Application form 2021-22 5-1

6
NatioNal taleNt Search ScholarShip exam 2021-22 (1st Stage) (For The Student Studying in Class 10th) [k.M f'k{kk vf/kdkjh dk;kZ y; ij vkos nu i= tek djus dh va fre frfFk & ,u0Vh0,l0 iz Fke pj.k ijh{kk 2022 ijh{kk frfFk & p;u gs rq nks Lrjks a ij fyf[kr ijh{kk vk;ks ftr dh tk,xhA iz Fke pj.k dh ijh{kk dk vk;ks tu jkT; LRkj ij ,l0lh0bZ 0vkj0Vh0 mRrjk[k.M }kjk ,oa f}rh; pj.k dh ijh{kk jk"Vªh; LRkj ij ,u0lh0bZ 0vkj0Vh0 ubZ fnYyh }kjk vk;ks ftr dh tk,xhA jkT; Lrj ij vk;ks ftr iz Fke pj.k dh ijh{kk es a p;fur Nk=ks a }kjk gh f}rh; pj.k dh ijh{kk es a iz frHkkx fd;k tk,xkA f}rh; pj.k gs rq jkT; dk dks Vk 79 fo|kfFkZ ;ks a dk gS A ijh{kk ds nks Hkkx gks a xs & ¼d½ ekufld ;ks X;rk ijh{k.k ¼MAT½ ¼[k½ 'kSf{kd vfHk{kerk ijh{k.k ¼SAT½A iz 'u cgq fodYih; oLrq fu"B iz dkj ds gka s xs ] mRrj i=d ds :i es a vks 0,e0vkj0 'khV dk iz ;ks x fd;k tk,xkA iz 'u i=ks a dk Lrj d{kk 10 dh lkoZ tfud ijh{kk ds led{k gks xkA ekufld ;ks X;rk ijh{k.k (MAT) ,oa 'kSf{kd vfHk{kerk ijh{k.k ¼SAT½ nks uks a es a i` Fkd&i` Fkd U;w ure vgZ dkjh va d ¼lkekU; oxZ ds fy, 40% ,oa vkjf{kr oxZ SC, ST ,oa PH ds fy, 32% va d½ iz kIr djus okys vH;fFkZ ;ks a dh muds }kjk ekufld ,oa 'kSf{kd ;ks X;rk ijh{k.k es a iz kIr va dks a ds vk/kkj ij iz oh.krk lw ph (Merit List) rS ;kj dh tkrh gSA vkos nd mRrjk[k.M jkT; es a la pkfyr fdlh jktdh;] LFkkuh; fudk;] ekU;rk iz kIr ¼lfoRr@foÙkfoghu½ f'k{k.k la LFkk dh d{kk 10 es a la LFkkxr Nk=&Nk=k ds :i es a v/;;ujr gks A ,s ls fo|kFkhZ tks eq Dr@nw jLFk f'k{kk ¼Open & Distance Learning½ ds ek/;e ls d{kk 10 es a v/;;ujr gS] os Hkh bl ijh{kk gs rq vkos nu dj ldrs ga SA ;fn mudh vk;q ml o"kZ dh 01 tq ykbZ dks 18 o"kZ ls de gks A vk; lhek dk dks bZ iz frca /k ugha gSA vkos nd us d{kk 9 dh ijh{kk es a 60 iz fr'kr ¼vuq 0tkfr] tutkfr] fnO;ka x ds fy, 50 iz fr'kr½ va d iz kIr fd, gks a A vkos nu i= vko';d iz ek.k i=ks a lfgr la LFkk/;{k }kjk vxz lkfjr djokdj [k.M f'k{kk vf/kdkjh ds dk;kZ y; es a fu/kkZ fjr vfUre frfFk 12 uoEcj] 2021 rd tek djs a A jkT; ds jktdh;@jktdh; lgk;rk iz kIr fo|ky;ks a ds vH;fFkZ ;ks a gs rq fdlh Hkh iz dkj dk 'kq Yd ns ; ugha gSA jkT; ds futh fo|ky;ks a ds vH;fFkZ ;ks a gs rq ijh{kk 'kq Yd fuEuor~ fu/kkZ fjr gS& Joint Director, SCERT Uttarakhand, Dehradun vkos nu i= es a lHkh iz fof"V;ks a dks xEHkhjrk ls Hkjs a A v/kw js ,oa =q fViw .kZ :i ls Hkjs x, vkos nu i= fujLr dj fn, tk;s a xs A bl Hkkx dks ijh{kkFkhZ vius ikl j[ksa xs A schooleducation.uk.gov.in scert.uk.gov.in ls Mkmuyks M fd, tk ldrs gSaA 0135-2789710, 2789655 email - [email protected]

