guidelines for evaluation of application / proposals

Guidelines for Evaluation of Application / Proposals/ Nominations and selection for Shiksha Ratna/Vidhyarthi Khel Ratna/Vidharthi Kala Ratna Awards ................................................................................................................................. 1. The proposals/ Nominations for Shiksha Ratna, Vidhyarthi Khel Ratna and Vidhyarthi Kala Ratna Award will be received by the Nodal Officer (Director, Academic) in the Officer of Board of Secondary Education, Rajasthan, Ajmer before the last date and the time notified by the board. (Under normal circumstances the last date would be 14th August every year and the applications will be received by the Board Office up to 4:00 Pm. In case 14th August happens to be a holiday then next working day will be treated as last date. No application shall be accepted beyond stipulated time and date.) Note Please look for the notification for actual datelines. 2. The Nodal Officer will prepare a consolidated statement of all the application received, number them and will prepare a data base of names, affiliation, address, telephone numbers, e-mail, name of the forwarding authority etc. to be presented before the selection committee.

3. The nodal Officer will scrutinize all the proposals/nomination in respect of their completeness before placing them for consideration of the selection committee. Appropriate note will be attached for incomplete applications.

4. A preliminary meeting of the selection committee shall be arranged by the Nodal Officer in consultation with secretary, Board of Secondary Education, Ajmer and the Chairman of the committee constituted for this purpose.

5. The proposals/ Nominations received will be examined by the selection committee and if necessary, the information provided by the applicants shall be verified by any suitable mechanism to be determined by the Chairman of the Committee.

6. Incomplete proposals or unsuitable nominations/proposals shall be rejected by the committee giving reasons. The acceptable/suitable proposals will then be presented in the next meeting after necessary verification process is completed by the office.

7. Second and final meeting shall be preferably held at least one month before the declaration of the award of consultation with the secretary, Board of Secondary Education, Rajasthan, Ajmer and the Chairman of the committee.

8. The names of the persons recommended for Shiksha Ratna / Vidyarthi Khel Ratna/ Vidyarthi Kala Ratna Awards will be kept in a sealed envelope and handed over to Chairman. Board of Secondary Education. Rajasthan, Ajmer. All the proceeding of the meeting for the award and rejection of incomplete applications shall be kept confidential.

9. The Chairman, Board of secondary Education, Rajasthan, Ajmer will announce all the three awards. The announcement shall be appropriately notified and published in news media.

10. The secretary, Board of Secondary Education, Rajasthan, Ajmer will inform the awardees about the decision of the committee along with the programme of the award ceremony, details of the entitlement of the travel support, accommodation arrangements etc. much in advance by registered post and / or any other suitable mode to ensure its delivery in time.

11. To complete the quorum, the presence of at least Five members including Chairman, Nominated Member of the Board, one professor and one school teacher shall be necessary. In case of division of votes the Chairman will have the final voting right. Secretary will not have any voting right.

12. The constitution of the selection committee will be as under:

(A). SHIKSHA RATNA AWARD

(i). Chairman of the selection committee will be Ex-Vice-Chancellor of any of the state

funded Universities in Rajasthan having no conflict of interest or Ex. Chairman, BSER, Ajmer. (ii). Two senior professors of relevant field of any State Universities to be nominated by Chairman, Board of Secondary Education, Ajmer (iii). One member of the Board of Management, BSE, Ajmer to be nominated by Chairman, Board of Secondary Education, Ajmer (iv). Two School Teachers in the relevant field to be nominated by Chairman, BSER, Ajmer (v). One school administration to be nominated by the Chairman, BSER, Ajmer (vi). Secretary of the Board will act as Co-ordinator (B). VIDHYARTHI KHEL RATNA AWARD (i). Chairman of the selection committee will be Ex-Vice Chancellor of any of the state funded Universities in Rajasthan having no conflict of interest or Ex. Chairman, BSER, Ajmer (ii). Two senior professors preferably of relevant field of any State Universities to be nominated by Chairman, Board of Secondary Education, Ajmer (iii). One member of the Board of Management, BSE, Ajmer to be nominated by Chairman, Board of Secondary Education, Ajmer (iv). Two School Teachers in the relevant field (Games and Sports) to be nominated by Chairman, BSER, Ajmer (v). One School administrator to be nominated by the Chairman, BSER, Ajmer (vi). Secretary of the Board will act as Co-ordinator (C) VIDHYARTHI KALA RATNA AWARD (i). Chairman of the selection committee will be Ex-Vice Chancellor of any of the State funded Universities in Rajasthan having no conflict of interest or Ex. Chairman, BSER, Ajmer (ii). Two senior professors preferably of relevant field of any State Universities to be nominated by Chairman, Board of Secondary Education, Ajmer (iii). One member of the Board of management, BSE, Ajmer to be nominated by Chairman, Board of Secondary Education, Ajmer (iv). Two School Teachers in the relevant field (any branch of Art) to be nominated by Chairman, BSER, Ajmer (v). One School administrator to be nominated by the Chairman, BSER, Ajmer (vi). Secretary, of the Board will act as Co-ordinator Note: The Chairman, nominated Member of the Board and Secretary for all the awards will be common for all the selections. However, Board may like to nominate different persons in different categories depending upon the nature of award and the specialization of the experts to be nominated.

