Documentos de Académico
Documentos de Profesional
Documentos de Cultura
The application form duly completed in all respects in the given application form with duly signed
declaration should be sent to Director, Directorate of Distance Education, B.R.A. Bihar
University, Muzaffarpur-842001 only so as to reach on or before the due date notified in the
advertisement. No separate documents (enclosures) are to be attached with this application form.
(4cm x 5cm)
duly attested by
Gazette Officer
2. Medium Code
a) Hindi - H b) English - E
3. Name
Leave one box blank after First, Second and Surname
4. Name of Father/Mother/Husband
Strike out whether not applicable
b) Telephone No.
7. Sex Code
a) Male-M
b) Female-F
8. Category Code
a) General-1 b) BC-2
b) Divorce-2
d) Unmarried-
c) EBC-3
e) SC-5
d) WBC-4
f) ST-6
11. Nationality
12. State
13. Educational Qualifications: (Graduation and onwards)
Name of Degree
Year of Completion
Subjects
% of Marks
University
Nature of post
(temporary/permanent
with years)
Type of School
(Recognised/Unrecognised)
No. of
Years
EXPERIENCE CERTIFICATE
(PLEASE USE THIS FORMAT ONLY)
1. Name of the Teacher-student
: ...........
: ...........
3. Pay scale
: ...........
4. Salary
: ...........
5. Date of appointment
: ...........
6. Employer
: ...........
7. Date of Joining
: ...........
9. Subject of teaching
: ...........
: ...........
: ......... Board
The information given above is true to the best if my knowledge and belief.
Any discrepancy if any will be of my responsibility.
Principal
EMPLOYMENT CERTIFICATE
This is to certify that Mr./Ms./Mrs. ..
has been teaching in this school since as Postgraduate/Graduate/
Primary/Assistant Teacher teaching at Sr. Secondary/Secondary/Primary level and
he/she is a full time teacher of this school. He/she has ..... years of
teaching experience. This school is Govt. /Govt. aided/unaided and is duly
recognized by the Central or a State Government or a union territory.
Signature of Principal/Headmaster/Headmistress
Name:...
Designation:.....
Address:....
.....
(Seal/Stamp)
Place:
Date:.
DECLARATION BY APPLICANT
I hereby declare that I have read and understood the conditions or eligibility for
the B.Ed. programme for which I seek admission. I fulfill the minimum eligibility
criteria and I have provided necessary information in this regard in the applications
form. I shall provide proof of my eligibility alongwith the original certificates in the
event of qualifying for admission after Entrance Test. I have carefully gone through
the rules of the University as printed in the Prospectus and I undertake to abide by
the rules. In the event of any information being found incorrect or misleading at any
state or at any time my candidature shall be liable to be cancelled by the University
and I shall not claim for refund of fee paid by me to the University.
Date:
(Recognized by HRD, Govt. of Bihar, ERC, NCTE and DEC, New Delhi)
Enrollment No. :
Sir,
I have to request you to kindly admit and enroll me with Directorate of Distance Education as a student
of B.Ed. (Distance Mode) Programme (................) (Details are given below).
1. Name of the Candidate
: .......
(IN ENGLISH)
: .......
2. Name of the Candidate
(IN HINDI)
3. Fathers/Guardians Name : .......
4. Date of Birth
: .......
5. Permanent Address
: .......
6. Address for Correspondence : .......
7. Category
: .......
8. Sex (Male/Female)
: .......
: .......
9. Rural/Urban
10. Marital Status
: .......
11. Contact No.
: .......
12. Educational Qualifications: (Matriculation onwards):Name of Degree
Board/University
Year of
Subjects
Marks
% of
Completion
Obtained Marks
Matriculation
Intermediate
Graduation
Post-Graduation
13. Institution where studied last with Board/University:......
EDU
14. (i) Methodology Courses: EDU
EDU
(ii) Special Course:
15. Details of Teaching Experience:
Type of School
Post held
No. of
Name of the
Nature of Post
(Recognized )
(PGT/TGT/Primary
Years
School with
(Temporary/Perm
Teacher/Asst.
Teacher)
Address
anent with years)
p
h
o
t
o
g
r
a
p
h
(
4
c
m
x
5
c
m
)
d
u
l
y
a
t
t
e
s
t
e
d
b
y
Date:
Date
Amount
Assistant
Administrative Officer
Signature of DM/SDO/BDO/CO
Place:
Name: .
Date:
Seal/Stamp: .