Transcript of Application form 2021-22 5-1

NatioNal taleNt Search ScholarShip exam 2021-22 (1st Stage)

(For The Student Studying in Class 10th)

[k.M f'k{kk vf/kdkjh dk;kZy; ij vkosnu i= tek djus dh vafre frfFk & ,u0Vh0,l0 izFke pj.k ijh{kk 2022 ijh{kk frfFk &

p;u gsrq nks Lrjksa ij fyf[kr ijh{kk vk;ksftr dh tk,xhA izFke pj.k dh ijh{kk dk vk;kstu jkT; LRkj ij ,l0lh0bZ0vkj0Vh0

mRrjk[k.M }kjk ,oa f}rh; pj.k dh ijh{kk jk"Vªh; LRkj ij ,u0lh0bZ0vkj0Vh0 ubZ fnYyh }kjk vk;ksftr dh tk,xhA jkT;Lrj ij vk;ksftr izFke pj.k dh ijh{kk esa p;fur Nk=ksa }kjk gh f}rh; pj.k dh ijh{kk esa izfrHkkx fd;k tk,xkA f}rh; pj.kgsrq jkT; dk dksVk 79 fo|kfFkZ;ksa dk gSA ijh{kk ds nks Hkkx gksaxs & ¼d½ ekufld ;ksX;rk ijh{k.k ¼MAT½ ¼[k½ 'kSf{kd vfHk{kerkijh{k.k ¼SAT½A iz'u cgqfodYih; oLrqfu"B izdkj ds gkasxs] mRrj i=d ds :i esa vks0,e0vkj0 'khV dk iz;ksx fd;k tk,xkAiz'u i=ksa dk Lrj d{kk 10 dh lkoZtfud ijh{kk ds led{k gksxkA

ekufld ;ksX;rk ijh{k.k (MAT) ,oa 'kSf{kd vfHk{kerk ijh{k.k ¼SAT½ nksuksa esa iFkd&iFkd U;wure vgZdkjh vad ¼lkekU; oxZds fy, 40% ,oa vkjf{kr oxZ SC, ST ,oa PH ds fy, 32% vad½ izkIr djus okys vH;fFkZ;ksa dh muds }kjk ekufld ,oa 'kSf{kd;ksX;rk ijh{k.k esa izkIr vadksa ds vk/kkj ij izoh.krk lwph (Merit List) rS;kj dh tkrh gSA

vkosnd mRrjk[k.M jkT; esa lapkfyr fdlh jktdh;] LFkkuh; fudk;] ekU;rk izkIr ¼lfoRr@foÙkfoghu½ f'k{k.k laLFkk dh

d{kk 10 esa laLFkkxr Nk=&Nk=k ds :i esa v/;;ujr gksA,sls fo|kFkhZ tks eqDr@nwjLFk f'k{kk ¼Open & Distance Learning½ ds ek/;e ls d{kk 10 esa v/;;ujr gS] os Hkh bl ijh{kk gsrq

vkosnu dj ldrs gaSA ;fn mudh vk;q ml o"kZ dh 01 tqykbZ dks 18 o"kZ ls de gksAvk; lhek dk dksbZ izfrca/k ugha gSAvkosnd us d{kk 9 dh ijh{kk esa 60 izfr'kr ¼vuq0tkfr] tutkfr] fnO;kax ds fy, 50 izfr'kr½ vad izkIr fd, gksaA

vkosnu i= vko';d izek.k i=ksa lfgr laLFkk/;{k }kjk vxzlkfjr djokdj [k.M f'k{kk vf/kdkjh ds dk;kZy; esa fu/kkZfjr vfUre

frfFk 12 uoEcj] 2021 rd tek djsaA

jkT; ds jktdh;@jktdh; lgk;rk izkIr fo|ky;ksa ds vH;fFkZ;ksa gsrq fdlh Hkh izdkj dk 'kqYd ns; ugha gSAjkT; ds futh fo|ky;ksa ds vH;fFkZ;ksa gsrq ijh{kk 'kqYd fuEuor~ fu/kkZfjr gS&

