats reserved for the category. The service seniority of the Inservice candidates of secondary schools will be counted from the date of joining in Government / Government Aided / Recognized High Schools against sanctioned Hindi posts / date of recognition of Class X whichever is later. Other criteria as decided by the Director, Secondary Education, Orissa.

5.2

Admission : Selection will be made as per availability of seats on the basis of merit in case of fresh candidates and service seniority in case of inservice candidates.

6.0

Submission of Application Form : All candidates shall submit their filled in application forms to the Principal of the Institution by Registered / Speed Post so as to reach the Principal on or before 10.11.2011. Applications received through any othe r mode shall not be entertained. The Inservice Teachers should submit their application forms to their respective Inspector of Schools on or before 10.11.2011. Their application forms will be forwarded to the Director, Secondary Education by the Inspector of Schools on or before 16.11.2011. The filled in Application Form of any Inservice Teacher will not be entertained directly from CI or the candidate at HTTI, Cuttack. Incomplete Application Form received after the last date of submission shall be summarily rejected. The authority shall not be responsible for postal delay.

7.0 7.1

Documents to be submitted : For Fresh Candidates Certificates and Marksheets from HSC to Graduation including the mark-sheet of first year, second year and third year of + and Rastra Bhasha Ratna / 3 Shastri / Snatak as the case may be. Certificate of Headmaster of the school to the effect that he / she has passed HSC in Oriya medium (in the cases who have passed from Board of Secondary Education, Orissa without Oriya as MIL). Residential Certificate issued by Tahasildar / Additional Tahasildar. Candidates from states other than Orissa have to submit the equivalent certificate of Utkal University of +3 level at the time of admission. Migration Certificate to be produced by the candidates other than Utkal University at the time of admission. Caste Certificate in case of SC, ST and OBC / SEBC candidates PH Certificate in case of PH candidates Ex-serviceman Certificate in case of son / daughter / spouse of Exserviceman. Green Card in case of applicant under Green Card category. One recent stamp size colour photograph to be firmly pasted to the form at the specified space. Five computerized / typed address tags. Copies of all certificates / marksheets shall be signed by the candidates in full.

N.B: 7.2

For Inservice candidates All inservice candidates shall submit the photocopies of the following documents attested by the Headmasters / Headmistress as mentioned below along with their application forms. Copy of the appointment letter and joining letter. Copy of the Service Continuance Certificate. Copy of the first and last page of the Service Book in case of teachers serving in Government / Government aided schools. Copy of the approved management at the time of appointment of inservice candidates Copy of the resolution of Management in case of Non-Government and nonaided recognized schools showing that the appointment has been regularized. Copy of application for obtaining Class X recognition and subsequent renewal of recognition till date wherein the name of the concerned teachers has been mentioned year-wise till date duly countersigned by concerned CI of schools. Copy of the Caste Certificate for claiming reservation under SC / ST / OBC SEBC categories shall be submitted. Copies of all m arksheets & certificates from HSC to graduation. The inservice candidates shall have to submit an affidavit to the effect that he / she shall continue in the school in question, for a period of at least 10 years after completion of his / her B.H.Ed. training.

At the time of Admission : All candidates selected for admission shall submit the following, in original All certificates, marksheets and documents, as applicable CLC and Conduct Certificate issued by the institution last attended Intimation Letter of selection Two passport size photographs

8.0

Fees : 8.1 Institution Fees at the time of admission: Admission Fee Tuition Fee Students Council Caution Money (Refundable) Magazine College Calendar Identity Card Games and Sports House Examination and Proctorial Record Common Room Dramatic Society Community Fund Electric Maintenance Audio-Visual Society Office Contingency Electric Consumption for two buildings Water Charges and Others Furniture Purchasing Telephone Garden Fund Cultural Forum Planning Forum Library Development Laboratory Development Furniture Maintenance Film and Photography Students Welfare Students Aid Fund SUPW Contingency Field Trip / Study Tour Institution Betterment Computer Purchasing and Maintenance Web-site Launching and Updating Internet Launching & Maintenance Insurance Fee Total

40.00 480.00 30.00 135.00 110.00 50.00 20.00 80.00 110.00 40.00 110.00 55.00 145.00 165.00 220.00 220.00 110.00 550.00 110.00 30.00 90.00 30.00 275.00 135.00 143.00 35.00 25.00 25.00 50.00 90.00 352.00 550.00 330.00 220.00 6.00 5166.00

However, in case of PH candidates, tuition fees and all other related fees will be exempted for the following categories of disabled students. Blind students who have used Braille for studies. Hearing Impaired and dumb students. Orthopaedically handicapped students with disability of more than 75%.

rrr

INSTRUCTION FOR FILLING UP OF THE APPLICATION FORM

Photograph : Paste your recent colour stamp size photograph (not older than three months) on the specified place in the top-right hand corner. Digital or black and white photographs should not be pasted. Do not staple or pin the photograph. Demand Draft (01) : Write the Demand Draft No. in the first box and the date of the DD in the second Box. Discipline (02) : Tick (P ) the Arts box if you are an Arts Graduate and in the Science Box if you are a Science Graduate. Example If BA : Arts

If B.Sc. : Science

Social Group Category (3) : 3.1 Tick (P ) the appropriate box of social category i.e. General, SC, ST, OBC / SEBC, as applicable. You will be considered for the category only if your claim for the category is supported by appropriate Certificate. 3.2 Tick ( P ) the appropriate box of special reserved category i.e. PH / OOT / Ex-serviceman / Green Card, if your claim is for any special reserved category supported by appropriate certificate. One can claim only for one special reserved category. Name (4) : Write your name in Capital letters as it appears in your High School Certificate. Sex, Religion and Nationality (5) : Tick ( P ) the appropriate box only given in 'a'. Write your religion and nationality in the respective box. Date of Birth (6) : Write the day, month in two digits and year in four digits as recorded in the HSC Certificate. If your date of birth is 28th April, 1989 write as : Day 1 9 8 9 2 8 Month 0 4 Y ear

Age (7) : Calculate your age as on 30.06.2011 by subtracting your date of birth from this date and write the results in the boxes as described earlier. Example, If your date of birth is 28.04.1989 then your age as on 30.06.2011 is : {30.06.2011 - 28.04.1989 = 02.02.22. This will be written as : 2 2 Years 0 2 Months 0 2 Days

Permanent Address (8) : Write your permanent Address. Correspondence Address (9) : Write your complete address for correspondence in Capital letters. Telephone No. (10) : Write your Telephone No. in the specified space in the Application Form. Mother's Name (11) : Write your Mother's name as it appears in HSC Certificate. Name of the Father / Spouse / Guardian (12) : Write the name of your Father / Spouse (if married) / Guardian (if your parents are not alive). Oriya up to HSC Level / Higher Level (13) : Tick (P ) YES box if you have studied Oriya as a subject of study in HSC / higher level examination or equivalent or higher examination or passed special test conducted by Board of Secondary Education, Orissa. Tick (P ) NO box if you do not satisfy any one of the above conditions. Passed HSC Examination of BSE in Oriya Medium (14) : Tick (P ) the box, if you have passed HSC Examination of BSE, Orissa in Oriya medium with MIL (Urdu / Bengali / Telugu....) other than Oriya and a certificate to the effect from the Headmaster of the School is to be attached with the Application Form. School subject at the Graduation Level (15) : Write your Honours subject and Pass / Elective in given place. Academic Qualification (16) : Write the name of the Examining Body (Board / Council / University), year of passing and subject studied in appropriate space. Write the maximum marks and marks obtained in HSC as well as +2 excluding the marks obtained in Extra / fourth optional, if any in the given space.
1

