Board of Secondary Education, Rajasthan Ekk/;fed f’k{kk cksMZ] jktLFkku
APPLICATION FORM FOR PRAVESHIKA EXAMINATION‐2014
Ikjh{kk vkosnu i= izosf’kdk ijh{kk & 2014
¼dsoy Lo;aikBh ijh{kkfFkZ;ksa ds fy;s½
F. O. CODE
1. Required Centre Place Name & Code (okfaNr ijh{kk dsUnz LFkku o dksM) : LFkku ………..…. dksM LFkku ………. dksM 2. Student’s Name (fo|kFkhZ dk uke) : ………...
3. Father’s Name ¼firk dk uke) : ………....
4. Mother’s Name (ekrk dk uke) : ……….….
5. Date of Birth(tUe frfFk vadksa esa) : DD(fnu) MM(ekg) YYYY (o"kZ)
In Words(tUe frfFk ’kCnksa esa) :……….
6. Category Code (Js.kh dksM) : ¼Js.kh p;u gsrq ihNs fy[ks fo’ks"k funsZ’k la[;k 1 ns[ks½ Js.kh dk uke …….………...Js.kh dksM 7. Only for Category IV & VI( dsoy Js.kh 4 o 6 ds fy;s)
as applicable ( tks ykxw gks)
(IV) ADDITIONAL SUBJECTS (vfrfjDr fo"k;) (4)
(VI) MARKS IMPROVEMENT (vad lq/kkj) (6)
1. ………
2. ………
3. ………
4. ………
As Applicable from Number 8 to 12 (Øekad 8 ls 12 rd tks ykxw gks djsa)
8. Gender (fyax) : (01) MALE (iqw#"k) (02) FEMALE (efgyk) 9. Medium (ek/;e) : (01) HINDI (fgUnh) (02) ENGLISH (vaxzsth) 10. Other (vU;) :
(01)BLIND (n`f"Vghu) (02) HANDICAPPED (fodykax) (03) ALBINO (lw;Zeq[kh) (04)SOLDIER (lSfud) (05) DEAF & DUMB (ewd&cf/kj) (06) CEREBRAL PALSY (lsjsczy ikYlh) (07)POLIO/PARALYSIS/DISABILITY BY BIRTH (iksfy;ks@ydok@tUetkr v{kerk) (08) LEARNING DISABILITY (vf/kxe v{kerk) 11. BPL (ch-ih-,y-): YES (gkWWa) NO (ugha)
12. CASTE CATEGORY(tkfr Js.kh) : (05) Gen (lkekU;) (06) MINORITY (vYi la[;d) (07) SC (vuqlwfpr tkfr) (08) ST (vuqlwfpr tutkfr)
(09) OBC (vU; fiNMk oxZ) (10) SPECIAL OBC (fo’ks"k fiNMk oxZ)
ŸÙ≈U —- ¿UÊòÊflÎÁûÊ /¬È⁄US∑§Ê⁄U ©U¬⁄UÙÄà øÿÁŸÃ üÊáÊË ∑§ •ÊœÊ⁄U ¬⁄U „UË ºË ¡ÊflªË–
13. ADDRESS (Nk= dk iw.kZ irk) :
House No. /Street /Place Name (edku ua-@xyh ua-@LFkku) : ………..……….………..………....
Village/Town/City (xzke@dLck@’kgj) : ……….………....………..…………...
District (ftyk) : ……… STATE (jkT;) :……….……….……… PIN CODE NO.(fiudksM ua-) : ………..
14. Student/Guardian’s Phone No.(fo|kFkhZ@vfHkHkkod dk Qksu ua.) : STD Code(,lVhMh dksM) : ………..…Phone No( Qksu ua-) : ………...
Student/Guardian’s Mobile No. (fo|kFkhZ@vfHkHkkod dk eksckbZy ua-) : ………...……...
