B.Ed Admission Selection Test:Application Form For I Stage Scrutiny

Form No.
Price Rs. 50/- only
NALANDA OPEN UNIVERSITY
Biscomaun Bhawan, Gandhi Maidan, Patna - 800 001
B.Ed. ADMISSION SELECTION TEST, 2012
(Application Form for 1st Stage Scrutiny)

1. Name of the applicant in Block letters in Roman Script as per Matriculation Certificate
2. Name of the applicant in Devnagri Script
3. Mother's Name ___________________________________________________________________
4. Father's/Husband's Name___________________________________________________
5. Permanent Address _________________________________________________________________
________________________________________________________ PIN
Tel. No.
6. Address for Correspondence____________________________________________________
________________________________________________________ PIN
Tel. No.
7. (i) Date of Birth
(ii) Age
8. Gender MALE
9. Nationality
11. Candidate's Reservation Category : Tick reservation category mentioned below to which the
candidate belongs to and attach certificate in proof thereof issued by Competent Authority.
(Note : Do not tick more than one category (Except Physically Handicapped and WBC candidates)
otherwise your application form may be treated as invalid.)
In case no block is ticked it shall be assumed that the candidate belongs to General category.
i. Scheduled Caste
ii. Scheduled Tribe
iii. Extremely Backward Caste (EBC or Annexure I)
iv. Other Backward Caste (OBC or Annexure II)

Affix Stamp Size
Coloured Photo
of
2cm x 3.25cm
(1)
FEMALE
Mobile No./
Mobile No./
v. Women of Backward Caste (WBC)
vi. General
vii. Physically Handicapped
(2)
Points that Candidate
scores on Self-Assessment
Matric
Intermediate
Graduate
Post Graduate
1 2 3 4 5
Total Points
NOTE : (i) Procedure for Self Assessment of Educational Points : In column (5) of the chart at S.N.–
14 above, the candidate should himself write down the points that he expects to score on the basis of points to be given to each level of examination he/she has passed from Matric onwards in the manner as given below :
6 points are to be awarded for 1st Division, 3 points for 2nd Division and 1 point for 3rd Division for each of Matric, Intermediate, Graduate and Post Graduate examinations, excepting that no point is to be awarded for graduate examination if the candidate has secured less than 45% of marks; but if he/she has secured 2nd or 1st Div. in the Graduate examination, he/she will get 3 points for 2nd Div. and 6 points for 1st Dvi. Similarly, if a candidate has secured first division in his Matric examination, he will get 6 points, but if he has secured 2nd division in the same examination, he will get only 3 points and 1 point for having secured 3rd division. In the same manner, points will be given for Intermediate, Graduate and Post Graduate examinations and, thus, total points obtained by the candidate will be arrived at.
(i) (S.N.–14)

Percentage
of Marks
obtained
Div./Class
awarded
Name of the
Exam Passed
Name of the institution from where the
qualification has been acquired
S(Attach attested copy of the disability certificate issued by the Competent Authority and caste certificate)
12. Background
(Urban/Rural/Tribal)
13. Marital Status
(Married/Unmarried/ Separated/Widowed)
14. Educational Qualifications (Matriculation Onwards) and Self Assessment of Educational Points :
B.Ed. ADMISSION SELECTION TEST, 2012
(3)
NOTE : (ii) No point is to be given for any examination other than Matric, Intermediate, Graduate and Post
Graduate qualifications.
NOTE : (iii) Candidates securing less that 45% of marks at Graduate level need not apply as they are not
qualified to be admitted to B.Ed. programme.
15. Teaching Experience
(1) Instructions for Candidates
To get admission into two years B.Ed. programme of Nalanda Open University, every candidate
will have to have the teaching experience in the following manner :
(i) He/she must have completed atleast two years of teaching experience, as on 31.05.2012, as a
regular or temporary teacher in a Primary/Middle/Secondary/Higher Secondary School
permanently recognised by the Central Government/State Government/Public Sector Undertaking
or a body incorporate as established under law. Teaching experience acquired for teaching
Intermediate classes will not be reckoned as a teaching experience for this purpose.
(ii) He/she must have acquired the aforesaid two years of teaching experience as a paid teacher,
appointed against a regular/temporary vacancy.
(iii) He/she must be serving as a teacher on the date he/she files his/her application for admission into
B.Ed. programme of Nalanda Open University.
(2) Declaration to be made and documents to be filed in support of Teaching Experience :
Every candidate must sign the following declarations and enclose necessary certificates in support
of his/her teaching experience as below :
B.Ed. ADMISSION SELECTION TEST, 2012
(4)
(A) Declaration of the Applicant of his being still in Service on the date he/she
submits his/her application
This is to certify that I have been appointed as a teacher in ................................................on.......................
and still serving in ......................................................................., as a regular /temporary teacher in the
scale/fixed scale of........................................................................
(..................................................................) (..................................................................)
Counter signed by the Head or In-charge Name & Signature of the Applicant of the institution with date and seal were the applicant is still serving
Date:
Place:
(B) Salary Payment Certificate
This is to certify that Mr./Ms..............................................................................................................,
who is a properly appointed regular /temporary teacher in this school in the pay scale/fixed scale
of.................................................., is getting regular salary as per rule of the school. (Attach Attested
Photocopy of Bank Pass Book / Attested Photocopy of Salary Disbursement Register.)
Signature and Seal
of Headmaster
(Name of the school.......................................)
(Name of the School)
(Name of the School)
(Date of appointment)
B.Ed. ADMISSION SELECTION TEST, 2012

