a For Office Use Only CATEGORY GEN / OBC / SC / ST LU Other Univ UE CTW Sign of Issuing Authority University of Lucknow Class Div. % Weightage High School Intermediate Graduation Post Grad. B.Ed. (Theory) Total Application Form for M.Ed. Admission Test 2013,e0,M0 ços'k ijh{kk & 2013 gsrq vkonsu i= Bank Draft details: D.D. No.: Date:... Rs... Issuing Bank:. Branch:..... (i) fgunh es... (ii) vaxzsth es a (In English Capital Letters).... 2. firk dk uke (Father s Name)... 3. ekrk dk uke (Mother s Name)... 4. i=kpkj dk irk (Postal Address).. 5. VsyhQksu ua0,l-vh-mh- dksm lfgr (Telephone No. with STD Code) :-.. eksckby (Mobile).. 6. (i) LFkk;h irk (Permanent Address)......... (ii) bz- esy (E-mail)... 7. tue&frffk (Date of Birth)..... 1 self attested (Self Attested)
8. 'ksf{kd ;ksx;rk (Academic Qualifications) Ø0la0 Ikjh{kk dk uke S.No Name of Examination 1. gkbz Ldwy High School cksmz@fo'ofo ky; Board/ University o"kz Year Js.kh Div fo k; Subjects iw.kkzad Max. çkirkad Obtained çkirkkad% % 2. b.vjehfm,v vfkok led{k Intermediate or Equivalent 3. ch-,-@ch-dke-@ch-,l&lh- B.A./B.Com./B.Sc. 4.,e--,-@,e-dke-@,e-,l&lh- M.A./M.Com./M.Sc. 5. ch-,m-@,y-vh-¼ls)kfurd½ B.Ed./L.T. (Theory) 6. ch-,m-@,y-vh-¼f'k{k.k vh;kl½ B.Ed./L.T. (Practice in Teaching) egroiw.kz % lhkh mrh.kz ijh{kkvksa ds vad i=ksa] izek.k i=ksa o fmfxz;ksa dh Lo izekf.kr izfr;k dzekuqlkj layxu dhft,a Important: Attach Self attested copies of all Mark-Sheets, Certificates and Degrees of all examination passed according to serial numbers. 9- ;fn bl o"kz ch0,m0 ijh{kk y[kuå fo'ofo ky;@lec) egkfo ky; ls nh gs rfkk ifj.kke?kksf"kr ugha gqvk gs rks vuqøekad dk myys[k djsa ----------------------------------------------------------------------------------------- If appeared in B.Ed. from Lucknow University or its Associated College and the results are not declared then enter the roll no 10- fueufyf[kr es a vki ftl Js.kh@Jsf.k;ksa es a vkrs gsa ml@mu ij lgh dk fu'kku yxk;s a rfkk blds çek.k Lo:i vkosnu&i= esa fn;s x;s çk:i es a l{ke vf/kdkjh }kjk çek.k&i= çlrqr djsaa To which of the following category/categories do you belong? Put a tick in the box and in proof of this, furnish certificate from the competent authority in the format given in the application form. (i) lkeku; (General) 2
(ii) vuqlwfpr tkfr (Scheduled Caste) (iii) vuqlwfpr tu&tkfr (Scheduled Tribe) (iv) vu; finm+k oxz (Other Backward Class) (v) y[kuå fo'ofo ky; ds v/;kid@dezpkjh ;k muds iq=@iq=h@iruh@ifr (Teacher/Employee of Lucknow University or Their Son/Daughter/Husband/Wife) (VI) y[kuå fo'ofo ky; ds lg;qdr egkfo ky;ksa ds v/;kid ds iq=@iq=h@iruh@ifr (Son/Daughter/Husband/Wife of Teacher of Associated Colleges of Lucknow University) (VII) LorU=rk lsukuh (Freedom Fighter) (VIII) HkwriwoZ lsfud (Ex-Serviceman) (IX) fodykax (Physically Handicapped) 11. Domicile : Uttar Pradesh Other State 12. B.Ed. : Lucknow University Other University?kks"k.kk esa,rn~ }kjk?kks"k.kk djrk@djrh gw fd esaus lelr funsz'k HkyhHkk fr i<+ fy, gsaa esjs }kjk dksbz lwpuk u rks fnikbz xbz gs vksj u gh foñr djds nh xbz gsa ;fn Hkfo"; es a blesa dksbz =qfv ikbz xbz rks mldk mùkjnkf;ro esjk gksxk vksj fo'ofo ky; ç'kklu dks iw.kz vf/kdkj gksxk fd esjk ços'k fujlr dj ns vksj esjs fo#) vu; leqfpr dk;zokgh djsa ços'k ijh{kk] lk{kkrdkj rfkk dkmaflfyax dh frffk;ks a