SELECTION CRITERIA

The selection committee while scrutinizing the application/proposals/ nominations will take in to consideration the following : (A) SHIKSHA RATNA AWARD The teaching performance as determined by the results of last five years preferably in mainstream teaching subject and the potential to perform even better in the future will remain the major criterion while considering the applicant for award.

(B) School teacher holding the administrative positions in Various capacities will also be eligible to apply for this award. However, there tenure on such administrative position shall not be considered for there assessment. While counting five years' performance, only those years of teaching will be considered excluding the period spent by him/her on administrative position. Moreover, the other conditions of eligibility will remain the same

The other criteria to be considered are as under :

1. Statesmanship 2. Patriotism

3. Inculcation of culture value 4. Upliftment of poor

5. Promotion of girl education 6. Student support

7. Community service 8. Improvement of environmental quality

9. Demonstration of leadership quality 10. Administrative acumen

11. Perpetuation of ethical and moral values 12. Discipline

13. Commitment to profession 14. Creativity

15. Innovation

To maintain the transparency of the process of selection for the award following weigtage scale is provided for consideration by the selection committee.

Note : The scale provided is only indicative. The selection committee may consider any other parameter of performance in deserving cases

(B) VIDHYARTHI KHEL RATNA AWARD

The Student to be selected for this award shall have demonstrated excellent performance in any branch of games, sports and athletics as determined by his/her representation in the state/national or equivalent activities during last two years of school education.

To maintain the transparency of the process of selection for the award following weightage scale is provided for consideration by the selection committee.

Performance Parameter Per cent weightage

Teaching performance to be determined by the student results 50

Nations Building 5

Inculcation of culture and Ethical Values 5

Commitment to profession 5

Environmental quality improvement 5

Promotion of Girl Education 5

Community Service 5

Poverty Alleviation 5

Academic Publication 5

Innovation in teaching 5

Training and Progression 5

Total 100

Note : The scale provided is only indicative. The selection committee may consider any other parameter of performance in deserving cases. (C) Addendum to evaluation guidelines for khel Ratna Award.

(i) In the recommedation of " Khel Ratna Award" the performance of players in team events should be considered with the following scores.

level National State

Gold 40 20

Silver 30 15

Bronze 20 10

Participation 10 05

Team Captain 5 5

Best Players/

Man of the match 5 5

Man of the tournament 5 5

(ii) For outstanding players participating at the international level, requirement of continuous Two Years' performance can be waived-of and he/she can be assessed on only year's performance. The scores will be awarded as per the following criteria :

(A) Solo Event

level World Asia State Gold 240 200 160 Silver 180 150 120 Bronze 120 100 80 Participation 100 90 80 (B) Team Event

Gold 120 100 80 Silver 90 75 60 Bronze 60 50 40 Participation 50 45 40

Captain 15 15 15

Best Players/ Man of the match 15 15 15 Best of the tournament 15 15 15

Parameters of Evaluation Per cent weightage

Performance Excellence as determined by the demonstration of performance in games, sports and athletics to be determined by the performance/ result of last 2 years at national and above level

As given below 75

Gold 30

Silver 20

Bronze 15

Participation 10

Generation of Cultural, Ethical and Moral Values through games and sports

15

Any other personal achievement not covered above.

