M.Ed. Admission form in english(2015-2016)

REGIONAL INSTITUTE OF EDUCATION, BHOPAL
(National Council of Educational Research and Training)
Application form for M.Ed. Course
(2015-16)
1. Name of the Applicant
:
...................................................................
2. Mother's Name
:
...................................................................
3. Father's Name
:
...................................................................
4. Category (Gen/OBC/SC/ST/PH/Minority)
:
...................................................................
5. Domicile
:
...................................................................
:
...................................................................
Paste recent
passport
size
photograph
here and
sign in the
box given
below.
(M.P./C.G./M.H./Guj./Goa/Daman & Diu/D & NH)
6. Date of Birth
(According to high school certificate)
7. Parent's/Guardian's Annual Income in 2014-15 :
Rs. ...............................................
8. (a) Address for Correspondence (with pin code) : ...................................................................
...................................................................
...................................................................
(b) Permanent Address (with pin code) :
...................................................................
...................................................................
...................................................................
(c) Phone No. (with STD code)
Mobile No.
(d) e-mail ID
9. Details of Bank Draft/Postal Order
:
...................................................................
:
...................................................................
:
...................................................................
:
Amount. ........................ No. ...................
Date of Issue......../....../...................
10. Educational Qualifications (supportive documents should be self attested)
Examination
Board/
University
Year
Subjects
Total Marks
Marks
Obtained
Percentage
High School
Hr. Sec.
Graduation ............
Post. Graduation....
Any Others ............
11. Percerntage of Marks in B.Ed.
: Total ...................Theory ................Practical................
REGIONAL INSTITUTE OF EDUCATION, BHOPAL
(National Council of Educational Research and Training)
Application form for M.Ed. Course
(2015-16)
1. Name of the Applicant
:
...................................................................
2. Mother's Name
:
...................................................................
3. Father's Name
:
...................................................................
4. Category (Gen/OBC/SC/ST/PH/Minority)
:
...................................................................
5. Domicile
:
...................................................................
:
...................................................................
Paste recent
passport
size
photograph
here and
sign in the
box given
(M.P./C.G./M.H./Guj./Goa/Daman & Diu/D & NH)
6. Date of Birth
(According to high school mark sheet)
7. Parent's/Guardian's Annual Income in 2014-15 :
Rs. ...............................................
8. (a) Address for Correspondence (with pin code) : ...................................................................
...................................................................
...................................................................
(b) Permanent Address (with pin code) :
...................................................................
...................................................................
...................................................................
(c) Phone No. (with STD code)
Mobile No.
(d) e-mail ID
9. Details of Bank Draft/Postal Order
:
...................................................................
:
...................................................................
:
...................................................................
:
Amount. ........................ No. ...................
Date of Issue......../....../...................
10. Educational Qualifications (supportive documents should be self attested)
Examination
Board/
University
Year
Subjects
Total Marks
Marks
Obtained
Percentage
High School
Hr. Sec.
Graduation ............
Post. Graduation....
Any Others ............
11. Percerntage of Marks in B.Ed.
: Total ...................Theory ................Practical................
Undertaking
I ..................................................Daughter/Son of ................................................ certify that the
information given above is correct to the best of my knowledge and belief. I agree to abide by the rules and
regulations as laid down by Regional Institute of Education, Bhopal from time to time during the tenure of the
course.
No. of Enclosures: - …………………….
Date: ..............................
Place:...............................
Signature of the Parent/Guardian
Signature of the Candidate