dks tkuuk,oa mles a fd;s x;s ifjorzuksa dks f'k{kk fohkkx] y[kuå fo'ofo ky; ls irk djuk esjk mùkjnkf;ro gsa I hereby declare that I have read all the instructions and the entries made in this application form are true and nothing has been concealed nor has anything been given in destorted form. If, in future any of these entries are found to be incorrect, I shall be responsible for it and the University shall have full right to cancel my admission and take other suitable action against me. It is also my responsibility to be in touch with the Department of Education, Lucknow University regarding the date/dates of admission test, interview, counselling and changes, if any, in the dates. Date... layxudks a dh lwph (List of Enclosures) : 1.... 2.... 3.... 4.... vh;fkhz dk iw.kz glrk{kj Full Signature of the Candidate In Hindi... In English... 5.... 6.... 7.... 8.... 3
y[kuå fo'ofo ky; M.Ed. Admission Test-2013 miflfkfr fooj.k ATTENDANCE SHEET vuqøekad dks NksM+dj 'ks"k çfof"v;k vh;fkhz }kjk Hkjh tk;saxha All entries except the Roll No. to be filled in by the candidate (i) fgunh es a ---------------------------------------------------------------------------------------------------------------------------- (ii) In English (Capital Letters).. (Seflf Attrested) 2- firk dk uke (Father's Name)... 3- ekrk dk uke (Mother's Name). ¼vH;kFkhZ ds iw.kz glrk{kj½ 4- vh;fkhz dk irk (Address of the Candidate)...... 5- Qksu uecj (Phone Number)... ijh{kk frffk (Date of Test) Sept., 08, 2013. Time: 10.00 A.M. to 1.00 P.M. ijh{kk frffk d{k fujh{kd dh miflfkfr esa vh;fkhz ds glrk{kj d{kk fujh{kd ds glrk{kj 4
y[kuå fo'ofo ky; M.Ed. Admission Test-2013 ços'k i= ADMIT CARD (PROVISIONAL) vuqøekad dks NksM+dj 'ks"k çfof"v;k vh;fkhz }kjk Hkjh tk;saxha All entries except the Roll No. to be filled in by the candidate (i) fgunh es a --------------------------------------------------------------------------------------------------------------------------------------- (ii) In English (Capital Letters)... 2- firk dk uke (Father's Name)... 3- ekrk dk uke (Mother's Name)... 4- vh;fkhz dk irk (Address of the Candidate)...... 5- Qksu uecj (Phone Number with STD Code)... ijh{kk frffk (Date of Test) Sept.,08, 2013 Time : 10.00 A.M. to 1.00 P.M. ços'k ijh{kk dsunz (Center of Test) Lucknow University, Lucknow (Self Attested) ¼vH;kFkhZ ds iw.kz glrk{kj½ INSTRUCTIONS FOR CANDIDATES You must reach your allotted Test Centre by 9.30 A.M. positively on September 8, 2013. Bring your Admit Card with you, failling which you will not be allowed to appear in the Test. Write your Roll No. in all correspondence with the University. Calculating and Communication Aids, Mobile Phone, Pagers, Earphones etc. are not allowed. However, you may bring hard board pad to the Centre provided nothing is written on it. No extra paper for rough work is to be brought by you. Vacant space provided in the Question Booklet may be used for rough work. The Admit Card must be preserved without making any changes on it as this is required to be presented at the time of admission to M.Ed. course, if selected. Read and follow all instructions written on the Question Booklet provided to you on the Examination day. No candidate will be allowed to enter the Examination Hall after 30 minutes of the commencement of Test. 5