Government of KarnatakaBangalore

Application form for Admission to Two Years B.Ed Course For the Year 2015-16

AS:J-3/.Er zRw/2015-16Notification No & Date

820802Application No01.

ABHISHEK RCandidate's Name02.

CTE, ChitradurgaNodal Centre03.

06 Jul 1994Date of Birth04.

ChitradurgaNative District05.

NoWhether you are belong to Hyderabad-Karnataka Candidate, Under 371(J) Notification?

06.

NILIf Yes Specify the District06a.

2ACategory07.

MaleGender08.

NoPhysically handicapped09.

KarnatakaState10.

KannadaMother Tongue11.

YesHave you Studied in Kannada medium from 1st to 10th Std

12.

ArtsCombination Studied in Degree Level13.

GEETHAMMAMother's Name14.

REVANAPPAFather's Name15.

Postal Address

16e. State Karnataka16a. Location CHIKKAPURA POST

16f. Pincode 57752016b. Street ECHALANAGENAHALLI

16.h - 9880820477Mobile NoTelephone No.City16c. 16g.CHITRADURGA

16f. E-Mail taranginicomputers@gmail.com16d. District CHITRADURGA

Permanent Address

ECHALANAGENAHALLIStreet17a. CHITRADURGADistrict17d.

17e. State Karnataka17b. Location CHIKKAPURA POST

577520Pincode17.f 17.g Telephone No.CHITRADURGA17c. City -

NoneSpecial Group18

SSLC Details

KarnatakaSSLC Exam Board affiliated to19.

KannadaS.S.L.C Medium19a.

Languages studied at S.S.L.C

Language I19b. EnglishLanguage II19c.Kannada

625Maximum Marks 19d. Obtained Marks19e. 307

PUC Details

KarnatakaII PUC/Equv Exam Board affiliated to20a.

451881Registration Number of II PUC20b.

20d. PUC Medium Kannada20c. II PUC Year of Passing 2012

Languages studied at PUC

20f. Language II English20e. Language I Kannada

20h. Obtained Marks 43920g. Maximum Marks 600

Qualifying Examination details

YesHave you Studied Bachelor Degree21

Year Total Obtained MarksTotal Maximum Marks

I

Percentage

II

Elective Subjects Studied at Degree Level

EnglishOptional I21e.

Total

III

21k.

English

Languages studied at Degree Level

21l. Language II

Bachelor Degree Details

History

Sociology

21g. Optional II

KannadaLanguage I

Optional III21i.

21a. Passed all the 3 years in University Examinations Yes

DAVANAGERE UNIVERSITY21d. University Studied at Degree Level

Degree B.A21b.

IV

1000

1800

1000

Nil

645

629

Nil

1240

3800 2514

66.158

Other Degree NIL21c.

Other Optional I21f.

Other Optional II21h.

Other Optional III21j.

NIL

NIL

NIL

NoHave you Studied PG Degree21m.

Below 2.5 LakhsAnnual Income22.

11000Exact Income23.

NoPresently working in Govt. /Aided Institution24.

Institutions in the Order of Preference

Institution Type InstitutionPreference District

Chitradurga Government College College of Teacher Education1

Chitradurga Unaided College PVS College of Education2

Chitradurga Unaided College Smt. Hemavathi Kuvempu Women's3

Chitradurga Unaided College Sri Raghavendra College of Education4

Chitradurga Unaided College St. Mary's College of Education5

Chitradurga AidedCollege Sree Venkateshwara Colleg of Education6

Chitradurga Unaided College Bapuji College of Education(B.Ed.)7

Chitradurga Unaided College Sri. B.G.N.M Vividodesha Samsthe8

Declaration

I solemnly declare that the information provided in above pages of the coding sheet is true. In case any information is found to be false or incorrect, I shall forfeit the claim to be considered for selection.

Signature of the Applicant

04-Jan-2016 03:28:38 PMDate

103.231.218.158IP Address

:

: