tokgj uoksn; fo|ky; p;u ijh{kk 2015&16
JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST 2015-16
ysVjy ,aVªh & d{kk 9 oha
LATERAL ENTRY – CLASS IX
vkosnu i=
APPLICATION FORM
Roll No.jksy ua-
(To be left blank. To be filled by the Office of Principal, JNV)
¼jksy ua- dk dkye fjDr NksM+s] bls dk;kZy; }kjk Hkjk tk,xk½
1.vH;fFkZ dk uke ------
Name of the Candidate(in block letters)
2.firk dk uke------
Father’s name (in block letters)
3.ekrk dk uke------
Mother’s Name (in block letters)
4.vfHkHkkod dk uke ------
¼;fn ekrk@firk ds vfHkHkkod u gksus dh fLFkfr esa ½
Name of the Guardian(in case Father/Mother is not guardian)
5.vfHkHkkod ds lkFk laca/k ------
Relationship with Guardian
6.vH;fFkZ dh jk”Vªh;rk------
Nationality of the Candidate
7.orZeku irkPresent Postal Address :
…………………………………………………………………………………….
…………………………………………………………………………………….
…………………………………………………………………………………….
nwjHkk”k dz- Tel :______/______eksckbZy ua-Mobile No______
STD Code Number
8.ckWDl esa lgh dk fu’kku yxk,Wa ¼Tick( the appropriate Box) :
(v&a) fyax (Sex) yM+dk (Boy) yM+dh ( Girl)
(c&b) oxZ Category lkekU; ¼Gen.) v-tk- ¼SC) v-t-tk-¼ST) v-fi-o-¼OBC)
(l&c) / {ks= Area Status : / ‘kgjhUrban / xzkeh.k Rural(n&d) / oSokfgd fLFkfr Marital Status : / fookfgrMarried / vfookfgr Unmarried
9.v& tUefrfFk ¼vadksa esa½(a) Date of Birth (in figures)
fnukad Date / Ekkg Month / Ok”kZ / YeartUefrfFk ‘kCnksa ¼Date of Birth (in words)……………………………………………………………
c igpku fpg~u (b) Identification Mark……………………………………………………………
10.fo|ky; dk uke tgkWa vH;fFkZ d{kk 8 oha esa l= 2014&15 eas v/;;ujr jgk
Name of the school where candidate was studying his/her class VIII during 2014-2015 :
……………………………………..…………………………………………………
c& D;k ekU;rk izkIr gS gkWa@ugha esa fu’kku yxkb, gkWa@ugha
(b)Whether recognized (Tick ( appropriate)Yes/No
11.d{kk 8 oha esa i<+kbZ dk ek/;efgUnh Hindi vaxzsthEnglish Medium through which candidate is studying in Class VIII :
12.vH;fFkZ o vfHkHkkod dk izek.k i=
CERTIFICATE BY CANDIDATE/GUARDIAN
izekf.kr fd;k tkrk gS fd mi;qZDr tkudkjh esjs Kku ,oa fo’okl ls iw.kZRk;k lR; gS A ;fn mDr tkudkjh vlR; ikbZ tkrh gS rks eq>s lfefr dk fu.kZ; loZekU; gksxk ACertified that the information given above is true to the best of my knowledge and belief. In case any of the information given above is found incorrect, I will abide by the decision of the Samiti.
firk@ekrk@vfHkHkkod dk gLrk{kj frfFk ds lkFk½ vH;fFkZ ds gLrk{kj ¼frfFk ds lkFk
Signature of Father / Mother / Guardian(With date Signature of Candidate (With date)
- Ldwy ds iz/kku ikBd dk izek.k i= tgkWa vH;fFkZ us d{kk 8 oha l= 2014&15 esa v/;;u fd;k ACertified by the Head of the School where candidate has studied in Class -VIII during 2013-14 :
izekf.kr fd;k tkrk gS fd fp-@dq(This is certified that Master/Ms)------firk Jh ¼S/o, D/o Shri)------bl fo|ky; esa fnukad ¼was studying in the School since)------ls v/;;ujr jgs vkSj d{kk 8 oha dh ijh{kk esa , ¼he/she has passed /appeared for his/her Class VIII examination from this school) A fo|ky; fjdkMZ ds vuqlkj budk tUefrfFk¼As per school record his/her date of birth is) (vadksa esa ¼in figures)………………………….…………………
…...... ’kCnksa esa (in words)……...... ………………………………………………………………………… gS rFkk v-tk-@v-tk-tk@v-fi-o- ds gSa rFkk budh tkfr ¼He/She belongs to SC/ST/Other category and his/her caste is)……………………………….gS A
;g izekf.kr fd;k tkrk gS fd vkosnd ds }kjk Hkjh xbZ lkjh izfof”B;kWa ‘kkyk vfHkys[kksa ds vuqlkj iw.kZr;k lR; gS ¼This is also certified that entries made by the applicant in the application form are correct as per school record).