Joint Director, SCERT Uttarakhand, Dehradun

vkosnu i= esa lHkh izfof"V;ksa dks xEHkhjrk ls HkjsaA v/kwjs ,oa =qfViw.kZ :i ls Hkjs x, vkosnu i= fujLr dj fn, tk;saxsA

bl Hkkx dks ijh{kkFkhZ vius ikl j[ksaxsA

schooleducation.uk.gov.in scert.uk.gov.in ls MkmuyksM fd, tk ldrs gSaA

0135-2789710, 2789655

email - [email protected]

3 2 2 2 1 0 7 1 0 0 1

0 0 0 0 0 0 0 0 0 0 01 1 1 1 1 1 1 1 1 1 12 2 2 2 2 2 2 2 2 2 23 3 3 3 3 3 3 3 3 3 34 4 4 4 4 4 4 4 4 4 45 5 5 5 5 5 5 5 5 5 56 6 6 6 6 6 6 6 6 6 67 7 7 7 7 7 7 7 7 7 78 8 8 8 8 8 8 8 8 8 89 9 9 9 9 9 9 9 9 9 9

Roll Number

INSTRUCTIONS FOR THE CANDIDATE

1. Make sure that the Admit Card is not detached from application form. It will be returned to you after the allotment of Roll Number. It is herebyadvised, that Candidate should collect the Admit Card from the concerning Block Education office at least one week before the examination.

2. Report the Examination Centre at least half an hour before the commencement of the examination and occupy the seat that bears your Roll Number.

3. Do not carry Mobile, Calculator, Mathematical & Physical Table or any other kind of ready reckoner in the examination hall.

4. The examination will be conducted in two sessions i.e. I session (Paper Ist)- 10:00 AM to 12:00PM, II session (Paper IInd)- - 01:30 PM to 03:30PM. on 16 January 2022 (Sunday)

5. Details regarding questions paper are as follows :(i) Paper I: Mental Ability Test (MAT) consisting of 100 compulsory questions.(ii) Paper II : Scholastic Aptitude Test (SAT) consisting of 100 compulsory questions from eight subjects (History, Geography, Civics,

Economics, Physics, Chemistry, Biology and Mathematics)6. Each question carries 1 (one) mark. There is no Negative Marking.

7. Write your eleven (11) digits Roll Number, as given in the Admit Card, on the Answer Sheet and on the cover page of the Question Booklet in thespace provided. Do not write your name in any part of the Question Booklet or Answer Sheet.

8. All questions in the booklet are of objective type. For each question four possible answers are given, only one is the correct answer. Darken the circleof your choice in the OMR Answer Sheet.

9. Follow Instructions for OMR sheet. Use only Blue/Black Ball Point Pen for darkening the correct answer and for filling informations.10. If you will darken more than one circle or circle is half darken then your answer will not be considered.Example :Q 1. Golden Temple is situated –A – Bhopal B- Amritsar. C- Hissar. D- Dehradun.Ans. The correct response of this question is ‘B’ therefore darken the circled space as-

A B C D

11. During the Examination follow the instructions of the invigilator strictly.12. Hand over the OMR answer sheet to the Invigilator before leaving the examination hall.13. After examination you can take home your Question booklet and carbon copy of OMR sheet with you.14. Extra time of 30 minutes will be given to the Visually Impaired candidate.

1- vH;FkhZ ;g lqfuf'pr dj ysaa fd izos'k i= dks vkosnu i= ls [k.M f'k{kk vf/kdkjh dk;kZy; }kjk vyx fd;k tk,xkA izos'k i= vkidks [k.Mf'k{kk vf/kdkjh ds }kjk vuqØekad vkcafVr djus ds ckn fn;k tk,xkA vH;FkhZ ;g lqfuf'pr djsa fd og viuk izos'k i= lacaf/kr [k.M f'k{kkvf/kdkjh ls ijh{kk frfFk ls ,d lIrkg iwoZ izkIr dj ysaA