15. Previous Academic Details (iwoZ ’kS{kf.kd ;ksX;rk):
16. Student’s Photo and Signature (fo|kFkhZ dk QksVks ,oa gLrk{kj)
Student’s Photo(fo|kFkhZ dk QksVks)
uksV% QksVks ij gLrk{kj ugha djsaA
Student’s Signature(fo|kFkhZ ds gLrk{kj)
Use Black Pen/Marker For Signature gLrk{kj dsoy dkyh L;kgh dk isu vFkok ekdZj ls gh djsa
CLASS (d{kk) YEAR (o"kZ) ROLL NO.(ukekad) RESULT (ifj.kke) NAME OF SCHOOL/BOARD (Ldwy@cksMZ dk uke)
VIII
IX
X/izosf’kdk
izosf’kdk ijh{kk Lo;aikBh ijh{kkFkhZ
PASTE PASSPORT
SIZE PHOTO
2 1
vxzs"k.k vf/kdkjh dk izek.khdj.k %&
gLrk{kj --- 'kkyk dh eqnzk ¼Seal½---
fo|ky; dk uke ---F.O. dksM
Ekk/;fed f’k{kk cksMZ] jktLFkku] vtesj
vkWu ykbZu vkosnu i=&2014 ¼Lo;aikBh½ Hkjus gsrq vko’;d funsZ’k ,oa fof/k
izosf’kdk ijh{kk&2014
cksMZ dh osclkbZV www.rajeduboard.nic.in
cksMZ }kjk iszf"kr uewuk vkosnu i= ,oa mlds ihNs eqfnzr funsZ’kksa dh iw.kZr% ikyuk djsa vU;Fkk vkosnu i= esa dh tkus okyh izfof"V;kWa =qfViw.kZ gksus dh laHkkouk jgsxhA
uewuk vkosnu i= cksMZ dh mDr osclkbZV ls Hkh MkmuyksM fd;k tk ldrk gSA lkekU; funsZ’k%&
ladsr & lgh dk fpUg oxZ1- lHkh izfof"V;kWa djuk vfuok;Z gSA 2- vkosnu i= dsoy vaxzsth esa gh Hkjk tkosA 3- Nk= ;Fkk LFkku lgh dk fpUg vo’; yxkosaA
4- vfuok;Z fo"k; fgUnh¼01½] vaxzsth¼02½] laLd`r¼95½ foKku¼07½] lkekftd foKku¼08½ ,oa xf.kr¼09½ fo"k; ¼dsoy Js.kh 1 o 2 ds fy;s½ Lo;eso eqfnzr gksaxs vr% vkosnu i= esa ugha fy[ks x;s gSaA
5- vkosnu i= ds Øekad 1 ls 16 rd Hkjus gsrq fuEukuqlkj dk;Zokgh djsa&
& vxzs"k.k vf/kdkjh viuk F.O.Code dk vadu oxZ esa djsaA
& Øekad 1 esa Nk= ijh{kk dsUnz gsrq nks LFkku dk uke o ftys dk dksM vkosnui= esa fu/kkZfjr LFkku o oxZ esa vafdr djsaA & Øekad 2 ls 4 esa Nk=] firk o ekrk dk uke dsoy vaxzsth ds cMs v{kj ¼CAPITAL LETTERS½ esa gh vafdr djsaA & Øekad 5 esa tUefrfFk vadksa o 'kCnksa esa vafdr djsaA
fo’ks"k funsZ’k%&
1- Øekad 6 ij fuEukafdr ftl Js.kh (CATEGORY) esa Nk= izfo"V gks jgk gS mldk uke o Js.kh dksM vkosnu i= esa fu/kkZfjr LFkku ij vafdr djsa%&
(I) ALL SUBJECTS(1-lEiw.kZ fo"k;) (II) DIVISION IMPROVEMENT(2-Js.kh lq/kkj) (IV)ADDITIONALSUBJECTS(4-vfrfjDrfo"k;) (VI) MARKS IMPROVEMENT (6-vad lq/kkj)