16. Attach another coloured photograph in the space below and also put your signature both in English
and Hindi in the space provided for.
Stamp Size
Coloured Photo
Signature in English
fgUnh esa
17. Important Documents to be Attached with Application Form
Applicant must attach self attested photo-copy of the following documents alongwith the
Application Form in the following order:
1. Self attested Photocopy of marksheets and certificate / degrees of all examniations.
(i) Matriculation, (ii) Intermediate, (iii) Graduation (iv) Post Graduation.
2. Self attested Photocopy of upto date Caste Certificate issued by C.O / S.D.O. / D.M
3. Self attested Photocopy of annual Income Certificate (Only for WBC Candidates).
4. Self attested Photocopy of Appointment letter/letters and Joining letter.
5. Self attested Photocopy of Teaching Experience. (Issued by competent Authority)
6. Self attested Photocopy of certificate of Physically handicapped issued on prescribed formate
(Only for PH Candidates).
7. Self attested Photocopy of Salary Payment Certificate from the head of the institution.
8. Proof of salary payment : Bank pass book / Photocopy of Salary Disbursement Register/
Service Book
B.Ed. ADMISSION SELECTION TEST, 2012
(6)
9. Self attested Photocopy of School Recognition Affiliation Certificate or a certificate from the school
Headmaster/Incharge that school is recognised by the B.S.E.B./C.B.S.E./I.C.S.E. or other Board.
(Please mention school affiliation No.)
10. Self attested attested photo-copy of the Appointment letter, showing appointment as a paid
teacher in a temporary/regular vacancy of a recognised school.
11. Self attested photo-copy of the certificate of teaching experience, issued by the Head of the School, showing atleast two years of teaching experience as a paid theacher as on 31.05.2012.
If a candidate completes 2 years of teaching experience after adding services rendered by him/her in more than one recognised school, then, he/she must produce attested photocopies of appointment letters and copies of teaching experience of all schools wherever he/she has served.

B.Ed. ADMISSION SELECTION TEST, 2012
(7)
DECLARATION BY APPLICANT
I........................................................................, son/daughter of .........................................................
of vill./town ............................................, P.S. ................................................, Dist ..........................................,
hereby declare that I have served as a regular/temporary teacher in a paid capacity in a recognised
school for atleast two years as on 31.05.2012.
I also declare that I have read and understood the conditions prescribed for B.Ed. Admission Selection
Test and that I fulfil the minimum eligibility criteria for which I have provided the necessary information as above. In the event of any information being found incorrect or misleading, at any stage my candidature shall be liable to be cancelled by the University at any time and I shall not be entitled for refund of any money paid by me to the University.
I enclose Bank Draft No. ___________________________drawn on ___________________,
dated __________________________, for Rs. __________________________ as the B.Ed. Admission
Selection Scrutiny/Written Test Fee, 2012.
Date : __________________
Place : __________________ Signature of the Candidate

(Name of the Candidate) (Father's Name)
(Name of the Bank)
B.Ed. ADMISSION SELECTION TEST, 2012

R E C E I P T
Form No.
Received application for B.Ed. Admission Selection Scrutiny/Written Test, 2012 from
Mr./Miss/Mrs. on
Signature of Receiving
Officer