2- ijh{kk dsUnz ij vk/kk ?k.Vk iwoZ igq¡puk lqfuf'pr djsa rFkk ijh{kk nsus gsrq vkcafVr vuqØekad okys LFkku ij gh cSBasA3- ijh{kk d{k esa eksckby] dSydqysVj] xf.krh; ,oa HkkSfrd Vscy ;k fdlh Hkh izdkj ds vuqfpr lk/kuksa dk iz;ksx oftZr gSA4- dks nks l=ksa esa vk;ksftr dh tk;sxhA izFke l= ¼izFke iz'u i=½ 10%00 am ls 12%00 pm, f}rh; l=

¼f}rh; iz'u i=½ 1%30 pm ls 3%30 pm rdA5- iz'u i= laca/kh funsZ'k fuEufyf[kr gSa %&

i . izFke iz'ui= % ekufld ;ksX;rk dk gS ftlesa 100 vfuok;Z iz'u gksaxsAii. f}rh; iz'ui= % 'kSf{kd vfHk{kerk dk gS ftlesa 100 vfuok;Z iz'u ¼bfrgkl] Hkwxksy] ukxfjd 'kkL=] vFkZ 'kkL=] HkkSfrdh] jlk;u]

tho foKku rFkk xf.kr½ gksaxsA6- izR;sd iz'u ,d vad dk gSA xyr mRRkj ij _.kkRed vad ugha fn;s tk,¡xs ¼mRrj xyr gksus ij vad ugha dkVs tk,¡xs½A7- mÙkj i=d vkSj iz'u iqfLrdk ds doj ist ij fn;s x, LFkku ij izos'k i= esa fn;s x;s 11 vadksa dk vuqØekad fy[ksaA iz'u iqfLrdk ,oa mÙkj

i=d ds fdlh Hkkx ij viuk uke u fy[ksaaA8- iz'u iqfLrdk esa lHkh iz'u oLrqfu"B gSaA izR;sd iz'u ds fy, pkj lEHkkfor mÙkj fn;s x, gSa ftuesa ls dsoy ,d gh mÙkj lgh gSA

9- vks0,e0vkj0 'khV ij fn, x, funsZ'kksa dk ikyu djsaA lgh mÙkj nsus vkSj lwpuk,¡ Hkjus ds fy, dsoy uhyh@dkyh iSu dk gh iz;ksx djsaA

10- ,d ls vf/kd xksyksa dks Nk;kafdr djus ;k vk/kk xksyk Nk;kafdr djus ij vad ns; ugha gksaxsA

iz'u 1- Lo.kZ efUnj fLFkr gS&¼v½ Hkksiky ¼c½ verlj ¼l½ fglkj ¼n½ nsgjknwumRrj& bl iz'u dk lgh mÙkj c gS vr% c dks Nk;kafdr fd;k x;k gSA v c l n

11- ijh{kk vof/k esa d{k fujh{kd ds funsZ'kksa dk ikyu djsaA12- ijh{kk d{k NksM+us ls igys vks0,e0vkj0 'khV dks d{k fujh{kd dks lkSai nsaA13- ijh{kksijkUr vH;FkhZ iz'u iqfLrdk rFkk vks0,e0vkj0 'khV dh dkcZu dkWih vius ikl j[ksaxsA14- nf"V ckf/kr vH;fFkZ;ksa dks nksuks l=ksa dh ijh{kk esa 30 feuV dk vfrfjDr le; ns; gSA15- OMR Sheet ij vuqØekad lko/kkuh ls HkjsaA vadkas dks fy[kus ds lkFk mlh vad esa xksys

dks Nk;kafdr djsaA (Fill up Roll No on OMR Sheet carefully.)

If Candidate's Roll No is 32221071001 then

he/she will darken circle as given)

APPLICATION FORM NATIONAL TALENT SEARCH EXAMINATION 2021-22 (1st Stage)

(For the Students Studying in Class X)Read the instructions carefully given on the next page before filling the application form.- Date of Examination- ¼ijh{kk frfFk½ 16 January 2022 (Sunday)- Name & address of the Agency for conducting first Level NTSE- S.C.E.R.T. (UK.) Dehradun.- Application fee, if any (write NIL, if there is no fee)

State level 11 digit Roll Number (to be filled by the B.E.O office)

1. vH;FkhZ dk uke ¼Jh o dq0 u fy[ksa½ Name of the Candidate (do not write Miss/Master)

2. firk dk uke ¼Jh@MkW@izks0 u fy[ksa½ Father’s Name (Do not write Mr./Dr/Prof)

3. ekrk dk uke ¼Jherh@MkW@izks0 u fy[ksa½ Mother’s Name (Do not write Mrs./Dr/Prof)

4. fyax 5- vH;FkhZ dk vkoklh; {ks= 6- vH;FkhZ dh tkfr 7- fnO;kaxrk dh fLFkfrSex Area where candidate resides Caste category of candidate Disability status of candidate

6 B. Do you belong to OBC category? D;k vki vU; fiNM+k oxZ ls lacaf/kr gSa\ (Please refer details given on www.ncbc.nic.in/user-

panel/centralliststateview.aspc) of Central list?

