BABASAHEB BHIMRAO AMBEDKAR UNIVERSITY (A Central University) VidyaVihar, Rae Bareli Road, Lucknow

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1 (A Central University) VidyaVihar, Rae Bareli Road, Lucknow Ph. No. : , Fax. No. : RESIDENTIAL COACHING ACADEMY Application form for Admission 2015 DD No. Date Bank (Please put tick mark wherever applicable) Program applied for : A. UPSC (Prelims-2016) or UPPSC Affix recent passport size color photograph and put signature B. Banking SSC RRB Exam Center: Lucknow Delhi Hyderabad Guwahati Ranchi Chennai (centers are tentative, subject to availability of sufficient number of candidates) Medium of examination : Hindi English 1. Name (in capital letters) : 2. Father s/husband s name : 3. Mother s name : 4. Date of birth : age (years) : (dd/month/year) as on Marital status : Married Unmarried 6. Category : SC ST Minority Women 7. Religion : 8. Phone No. : Page 1 of 5

2 9. Internal/External (write I for BBAU student/ E for non-bbau student) 10. Have you received coaching at Residential Coaching Academy of this University? Yes No If yes : year, Course, 11. Competitive exam Appeared:, Reg. No., Result 12. Have you received coaching at any other institutes/centers earlier? Yes No If yes, name of the Institute/Center Year, Competitive exam appeared, Result 13. Approximate distance from your native place to BBAU, Lucknow (in Km) : 14. Place of birth :, State 15. Is hostel accommodation required (after admission in RCA)? (Y/N) 16. Educational Qualifications (graduation onwards) (attach copy of mark sheets) : Sl. No. Degree Board/University Year Subjects 1. Graduation (BA/B.Sc/etc) 2. Post-graduation (MA/M.Sc/etc) 3. Others % of marks Division 17. Have you applied for any competitive examinations for which exam is yet to be held? : Yes No If yes, name of the examination 18. Have you qualified preliminary or first phase of any competitive exams?: Yes No If yes, name of the exam, year 19. Optional subjects opted for Mains (in case of Union Public Service Commission and State Public Service Commission) Mains Subjects : Father s/husband s Occupation : 21. Father s/husband s total Annual Income : Rs. Page 2 of 5

3 22. Correspondence Address : 23. Permanent address: 24. Declaration : I, hereby solemnly affirm that I have neither been involved in any criminal case nor any criminal case is pending against me in any court of law. I have not been debarred/ rusticated by the institution last attended/presently attending. I, hereby solemnly declare an oath that the entries made by me in the above columns are true to the best of my knowledge and belief and if at any time, entries are found incorrect, the admission may outrightly be cancelled and disciplinary action may be initiated against me. I will abide by the rules and regulations of RCA as well as of the University. Date : Signature of the candidate Page 3 of 5

4 25. Required enclosures (Original certificates/documents should not to be enclosed with the application form in any case) 1. A Demand draft of Rs. 100/- towards the application fee, drawn in favor of Finance Officer, BBAU, Lucknow and payable at Canara Bank, BBAU branch, Lucknow Self attested copy of HS/SSC in support of date of birth. 3. Self attested copy of marks sheets/grade sheets of qualifying examinations (graduation). 4. One self-addressed envelope with stamp worth of Rs. 25/- on it. 5. Photocopy of recent Income Certificate from the competent authority. 26. Last date : Duly filled-in application form along with DD and necessary enclosures should reach to The Director, Residential Coaching Academy (RCA), Babasaheb Bhimrao Ambedkar University, Lucknow , UP on or before 14 th September Pattern of Entrance exam : 100 questions carrying equal marks, objective type multiple choice, no negative marks for wrong answer, 2 hours duration. 28. Tentative dates (kindly visit for all the following updates) List of the eligible candidates will be announced on BBAU website : 21 st Sept Date of National Level Entrance Test : 27 th September 2015 Declaration of marks secured by candidates in Entrance Test: 05 th October 2015 Personal interview with candidates on : 8 th & 9 th October 2015 Announcement of the result of the selected candidates for Admission: 10 th October 2015 Admission for coaching program at RCA : 12 th October 2015 Coaching Classes commences from : 13 rd October 2015 For further updates and details/rules and regulations, of RCA about the admission process, please visit Residential Coaching Academy (RCA) webpage on the University website ( Admission to the National Level Entrance Test is purely provisional. Admission in RCA coaching program will be based on performance in the entrance exam, personal interview, certificates verification and suitability for the coaching program. Date : Signature of the candidate Page 4 of 5

5 Hall Ticket Hall Ticket RESIDENTIAL COACHING ACADEMY (RCA) National Level Entrance Test 2015 Exam Center : Date : Reg. No. Timing : a.m. to p.m. Name : Address : Candidate s signature (at the exam hall) Director, RCA Please don t cut here (A Central University), Vidya Vihar, Rae Bareli Road, Lucknow RESIDENTIAL COACHING ACADEMY (RCA) National Level Entrance Test 2015 Exam Center : Date : Reg. No. (A Central University), Vidya Vihar, Rae Bareli Road, Lucknow Timing : a.m. to p.m. Name : Address : Affix recent stamp size color photograph and put signature Affix recent stamp size color photograph and put signature Candidate s signature (at the exam hall) Director, RCA Page 5 of 5