10

Total 100

(C) VIDHYARTHI KALA RATNA AWARD

The Student to be selected for this award shall have demonstrated excellent performance in any branch of arts such as Dance/Drama/Theatre/Music-Vocal and instrumental/Folk art/ sculpture/ painting and drawing etc. during last 2 years of school education.

To maintain the transparency of the process of selection for the award following weightage scale is provided for consideration by the selection committee.

Note : The scale provided is only indicative. The selection committee may consider any other parameter of performance in deserving cases.

Parameters of Evaluation Per cent weightage

Performance Excellence as determined by the demonstration of performance in any branch of art to be determined by performance /results of last 2 years

60

Generation of Culture, Ethical and Moral Values through art 10

Community Service and Volunteer ship 10

Demonstration of creativity, innovation 10

Any other personal achievement not covered above. 10

Total 100

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2- नोडऱ अधधकारी सभी प्राप्त आवेदनों का समेककत वववरण तयैार कर उन्हें क्रमाॊक देdj नाम, सम्बद्धता, ऩता, दरूभाष

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3- नोडऱ अधधकारी सभी प्रस्तावों नामाॊकनों का चयन सममतत के समऺ रखने से ऩहऱे उनकी ऩणूणता की जाॉच करेगाA viw.kZ

आवेदनों के मऱए उधचत दटप्ऩणी layXu की जाएगीA

4- सधचव माध्यममक मिऺा बोडण अजमेर और इस कायण हेत ुबनायी सममतत के अध्यऺ के ऩरामिण से नोडऱ vf/kकारी चयन

सममतत की एक प्रारॊमभक बठैक की व्यवस्था करेगाA

5- प्राप्त प्रस्तावों@नामाॊकनों काs चयन सममतत के द्वारा जाॉचा जाएगा और आवश्यकता ऩM+ने ऩर आवेदक द्वारा दी गई

जानकारी को सममतत के अध्यऺ द्वारा तनधाणररत ककसी उऩयकु्त ववधध द्वारा सत्यावऩत ककया जाएगाA

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कम से कम एक महीने ऩहऱ ेरखी जाएगीA

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का;Zवाgh को गोऩनीय रखा जाएगाA

9- अध्यऺ माध्यममक मिऺा बोडण, अजमेर तीनों ऩरुस्कारों की घोषणा करेंगAे घोषणा समधुचत रूऩ से अधधसधूचत की जाएगी समाचार माध्यमों में प्रकामित की जाएगीA

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12-चयन सममतत का गठन तनम्न प्रकार होगा:- (अ) मिऺा रत्न ऩुरस्कार

(1) चयन सममतत का अध्यऺ राजस्थान राज्य द्वारा ववत्तीय सहायता प्राप्त ककसी भी ववश्वववद्याऱय का भतूऩवूण कुऱऩतत जजसका तनणणय व्यजक्तगत स्वाथों से प्रभाववत न हो या माध्यममक मिऺा बोडण, अजमेर का भतूऩवूण अध्यऺ

होगाA

(2) अध्यऺ माध्यममक मिऺा बोडण, अजमेर द्वारा मनोनीत ककसी भी राज्य के ववश्वववद्याऱय के दो वररष्ठ प्रोफेसरA

(3) अध्यऺ द्वारा मनोनीत माध्यममक मिऺा बोडण, अजमेर के प्रबॊधन बोडण का एक सदस्यA

(4) अध्यऺ माध्यममक मिऺा बोडण, अजमेर द्वारा मनोनीत दो ववद्याऱयी मिऺकA

(5) अध्यऺ माध्यममक मिऺा बोडण, अजमेर दारा मनोनीत एक ववद्याऱय प्रिासकA

(6) बोडण का सधचव इस सममतत का समन्वयक होगाA

(ब) ववद्याथी खेऱ रत्न ऩुरस्कार

(1) चयन सममतत का अध्यऺ राजस्थान राज्य द्वारा ववत्तीय सहायता प्राप्त ककसी भी ववश्वववद्याऱय का भतूऩवूण कुऱऩतत, जजसका तनणणय व्यजक्तगत स्वाथों से प्रभाववत न हो या माध्यममक मिऺा बोडण, अजमेर का भतूऩवूण

अध्यऺ होगाA

(2) अध्यऺ माध्यममक मिऺा बोडण, द्वारा मनोनीत ककसी भी राज्य के ववश्वववद्याऱय के दो वररष्ठ प्रोफेसर जो