v- Nk= ;fn lEiw.kZ fo"k;ksa esa izFke ckj izfo"V gks jgk gS rkss (I) ALL SUBJECTS ¼1-lEiw.kZ fo"k;½ ij lgh dk fpUg yxkosaA
c- Nk= ;fn ijh{kk esa ,d ckj izfo"V gksdj Js.kh lq/kkj gsrq lEiw.kZ fo"k;ksa esa iqu% izfo"V gks jgk gS rkss (II) IMPROVEMENT DIVISION ¼2-Js.kh lq/kkj½ ij lgh dk fpUg yxkosaA
l- Nk= ;fn vfrfjDr fo"k;@fo"k;ksa esa ¼foojf.kdk ds v/;k; 16 fofu;e 27½izfo"V gks jgk gS rkss (IV) ADDITIONAL SUBJECTS ¼4- vfrfjDr fo"k;½ ij lgh dk fpUg yxkosaA
n- Nk= ;fn iwoZ esa mRrh.kZ fo"k;@fo"k;ksa ds vadksa esa lq/kkj gsrq ¼ijUrq lEiw.kZ fo"k;ksa esa ugha½ izfo"V gks jgk gS rkss(VI) MARKS IMPROVEMENT ¼6-vad lq/kkj½ ij lgh dk fpUg yxkosaA
2- Øekad 7 ij Nk= }kjk Øekad 6 esa p;fur Js.kh (CATEGORY) ds vuqlkj dsoy Js.kh 4 o 6 ds Nk= lgh dk fpUg yxkrs gq, fy;s tk jgs fo"k;@fo"k;ksa dk uke vafdr djsaA
3- Øekad 8 ls 12 rd ;Fkk LFkku lgh dk fpUg vafdr djsa] mnkgj.kkFkZ &
Øekad 8 ij Nk= dk fyax ;fn iq#"k gS rks MALE ¼iq#"k½ ij lgh dk fpUg yxkosaA ;fn L=h gS rks FEMALE ¼efgyk½ ij lgh dk fpUg yxkosaA
Øekad 9 ij Nk= dk ek/;e ;fn fgUnh gS rks HINDI ¼fgUnh½ ij lgh dk fpUg yxkosaA ;fn vaxszth ek/;e dk gS rks ENGLISH
¼vaxzsth½ ij lgh dk fpUg yxkosaA
Øekad 10 ij Nk= ftl Other ¼vU;½ oxZ ls lacaf/kr gS] ml oxZ ds le{k lgh dk fpUg yxkosaA
Øekad 11 ij Nk= ;fn ch-ih-,y- Js.kh dk gS rks YES ¼gkWa½ ij lgh dk fpUg yxkosa vU;Fkk NO ¼ugha½ ij lgh dk fpUg yxkosaA Øekad 12 ij Nk= ftl CASTE CATEGORY(tkfr Js.kh) ls lacaf/kr gS] ml oxZ ds le{k lgh dk fpUg yxkosaA
4- Øekad 13 ij Nk= viuk iwjk irk e; fiudksM vafdr djsaA
5- Øekad 14 ij Nk= vius ?kj dk nwjHkk"k ua-,l-Vh-Mh- dksM lfgr ,oa eksckbZy ua- vafdr djsaA 6- Øekad 15 ij Nk= viuh iwoZ 'kS{kf.kd ;ksX;rk dk vadu djsaA
7- Øekad 16 ij Nk= vius vko{k fp= dks yxkos fdUrq mlij vius gLRkk{kj ugha djus gSA gLrk{kj gsrq fn;s x;s fu/kkZfjr LFkku ij dkyh L;kgh vFkok ekdZj isu ls gh vius gLrk{kj djsaA
vxzs"k.k vf/kdkjh dk izek.khdj.k&lHkh ijh{kkfFkZ;ksa ds ijh{kkFkZ vkosnu i= ij ;FkkLFkku iz.kkf.kr fd;k tkuk vko’;d gSA
izosf’kdk ijh{kk&2014 ds fo"k; ,oa fo"k; dksM lwph
Ø-l- vfuok;Z fo"k; dksM
1 fgUnh 01
2 vaxzsth 02
3 laLd`r 95
4 foKku 07
5 Lkkekftd foKku 08
6 Xkf.kr 09