fnukad ¼Date) :…………………………
iz/kkuikBd dk gLrk{kj Signature of the Head of School
fo|ky; dh eqgj (with official stamp)
tokgj uoksn; fo|ky; p;u ijh{kk 2015&16
JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST- 2015-16
ysVjy ,aVªh& d{kk 9 oha ¼LATERAL ENTRY – CLASS IX)
izos’k i= ¼ADMIT CARD)
ijh{kk frfFk % jfookj] 14 twu 2015
Day & Date of Examination
Sunday _14nd June 2015 jksy ua- Roll No.
le; % iwokZg~u 10%00 cts Time 10.00 Hrs.
(Candidates to report 30 Minutes before)
Venue : Tkokgj uoksn; fo|ky; ekukdSEi&jk;iqj N-x-
Jawahar Navodaya Vidyalaya
Mana-Camp Raipur (C.G.)
(1)vH;fFkZ dk uke(Name of the candidate)………………………………………………………
(2)firk dk uke(Father’s Name)………………………………………………………………
(3)tUe frfFk (Date of Birth)………………………………………………………………..
……………………………………‘kCnks esa (Words)………………………….vadksa esa (Figures)
(4)oxZ ¼Category) : tks ykxw gks ml ij xksy ?ksjk yxk,Wa(Encircle appropriate)
(i) yM+dk ¼Boy) / yM+dh Girl (ii) lk- Gen. / (v-fi-o-½OBC/ (v-tk-½SC / v-t-tk-¼ST)
(iii) ¼‘kgjh½Urban/¼xzkeh.k ½Rural
vkosnd dk gLrk{kj ¼Signature of the candidate in the presence of HM/Principal of the school where the candidate is studying in her/her class VIII during 2014-15.) / ijh{kk d{k esa vkosnd dk gLrk{kj To be left blank for obtaining signature of the candidate in the presence of Center Supdt. /Invigilator on the day of exam.………………………………………………………………………………………………………
ACKNOWLEDGEMENT
Receipt No.______Date:______
Received application form from Master/Ms.______S/o D/o Sh. ______Student of ______
______School for admission in Jawahar Navodaya Vidyalaya Selection Test Lateral Entry – IX, 2015-16.
PRINCIPAL
J.N.V.Mana-CampDistt. Raipur, State C.G.
BOOK POST
ADMIT CARD CLASS IX- LATERAL ENTRY
FROMThe Principal
Jawahar Navodaya Vidyalaya
Mana-Camp Raipur C.G.
Pin Code 492015 / To
Shri/Smt……………………….…………………..
Students Name ……………………………………
Address……………………………………………..
……………………………………………………..
…………………………………………………….
Pin Code ………………………………………..
Mobile No…………………………………………..
uksV& d`i;k viuk iqjk irk Li”V :i ls ntZ djsa
Eligibility :
a)Only those candidates who have studied in class VIII during the Academic Session 2014-15 in one of the Govt./Govt. recognized schools of the district where the Jawahar Navodaya Vidyalaya is functioning and where admission is sought.
b)Candidate appearing for the selection test must pass class VIII in the academic session 2014-15 from a Govt./Govt. recognized school in the district where he/she is seeking admission.
c)Candidates seeking admission must not have been born before 01.05.1999 and after 30.04.2003. This will apply to candidates of all categories including those belonging to SC/ST.
d)Navodaya Vidyalaya Samiti reserve the right to refer any candidate to a MEDICAL BOARD for confirmation of all age of the candidate in case a doubt arises about the age certificate produced by the candidate before the admission is given.
Date of Examination :14nd June 2015 at 10:00 hrs ( 10:00 am to 01:pm). in Jawahar Navodaya Vidyalaya Mana-Camp Raipur . The medium of test is English/Hindi
Last date of submission:Application forms filled in all respect are to be submitted to the office of Principal, Jawahar Navodaya Vidyalaya Mana Camp Raipur by 15th May 2015 either through Resigtered Post or in person.
Nature of the Selection Test
Sl.No. / Subject / Marks01 / English / 15
02 / Hindi / 15
03 / Maths / 35
04 / Science / 35
TOTAL / 100 Marks