Note - Please enclose a copy of the relevant reservation certificate in support of information at S.No. 6 & 7

8. i= O;ogkj dk irk (viuk vFkok firk dk uke u fy[ksa) Postal address for correspondence (Do not write father’s or your name)

9. ftl laLFkku easa d{kk 10 esa i<+ jgsa gSa mldk uke o irkA Name and address of the institution in which studying at Class X level

10. d{kk 10 esa i<+us okys fo|ky; dk izdkj (nwljs i"B ij ifjHkk"kk ns[kdj djsa) 11. fo|ky; dgk¡ fLFkr gS Type of the institution in which studying at Class X level (see definition overleaf and Tick which is appropriate*) Area in which the school is located

10 a. D;k vki dsUnzh; fo|ky;@uoksn; fo|ky; ds fo|kFkhZ gSa\ ;fn gk¡ rks 1 fy[ksa ;fn ugha rks 2 fy[ksaA

Are you student of Kendriya Vidyalaya/Navodaya Vidyalaya? If yes write 1, If no write 212. Medium of exam (a) at the State level (b) at the NCERT level Father’s education Father’s occupation

15.Mother’s education Mother’s occupation No. of family members

18. Number of brothers Number of sisters Birth order of the candidate among his/her brothers and sisters21. vfHkHkkod dh okf"kZd vk;] ¼mi;qDr ckWDl ij djsa½ Parental annual income (Tick appropriate box)

22. nwjHkk"k@eksckbZy ua0 23- bZ&esy E-mail address

24. Percentage of class IX

To be filled in by the Head of the Institution Certified that:(1) Master/Miss……….....…………………..is a regular student of this School/Institution and he/she has secured %

marks in the class IX annual examination i.e. when he/she was promoted from class IX to class X. He/She hassecured marks out of ……………….................................

(2) The particulars given by him/her in the application form have been verified and found in order.(3) Master/Miss …………….................……belongs to Scheduled Caste/Scheduled Tribe/Other Backward Class/Physically

disabled and Economically Weaker Section category as per the records maintained in the Institution. (to be filled forReserve category Candidates only)

Date ................

(Signature of the Candidate) Signature of the Principal with office sealSignature of the B.E.O with office seal

Space for thePhotograph (Passport

size and black &white).Photographshould be attestedby the Head of the

Institution

Amount D.D. Number Date of D.D Name of Bank

jkT; dksM o"kZ tuin dksM dsUnz dksM Ø-la- ¼ch0bZ0vks0 dk;kZy; }kjk Hkjk tk;sxk½ d{kk tUe frfFk State Code Year District Code Centre code Serial No. (to be filled by the B.E.O office) Class Date of Birth

1023 22

Pin code

Hkkb;ksa dh la[;k 19. cguksa dh la[;k 20. HkkbZ&cguksa ds chp vH;FkhZ dk Øe

1 2 3 4 5 2 to 3 lac 3 to 5 lac More than 10 lac 5 to 10 lacUp to 2 lac

ljdkjh LFkkuh; fudk; izkbosV ,MsM izkbosV vu,MsM xzkeh.k 'kgjh

G o v t .1 2 L o c a lB o d y

3 P r i v a t eA id e d

4 P r i v a t e U n a id e d 1 Rural 2 Urban

ijh{kk dk ek/;e ¼v½ jkT; Lrj ij ¼c½ jk"Vªh; Lrj ij 13.firk dk 'kSf{kd Lrj 14. firk dk O;oLkk;

ekrk dk 'kSf{kd Lrj 16. ekrk dk O;oLkk; 17. ifjokj ds lnL;ksa dh la[;k

lk-Gen

fi-tk-OBC

vuq-tk-SC

t-tk-ST

v-d-o-EWS

BLV DH LD AID MD None1 2 3 4 5 1 2 3 4 5 61 2 1 2

xzkeh.k-Rural

'kgjh-Urban

iq-Male

e-Female

OBC Caste NameNOYES State(As per central list)

1 2

Pin Code

PART - 2

3 2 2 2

CODING PLANRead Instructions carefully before filling up the Application Form1. Use only Blue or Black Ball Point Pen. Write in CAPITAL LETTERS. Do not mark or write outside the

boxes.2. Leave one box blank between two words. Limit your name and address within the space provided for it.

Please see example as given below.3. Tick OR Cross only one of the appropriate boxes in item nos. 4,5,6,7,10,11 & 214. Write code number in item nos. 12, 13, 14, 15 and 16 as given overleaf.5. It is the responsibility of the candidate and the Principal of the school to submit the filled in form to

the concerning Block Education Office before the last date. No request for condoning delay in submis-sion will be entertained whether it is due to the fault of the candidate or the Post office/Headmaster/Principal of his/her institution.

6. Incomplete or wrongly filled application forms are liable to be rejected.7. 4% reservation for Physically Challenged Group of Students, with benchmark disabilities of which, one

percent each shall be reserved for persons with benchmark disabilities under clauses (a), (b) and (c)and one percent for persons with benchmark disabilities under clauses (d) and (e) namely:

(a) blindness and low visions; (BLV)(b) deaf and hard of hearing; (DH)(c) locomotor disability including cerebral palsy, leprosy cured, dwarfism, acid attack victims and mus-

cular dystrophy; (LD)(d) autism, intellectual disability, specific learning disability and mental illness; (AID)(e) multiple disabilities from amongst persons under clauses (a) to (d) including deaf- blindness in the

posts identified for each disabilities' (MD)

8. Filling of Distt. and Centre code e.g., If Distt is Dehradun, code 05 and the centre is G.I.C. Kalsi, centre code 30 then Distt. and Centre code will be

Example for writing Name and Address

Candidate Name:

Father’s Name:

Mother’s Name

Postal Address : Do not try to write complete address in one line. Break it appropriately as shown below.

0 5 3 0

E d u ca t io n C o d e O c c u pa t i o n C o d e

N o F o r m a l E d u ca t io n 1P r o fe s s i o n a l , T e c h n i c a l a n d R e la t e d W o r k e r

1

U p to P r im a ry 2A d m in i s t r a t i ve , E x e c u t i ve a n d M a n a g e r i a l W o r k e r

2

U p p e r P r im a ry 3C le r i c a l a n d r e l a t e d W o r k e r

3

S e c o n d a r y 4B u s in e s s / S e r vi c e W o r k e r

4

S e n io r S e c o n d a r y 5F a r m e r , F i s h e r m a n a n d r e l a t e d w o r k e r

5

G r a d u a t io n 6P r o d u c t i o n a n d r e l a t e d w o r k e r , T r a n s po r t

6

P o s t g ra d u a t io n 7O pe r a t o r s a n d L a bo u r e r W o r k e r n o t c l a s s i f i e d by

7

D o c to r a l 8 N o t e m plo y e d 8

P r o fe s s io n a l d e g r e e (E n g g , M e d ic in e , M C A , M B A , e tc . )

9

E d u c a t io n o f F a t h e r o r M o t h e r( R e f e r t o i t e m N o s . 1 3 & 1 5 ) F a t h e r 's / M o t h e r 's O c c u p a t io n

(R e f e r t o i t e m N o s . 1 4 & 1 6 )

M ed ium C o de

En g lish 1 3

H in di 1 5

M ed ium o f E x am in atio n

( Re f e r to ite m 1 2 )

M edium o f Ex a m in a tio n Co de

O P N E G I

R E K H A N E G I

G E E T A N E G I

1 4 5 / 6 M O H I N I R O A D

D E H R A D U N 2 4 8 0 0 1PIN

TYPE OF SCHOOL/ INSTITUTION (Refer to item No.10)

GOVERNMENT A Government School is that which is run by the State Government or Central Goverment or PublicSector Undertaking of 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 institution such as ZilaParishad, Municipal Corporation, Municipal Committee, Notified Area Committee and CantonmentBoard.

PRIVATE AIDED A Private Aided School is that which is run by an individual or private organization and receives grantfrom government or local body.