यथा सॊभव सॊबॊधधत ऺेत्र के होaA (3) अध्यऺ द्वारा मनोनीत माध्यममक मिऺा बोडण, अजमेर के प्रबॊधन बोडण का एक सदस्यA

(4) अध्यऺ माध्यममक मिऺा बोडण, अजमेर द्वारा मनोनीत दो ववद्याऱयी मिऺक जो सॊबॊधधत ऺेत्र (खेऱकूद) के होaA

(5) अध्यऺ माध्यममक मिऺा बोडण, अजमेर दारा मनोनीत एक ववद्याऱय प्रिासकA


(स) ववद्याथी कऱा रत्न ऩुरस्कार (1) चयन सममतत का अध्यऺ राजस्थान राज्य द्वारा ववत्तीय सहायता प्राप्त ककसी भी ववश्वववद्याऱय का भतूऩवूण कुऱऩतत जजसका तनणणय व्यजक्तगत स्वाथों से प्रभाववत न हो या माध्यममक मिऺा बोडण, अजमेर का भतूऩवूण

अध्यऺ होगाA

(2) अध्यऺ माध्यममक मिऺा बोडण, द्वारा मनोनीत ककसी भी राज्य के ववश्वववद्याऱय के दो वररष्ठ प्रोफेसर जो

यथासॊभव सॊबॊधधत ऺेत्र के होA (3) अध्यऺ द्वारा मनोनीत माध्यममक मिऺा बोडण, अजमेर के प्रबॊधन बोडण का एक सदस्यA

(4) अध्यऺ माध्यममक मिऺा बोडण, अजमेर द्वारा मनोनीत दो ववद्याऱयी मिऺक जो सॊबॊधधत ऺेत्र ¼कऱा की कोई भी वव/kk½ के होaA (5) अध्यऺ माध्यममक मिऺा बोडण, अजमेर दारा मनोनीत एक ववद्याऱय प्रिासकA


नोट:- सारे ऩरुस्कारों के चयन हेतु अध्यऺ, बोडण का मनोनीत सदस्य और सधचव एक ही होंगे, हाऱाॉकक मनोनीत ककए जाने वाऱे

वविषेऻों की वविषेऻताऔर ऩरुस्कार की प्रकृतत के अनसुार बोडण मभन्न शे्रणी के मभन्न व्यजक्तयों को भी मनोनीत कर सकता हैA

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[ksydwn vkSj ,FkysfVDl esa fiNys nks o"kksZa ds

izn'kZu ds vk/kkj ij mRd`"V izn'kZu dk ewY;kadu

fuEukuqlkj 75

Lo.kZ ind 30

jtr ind 20

dk¡L; ind 15

dsoy Hkkxhnkjh 10

[ksydwn ds ek/;e ls lkaLd`frd vkSj uSfrd ewY;ksa

dk izlkj djuk

15

vU; dksbZ O;fDrxr miyfC/k ftldk mYys[k

Åij ugha fd;k x;k gksA

10

dqy 100


fopkj dj ldrh gSA

¼l½ fo|kFkhZ dyk jRu iqjLdkj

bl iqjLdkj ds fy, p;fur gksus okys Nk= dks dyk dh fdlh Hkh fo/kk tSls

u`R;@ukVd@fFk,Vj@Loj vkSj ok| laxhr@yksd dyk@ewfrZ@fp= vkSj fp=dkjh vkfn esa

fo|ky;h f'k{kk ds fiNys nks o"kksZa esa mRd`"V izn'kZu n'kkZuk gksxkA


egRoiw.kZ ekud fn;s x, gSaA


dyk dh fdlh Hkh fo|k esa fiNys nks o"kksZa ds ifj.kkeksa ds

vk/kkj ij mRd`"V izn'kZu

60

dyk ds }kjk lkaLd`frd o uSfrd ewY;ksa dk izlkj 10

lekt lsok vkSj Lo;alsod ds :i esa lsok 10

uokpkj vkSj jpukRedrk dk izn'kZu 10

vU; dksbZ O;fDrxr miyfC/k ftldk mYys[k Åij ugha

fd;k x;k gks

10

dqy 100


fopkj dj ldrh gSA

Board of Secondary Education, Rajasthan, Ajmer

YEAR - 20____- 20____ 1. Name in Full (Block letters) Mr./Miss/Mrs. _________________________________