The candidates having honours in +3 shall write the Honours marks in Honours column and marks obtained in all other subjects other than Honours in Pass column. The candidates without Honours shall write the total marks obtaind in Pass column. Mention the percentage of marks on the above basis in three digits after the decimal in appropriate box. Write the total percentage of marks obtained in all the examinations in the appropriate box. Declaration (17) : Sign the declaration in full at the bottom of the application above the caption "Full Signature of the Applicant". Write the date and place on the left side bottom in space as indicated. B. For Inservice Candidates : Photograph : Paste your recent colour stamp size photograph (not older than three months) on the specified place in the top-right hand corner. Digital or black and white photographs should not be pasted. Do not staple or pin the photograph. Demand Draft (1) : Write the Demand Draft No. in the first box and the date of the DD in the second Box. Name (2) : Write your name in Capital letters as it appears in your High School Certificate. Sex, Nationality, Religion (3) : Tick (P ) the appropriate box only given 'a'. Write your religion and nationality in the respective boxes. Caste (4) : Tick (P ) the appropriate box (General, SC, ST, OBC / SEBC) as applicable. You will be considered for the category if your claim for the category is supported by appropriate certificate. Date of Birth (5) : Write the day, month in two digits and year in four digits as recorded in the HSC Certificate. If your date of birth is 28th April, 1989 write as :Day 1 9 8 2 8 Month 0 4 Y ear

9 . Calculate your age as on 30.06.2011 by subtracting your date of birth from this

date and write the results in the boxes as described earlier. Example, if your date of birth is 28.04.1989 then your age as on 30.06.2011 is : [30.06.2011 - 28.04.1989 = 02 02 22. This be written as : 2 2 Years 0 2 Months 0 2 Days

Name of the School (6.1) : Write the complete name of the school, serving at present. Address (6.2) : Write the complete postal address of your school including Pin Code for correspondence. Status of School (6.3) : Tick (P ) the school status as appropriate (Direct payment and Block Grant school should be ticked as Government Aided Schools). Name of the Post Held (7.1) (for Regular High School Teachers) : (a) Tick (P ) the appropriate box. (b) Write the day, month in two digits and year in four digits on which you have actually joined against the sanctioned yardstick TGT post on regular appointment. (7.2) (for Regular Elementary School Teachers) : (a) Write the day, month in two digits and year in four digits on which you have actually joined against the post. (b) Write the year in four digits on which you have passed BA / B.Sc. as recorded in your Service Book. Telephone No. (8) : Write your telephone number / mobile number in the appropriate box. Declaration (9) : Sign the declaration in full at the bottom of the application above the caption "Full Signature of the Applicant". Write the date and place on the left side bottom in space as indicated.

APPLICATION FOR ADMISSION TO B.H.Ed. COURSE FOR THE SESSION : 2011-2012

FOR OFFICIAL USE ONLY Index No. Assessment Point

Paste one Stamp size colour Photograph here

Full Signature of the Assessing Officer

Full Signature of the Verifying Officer

1.

DD No.

Date :
[Put ( P) mark in appropriate boxes as applicable]

TO BE FILLED IN BY THE CANDIDATE IN HIS / HER OWN HANDWRITING

Name of the Hindi Examination passed for eligibility................................................................................ (Hindi as optional / honours in +3 Course / Rashtra Bhasa Ratna / Snatak (up to June, 2005) / Shastri) 2. 3. 4. 5. 6. 7. 8. Social Group Category : Special Reserved : PH General OOT SC ST Ex-servicemen OBC / SEBC Green Card

Name of the Candidate (in Capital letters) :____________________________________________ (a) Sex Date of Birth : Male : Female Day (b) Religion Month Years Y ear Months Days (c) Nationality

Age as on 30.06.2011 :

10. 11. 12. 13. 14. 15. 16.