PRIVATE UNAIDED Private Unaided School is that which is managed by an individual or a private organization and doesnot receive any grant either from government or local body.

×

STATE LEVEL NATIONAL TALENT SEARCH EXAMINATION 2021-22

VERIFICATION FORMState level 11 digit Roll Number (to be filled by the B.E.O office)

1. vH;FkhZ dk uke ¼Jh o dq0 u fy[ksa½ Name of the Candidate (do not write Miss/Master)

2. firk dk uke ¼Jh@MkW@izks0 u fy[ksa½ Father’s Name (Do not write Mr./Dr/Prof)

3. ekrk dk uke ¼Jherh@MkW@izks0 u fy[ksa½ Mother’s Name (Do not write Mrs./Dr/Prof)

4. tUe frfFk Date of Birth5. fyax 6- vH;FkhZ dk vkoklh; {ks= 7- a vH;FkhZ dh tkfr 8- fnO;kaxrk dh fLFkfr

Sex Area where candidate resides Caste category of candidate Disability status of candidate

9. i= O;ogkj dk irk (viuk vFkok firk dk uke u fy[ksa) Postal address for correspondence (Do not write father’s or your name)

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10. ftl laLFkku easa d{kk 10 esa i<+ jgs gSa mldk uke o irkA Name and address of the institution in which studying in Class X level

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11. d{kk nl esa i<+us okys fo|ky; dk izdkj (lgh ij djsa) 12. fo|ky; dgk¡ fLFkr gSType of the institution in which studying in Class X level (Tick which is appropriate*) Area in which the school is located

13. ijh{kk dk ek/;e ¼dksM Hkjsa½ (Medium of exam)v- jkT; Lrj (State Level) c- jk"Vªh; Lrj (National Level)

(Signature of the Candidate) (Signature of the Block Education Officer with date with Office seal)

Signature of the Invigilator MAT ------------------------- Signature of the Candidate MAT -------------------------at the examination Centre SAT ------------------------- in the presence of Invigilator SAT -------------------------

STATE LEVEL NATIONAL TALENT SEARCH EXAMINATION 2021 - 22 Name of the State/UT: UTTRAKHAND

ADMIT CARD

(To be filled in by the applicant)vkosnd dk uke %

_______________________firk dk uke Jh %

_________________

Name of the applicant Father's Name Sri

fo|ky; dk uke % _______________________________

tuin dk uke % __________________

Name of School Name of district

dks mDr ijh{kk esa lfEefyr gksus dh vuqefr nh tkrh gSA (Is permitted to appear for the above said examination)

i= O;ogkj dk iwjk irk % _________________________________________________________________________

Full Postal Address _______________________________________________________PIN code__________

Date of Examination : 16 January, 2022 (Sunday)Time of Examination : 1- MAT - 10:00 A.M to12:00 P.M. 2- SAT - 01:30 P.M. to 03:30 P.M.

Name of Examination centre (Given By B.E.O. Office) ___________________________________________________

Signature of the Block Education Officer with Office Seal

RECEIPTRECEIVED WITH THANK THE APPLICATION FORM OF NATIONAL TALENT SEARCH EXAMINATION - 2021-22 STAGE -1 SCHOLARSHIP

SCHEME (For the Students Studying in Class X) of Master/Miss ..........................................................................S/o/D/o .................................................................................. on date ..............................................

Signature of the Guardian Signature of the Block Education Officer with

Space for thePhotograph (Passport

size and black &white).Photograph

should be attested bythe Head of the

Institution

jkT; dksM o"kZ tuin dksM dsUnz dksM Ø-la- ¼ch0bZ0vks0 dk;kZy; }kjk Hkjk tk;sxk½ d{kk State Code Year District Code Centre code Serial No. (to be filled by the B.E.O office) Class

3 22 2

102 223

1 Govt. 2 Local Body 3 Private Aided 4 Private Unaided

ljdkjh LFkkuh; fudk; izkbosV ,MsM izkbosV vu,MsM xzkeh.k 'kgjh

1 Rural 2 Urban

3 22 2

State level 11 digit Roll Number (to be filled by the B.E.O office)

OBC Caste NameNOYES 1 2 State

7 b. Do you belong to OBC category D;k vki vU; fiNM+k oxZ ls lacaf/kr gSA (Please refer details given on www.ncbc.nic.in/user-

panel/centralliststateview.aspc) of Central list?