(In Hindi) ____________________________________________________________

2. Father's Name (Block letters) ___________________________________________

(In Hindi) ____________________________________________________________

3. Permanent Residential Address ____________________________________________________

______________________________________________________________________________

Tel. No. __________________Mob. No. ___________________ E-mail ____________________

4. Present Address (if diffrent from permanent address___________________________________

______________________________________________________________________________

Tel. No. _____________________ Mob. No. __________________ E-mail __________________

5. Current Affiliation_______________________________________________________________

______________________________________________________________________________

6. Date of Birth and age on 14th August of the current year ________________________________

7. Name and Address of School/Organization/Institution __________________________________

______________________________________________________________________________

8. (A.) Educational Qualifications

Class Board/University Year Major Subjects Div. Percentage Distinction

Secondary

Sr. Secondary

Graduation

Post

Graduation

Doctorate

Other

(B) In the declaration following shall be added- further, I declare that the school in Which I have been working

for last ten years ( period of assessment) in a school is affiliated to RBSE, Ajmer. I am not recipient of any

Central of State Government award instituted for the teacher.

9. Results of Last Five Years

Division Year_______

Year________

Year_______

Year_______

Year_______

Secondary I II III I II III I II III I II III I II III

Sr. Secondary

Application Proforma for Shiksha Ratna Award

Affix recent passport size photograph

duly signed

Mention percentage of students securing I, II and III division.

10. Contributions in the following areas:(Choose applicable areas & Attach supporting documents)

Paremeters YES/NO Parameters YES/NO

1. Statesmanship 9. Demonstration of leadership qualities

2. Patriotism 10. Administrative acumen

3. Inculcation of cultural value 11. Perpetuation of ethical and moral values

4. Upliftment of poor 12. Discipline

5. Promotion of girl education 13. Commitment to profession

6. Student support 14. Creativity

7. Community service 15. Innovation

8. Improvement of environmental quality

11. Special Achievements of students such as Merit/Awards be mentioned here :-

______________________________________________________________________________

______________________________________________________________________________

12. Previous Awards received, if any

______________________________________________________________________________

______________________________________________________________________________

13. Personal Statement in maximum 200 words (Attach separate sheet)

14. Reference (give Name, Address & Contact details):

Declaration

I here by, declare that the particulars and information given above are correct and true to the best of my

knowledge.

Date : ____/____/20____ Signature of Applicant

______________________________________________________________________________

Certificate/Nomination (Optional)

This is to certify that Mr./Miss/Mrs._________________________________ is current working as

__________________ in _________________at ________________. I have satisfied myself about the

particulars submitted by the applicant for Shiksha Ratan Award. I recommend his/her application for

consideration of the award.

Signature with Name & Official Seal

ek/;fed f'k{kk cksMZ] jktLFkku] vtesj

o"kZ & 20-------& 20----------

1. iwjk uke Jh@Jherh@lqJh ---------------------------------------------------------------------------------------------------------------------------------

(vaxzsth es) -----------------------------------------------------------------------------------------------------------------------------------------------------------------

2. firk dk uke -------------------------------------------------------------------------------------------------------------------------------------------------------------

(vaxzsth es) --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

3. LFkk;h fuokl irk ---------------------------------------------------------------------------------------------------------------------------------------------------

VsyhQksu ua------------------------------------------------eksckbZy ua------------------------------------------------bZ&esy----------------------------------

4. orZeku irk (;fn LFkk;h irs ls fHkUu gks) ---------------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------------------------------------------------------------------


5. tUefrfFk ,oa vk;q ¼pkyw o"kZ ds 14 vxLr dks½ -------------------------------------------------------------------------------------------

6. Ldwy@laxBu@laLFkk dk uke ,oa irk -------------------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------------------------------------------------------------------

7. Ldwy@laxBu@laLFkk dh lEc)rk ------------------------------------------------------------------------------------------------------------------

8. ¼v½ 'kS{kf.kd ;ksX;rk

d{kk cksMZ vFkok

fo'ofo|ky;

o"kZ eq[; fo"k; Js.kh izfr'kr fo'ks"k

miyCf/k

lSd.Mªh

lh- lSd.Mªh

Lukrd

LukrdksÙkj

fo|k

okpLifr

vU;

¼c½ ?kks"k.kk i= esa ;g mYys[k fd;k tk;s dh izkFkhZ us fiNys 10 o"kZ ,sls fo|ky;esa dk;Z fd;k gs tks ek/;fed f'k{kk cksMZ]

jktLFkku] vtesj ls lEc)rk izkIr gS rFkk mlus fdlh Hkh dsUnzh; ;k jkT; iqjLdkj gsrq ukafer ugha fd;k x;k gS@ ugha izkIr

fd;k gSA

9. xr~ ikap o"kksZa dk ifj.kke

Js.kh o"kZ_______ o"kZ_______ o"kZ_______ o"kZ_______ o"kZ_______

lSd.Mªh I II III I II III I II III I II III I II III lh- lSd.Mªh

fo|kfFkZ;ksa }kjk vftZr izFke] f}rh; o rr̀h; Js.kh dh izfr'kr dk mYys[k djsaA

;gka uwru

ikliksVZ lkbZt

dkQksVks fpidk

dj gLrk{kj

djsaA

f'k{kk jRu ds fy, vkosnu izi=

10. fuEu Js=ksa esa ;ksxnku ¼mi;qDr {ks= dk p;u dj vko';d nLrkost layXu djsa½

ekin.M gk¡@ugha ekin.M gk¡@ugha

1- jk"Vªokfnrk 9- usr`Ro xq.kksa dk izn'kZu

2- ns'kHkfDr 10- iz'kklfud dkS'ky

3- lkaLd`frd ewY;ksa dh f'k{kk 11- uSfrd vkSj lnkpj.k ewY;ksa dk

izlkj

4- xjhcksa dk mRFkku 12- vuq'kklu

5- ckfydk f'k{kk izksRlkgu 13- dk;Z izfrc)rk

6- fo|kFkhZ lgk;rk 14- l`tu'khyrk

7- lekt lsok 15- uokpkj

8- i;kZoj.k xq.koÙkk lq/kkj

11. fo|kfFkZ;ksa }kjk izkIr iqjLdkj vFkok esfjV tSlh fo'ks"k miyfC/k;ksa dk mYys[k ;gka djsaA

----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------

12. iwoZ esa izkIr iqjLdkj] ;fn gks rks

--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------

13. futh oDrO; vf/kdre 200 'kCnksa esa (vyx ls i= layXu djsa)

14. lanHkZ (uke] irk ,oa lEidZ fooj.k nsosa)

?kks"k.kk

eSa ,rn~ }kjk ?kks"k.kk djrk@djrh gw¡ fd Åij fn;k x;k C;kSjk ,oa tkudkjh esjs vfHkKku vuqlkj lgh ,oa

lR; gSA

fnukad : ____/____/20____ vkosnd ds gLrk{kj

________________________________________________________________________

izek.k i=@ukekadu (oSdfYid)

;g izekf.kr fd;k tkrk gS fd Jh@lqJh@Jherh--------------------------------------------------------------------------orZeku esa -------

--------------------------------in ij----------------------------------------------------------------------------------------------------------------

¼laLFkk dk uke½ ¼LFkku½

esa dk;Zjr gSA

eSaus vkosnd }kjk f'k{kk jRu ds fy;s fn;s x;s C;kSjs ls vius vkidks larq"V dj fy;k gSA eSa iqjLdkj

ds fy;s fd;s x;s vkosnu ijfopkj ds fy;s viuh vuq'ka"kk djrk@djrh gw¡A

¼uke lfgr gLrk{kj ,oa vkf/kdkfjd lhy½

Board of Secondary Education, Rajasthan, Ajmer

YEAR - 20____- 20____ 1. Name in Full (Block letters) Mr./Miss/Mrs. _________________________________

(In Hindi) ____________________________________________________________

2. Father's Name (Block letters) ____________________________________________

(In Hindi) ____________________________________________________________

3. Permanent Residential Address ____________________________________________________

______________________________________________________________________________

Tel. No. __________________Mob. No. _______________________ E-mail ________________

4. Present Address (if diffrent from permanent address___________________________________

______________________________________________________________________________

Tel. No. _____________________ Mob. No. _______________________ E-mail _____________

5. Date of Birth and age on 14th August of the current year _________________________________

6. Name and Address of School/Organization/Institution __________________________________

______________________________________________________________________________

7. (A) Educational Qualifications

Class Board/University Year Major Subjects Div. Percentage Distinction

Secondary

Sr. Secondary

Other

(B) Mention the sport/Game in which the applicant wishes to be considered ( Only one sport/Game)

8. Results of Last Five Years

Year Achievements Position

National

Level

State Level

District Level

Application Proforma for Vidhyarthi Khel Ratna Award

Affix recent passport size photograph

duly signed

9. Other Achievements :-

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

10. Previous Awards received, if any

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

11. Personal Statement in maximum 200 words (Attach separate sheet)

12. Reference (give Name, Address & Contact details):

Declaration

I here by, declare that the particulars and information given above are correct and true to the best of my

knowledge.