Permanent Address : 9. Address for Correspondence : Name :............................................................ Name :......................................................... At :........................................................... At :.......................................................... PO :........................................................... PO :.......................................................... Dist :.................................Pin ................... Dist:.................................Pin .................. Telephone:...................................................... / Mobile :...................................................... Mother's Name :____________________________________________________________ Name of the Father / Spouse / Guardian:_______________________________________________ Studied Oriya up to HSC / Higher level: Yes No Passed HSC Examination of BSE, Orissa in Oriya medium with MIL other than Oriya : Yes No School subjects at Graduation Level : Hons. __________________ Elective / Pass :_____________ Academic Qualification :
Name of the Board / Council / University Year of Passing Details of Marks
Maximum Marks
Marks Obtained (excluding extra / fourth optional)

Examination Passed HSC +2 Sc. / Arts +3 Sc. / Arts

Hindi Qualification (Pass / Elective / Hons. / Ratna / Shastri / Snatak)

% of Marks

Hons.
PASS (Other than Hons.)

17.

Declaration : I, Shri / Smt...................................................................................................... son / daughter / spouse of ......................................................................... do hereby declare that (i) the particulars furnished by me in the application form are true and (ii) if at any point of time any of the information / documents supplied by me are found incorrect, I shall be legally responsible for it and my admission shall be cancelled. Date : Place :

Total

Full Signature of the Applicant

FOR INSERVICE B.H.ED. CANDIDATES OF GOVERNMENT / GOVERNMENT-AIDED / RECOGNIZED SCHOOLS Paste one Stamp

1. 2. 3. 4. 5.

DD No.

Date :

N m o t eC n i a e( nC p t ll t e s ________________________________________ a e f h a d d t i a i a e t r ):
[Put ( P ) mark in appropriate boxes as applicable]

size colour Photograph here

(a) Sex Caste

: :

Male General :

Female SC Day

(b) Nationality ST

(c) Religion OBC / SEBC

Date of Birth

Month Y ear (In words ________________________________________)

6.

Age as on 30.06.2011 : Years Months Days Name and Address of the School where serving : 6.1 Name of the School :________________________________________________________ 6.2 Address of the School :________________________________________________________ 6.3 Status of School : a) Government Name of the Post held : 7.1. For High School Teachers : a) b) Assistant Teacher (Science / Arts) : b) Government Aided c) Recognized

7.

Science

Arts : Day Month

Date of Joining against the sanctioned yardstick post

Year 7.2. For Regular Elementary School Teachers : a) Date of Joining : Day 8. 9. Month Y ear b) Y ear of Passing (BA / B.Sc.) Examination : Telephone No................................. Mobile :......................................... Declaration by the Candidate :

I Shri / Smt...................................................................................................... son / daughter / spouse (strike which ever is not applicable) of ......................................................................... do hereby declare that the facts stated above are true and based on records, the Photocopies of which are enclosed herewith. If the above mentioned facts are found incorrect, my selection and admission into the Course shall be cancelled and appropriate legal action as deem fit shall be initiated.

Date : Place :
FOR OFFICIAL USE ONLY

Full Signature of the Applicant

Forwarded to the DI of Schools / Inspector of Schools, ....................................................... Education District / Circle, for verification and onward transmission to the Director, Elementary Education, Orissa / the Director, Secondary Education, Orissa. Date : Place : Full Signature of the Headmaster / Headmistress with Seal and Date Certified that I have verified the date of Joining of the applicant and found correct. His / her date of joining for counting the service seniority against regular sanctioned posts in case of elementary / regular sanctioned yardstick TGT post in case of secondary from (Mention the date)

Forwarded to the Director, Secondary / Elementary Education, Orissa, Bhubaneswar for necessary action. Date : Place : Signature of the DI of Schools / Inspector of Schools with Seal and Date Submitted to the Director, TE and SCERT, Orissa after verification of all the details of service and found eligible for Admission to B.Ed. Course, 2011-2012 within the specified quota for this Directorate. Signature of the Director, Secondary / Elementary Education, Orissa (with seal and date)