1

BLV

2

DH

3

LD

4

AID

5

MD None

6

iq-Male

e-Female

1

xzkeh.k-Rural

2

'kgjh-Urban

1 2

lk-Gen

fi-tk-OBC

vuq-tk-SC

t-tk-ST

vk-d-o-EWS

1 2 3 4 5

PART - 3

DISTRICT AND CENTRE CODE

FOR NTS EXAM (1ST STAGE) 2020- 21

District Code Centre Name Code District Code Centre Name CodeG.G.I .C. Almora 01 G.I.C. Chailusain 48

G.I.C. Bhakuna 02 G.I.C. Dhoomakot 49

G.I.C. Bhikyasain 03 G.I.C. Deuli 50

G.I.C. Chaukhutiya 04 G.I.C. Jaiharikhal 51

G.I.C. Daniya 05 G.I.C. Kaljikhal 52

G.I.C. Devayal Salt 06 G.I.C. Kot 53

G.I.C. Dhoulchhina 07 G.I.C. Kotdwar 54

G.I.C. Dwarahat 08 G.I.C. N augounkhal 55

G.I.C. Lamgada 09 G.I.C. Pauri 56

G.G.I .C. Ranikhet 10 G.I.C. Pabau 57

G.I.C. Syalde 11 G.I.C. Pokhra 58

G.I.C. Bageshwar 12 G.I.C. Rikhnikhal 59

G.I.C. Garud 13 G.I.C. Sri N agar 60

G.I.C. Kapkot 14 G.I.C. Syunsi 61

G.I.C. Deval 15 G.I.C. Thalisain 62

G.I.C. Gairsain 16 G.I.C. Berinag 63

G.I.C. Ghat 17 G.I.C. Dharchula 64

G.I.C. Gopeshwar 18 G.G.I.C. Didihat 65

G.I.C. Joshimath 19 G.I.C. Gangolihat 66

G.I.C. Karanprayag 20 G.I.C. Kanalichhina 67

G.I.C. N agnath Pokhri 21 G.I.C. Munsyari 68

G.I.C. N arayanbagad 22 G.I.C. Pipalkot 69

G.I.C. Tharali 23 G.I.C. Pithoragarh 70

G.I.C. Barakot 24 G.I.C. Gupatkashi 71

G.I.C. Champawat 25 G.I.C. Ramashrya 72

G.I.C. Lohaghat 26 G.I.C. Rudraprayag 73

G.I.C. Pati 27 G.I.C. Anjnisain 74

G.G.I .C. Rajpur Road 28 G.I.C. Baurari 75

G.I.C. Chakrata 29 G.I.C. Chhaam 76

G.I.C. Kals i 30 G.I.C. Ghoometidhar 77

S.B.M.I .C. Rishikesh 31 G.I.C. Hindolakhal 78

G.I.C. Selakui 32 G.I.C. Kirtinagar 79

A.R.V.I .C. Vikasnagar 33 G.I.C. Lambgaun 80

G.G.I .C. Jwalapur 34 G.I.C. N arendra 81

G.I.C. Roorkee 35 G.I.C. Thatyur 82

K.B.I .C. Laksar 36 G.G.I.C. Bajpur 83

N .K.I .C. Khanpur 37 G.I.C. Gadarpur 84

N .R.I .C. Manglor 38 G.G.I.C. Jaspur 85

R.N .I .C. Bhagwanpur 39 G.G.I.C. Kashipur 86

G.I.C. Betalghat 40 A.N .G.I .C. Rudrapur 87

G.I.C. Dhanachuli 41 G. I .C. Sirarganj 88

G.G.I .C. Haldwani 42 G.I.C. Tharu, 89

G.I.C. Kotabag 43 G.I.C. Chinyalisaur 90

G.I.C. N ainital 44 G.I.C. Dunda 91

G.I.C. Aukhalkanada 45 G.I.C. Mori 92

G.I.C. Ramgarh 46 G.I.C. N augaun 93

G.I.C. Purola 94

G.I.C. Uttarkashi 95

N ainital 07

G.I.C. Ram N agar 47

13

06

11

12

05

U.S. N agar

Uttarkashi

01

Haridwar

02

Rudraprayag

Pithoragarh

Almora

Bageshwar

10Champawat

DehradunTehri

03

04

09Chamoli

Pauri 08

Nagar

Sitarganj