Date : ____/____/20____ Signature of Applicant

______________________________________________________________________________

Certificate/Nomination (Mandatory)

This is to certify that Mr./Miss/Mrs._________________________________ is currently studying in

class __________________ in _________________________________________at ________________ I have

satisfied myself about the particulars submitted by the applicant for Vidhyarthi Khel Ratan Award. I

recommend his/her application for consideration of the award.

Signature with Name & Official Seal

ek/;fed f'k{kk cksMZ] jktLFkku] vtesj

o"kZ & 20-------& 20----------

1. iwjk uke Jh@Jherh@lqJh ---------------------------------------------------------------------------------------------------------------------------------

(vaxzsth es) -----------------------------------------------------------------------------------------------------------------------------------------------------------------

2. firk dk uke ------------------------------------------------------------------------------------------------------------------------------------------------------------

(vaxzsth es) ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

3. LFkk;h fuokl irk ---------------------------------------------------------------------------------------------------------------------------------------------------


4. orZeku irk (;fn LFkk;h irs ls fHkUu gks) ---------------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------------------------------------------------------------------


5. tUefrfFk ,oa vk;q ¼pkyw o"kZ ds 14 vxLr dks½ -------------------------------------------------------------------------------------------

6. Ldwy@laxBu@laLFkk dk uke ,oa irk -------------------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------------------------------------------------------------------

7. ¼v½ 'kS{kf.kd ;ksX;rk

d{kk cksMZ vFkok

fo'ofo|ky;

o"kZ eq[; fo"k; Js.kh izfr'kr fo'ks"k

miyCf/k

lSd.Mªh

lh- lSd.Mªh

vU;

¼c½ vkosnd ftl LiksVZl@xsEl esa vkosnu dj jgk gS@jgh gS mldk uke vafdr djsa ¼dsoy ,d LiksVZl@xsEl ½

8. miyfC/k dk fooj.k ¼vko';d gks rks vyx i= layXu djsa½

o"kZ miyfC/k;ka LFkku

jk"Vªh; Lrj

jkT; Lrj

ftyk Lrj

;gka uwru

ikliksVZ lkbZt

dk QksVks fpidk

dj gLrk{kj djsaA

fo|kFkhZ [ksy jRu ds fy, vkosnu izi=

9. vU; miyfC/k;ka

----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------

10. iwoZ esa izkIr iqjLdkj] ;fn gks rks

----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------

11. futh oDrO; vf/kdre 200 'kCnksa esa (vyx ls i= layXu djsa)

12. lanHkZ (uke] irk ,oa lEidZ fooj.k nsosa)

?kks"k.kk

eSa ,rn~ }kjk ?kks"k.kk djrk@djrh gw¡ fd Åij fn;k x;k C;kSjk ,oa tkudkjh esjs vfHkKku vuqlkj lgh ,oa

lR; gSA

fnukad : ____/____/20____ vkosnd ds gLrk{kj

________________________________________________________________________

izek.k i=@ukekadu (vfuok;Z)

;g izekf.kr fd;k tkrk gS fd Jh@lqJh@Jherh--------------------------------------------------------------------------orZeku esa -------

------------------------------------------------------------------------------------------------------------------------------------------------------------

¼laLFkk dk uke½ ¼LFkku uke½

esa v/;;ujr gSA

eSaus vkosnd }kjk fo|kFkhZ [ksy jRu ds fy;s fn;s x;s C;kSjs ls vius vkidks larq"V dj fy;k gSA eSa

iqjLdkj ds fy;s fd;s x;s vkosnu ij fopkj ds fy;s viuh vuq'ka"kk djrk@djrh gw¡A

¼uke lfgr gLrk{kj ,oa vkf/kdkfjd lhy½

guidelines for evaluation of application / proposals

Documents