State Council of Educational

Research & Training, Chhattisgarh

Shankar Nagar, Raipur
0771-2443596 Fax-0771-2443496

jkT; 'kSf{kd vuqla/kku vkSj

izfk{k.k ifj"kn~] Nkhlx<+]
'kadj uxj] jk;iqj

Website: www.scert.cg.gov.in Email: scertcg@gmail.com

jkT; Lrjh; jk"Vh; izfrHkk [kkst ijh{kk (NTSE)d{kk 10oha esa v/;;ujr~
jk"Vh; lk/ku lg izkoh.; Nk=o`fk ijh{kk (NMMSE) d{kk 8oha esa v/;;ujr~

l= 2015& 2016
ijh{kk lacaf/kr fu;e o 'krasZ foKfIr
foKfIr
foKfIr
vkosnu i= v/;;ujr~ fo|ky; esa tek djus dh vafre frfFk % 25 vxLr 2015
2015
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

NRrhlx<+ jkT; esa l= 2015&16 ds fy, 1-jkT; Lrjh;&jk"Vh; izfrHkk [kkst ijh{kk NTSE

2- jk"Vh; lk/ku lg&izkoh.; Nk=o`fRr ijh{kk NMMSE] jkT; kSf{kd vuqla/kku vkSj izfk{k.k ifj"kn~] 'kadj uxj]
jk;iqj] NRrhlx<+] }kjk fnukad 08 uoEcj 2015]fnu jfookj dks vk;ksftr dh tkosxhA
1- jkT; Lrjh;&jk"Vh; izfrHkk [kkst ijh{kk NTSE esa p;fur izfrHkkfx;ksa ds f}rh; Lrj dh ijh{kk
NCERT ubZ fnYyh }kjk yh tkosxhA f}rh; Lrj ijh{kk esa p;fur fo|kfFkZ;ksa dks MHRD@NCERT ubZ fnYyh }kjk
d{kk 11oha ,oa 12oha esa #-1250/- izfr ekg] xzstq,V ,oa iksLV xzstq,V esa #-2000/- izfr ekg ,oa ih,p-Mh esa ;wthlh
ukWeZl ds vuqlkj Nk=o`fk iznku dh tkrh gSA
A

ik=rk &l=
2015&16 ds d{kk 10oha esa v/;;ujr~ os lHkh fo|kFkhZ Hkkx ys ldrs gS tks NRrhlx< jkT; esas dsUnz
&
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2- jk"Vh; lk/ku lg&izkoh.; Nk=o`fRr ijh{kk NMMSE esa p;fur fo|kfFkZ;ksa dks
fu;eksa ds rgr d{kk 12 oha rd Nk=o`fRr iznku dh tkrh gSA

MHRD

ubZ fnYyh ds

ik=rk &l=
& 2015&16 ds d{kk 8oha esav/;;ujr~ os fo|kFkhZ Hkkx ys ldrs gS tks &
fo|kFkhZ ds firk@ikyd dh okf"kZd vk; dqy : 1-5 yk[k ,d yk[k ipkl gtkj ls vf/kd u gksA
NRrhlx<+ 'kklu }kjk lapkfyrkkldh; State Government ;k vkkldh; vuqnku izkIr PrivateAided
;k uxj fuxe@uxj ikfydk fo|ky; esa v/;;ujr~ gksaA
dsUnz 'kklu Central Govt. }kjk lapkfyr fo|ky; ;k vkkldh; vuqnku izkIr ;k xSjvuqnku izkIr Private
Unaided fo|ky; esa v/;;ujr~ fo|kFkhZ NMMSE ijh{kk esa Hkkx ugha ys ldrsA
B vkosnu i= ,oa izosk i= dk izk#i & 11- vkosnu i= ,oa izosk i= NTSE@NMMSE2015&16 dk izk#i
SCERTNkhlx<+ dh osclkbV www.scert.cg.gov.inls MkmuyksM dh tk ldrh gS ftls leLr ftyk fk{kk
vf/kdkjh] lgk vk;qDr v-tk-d- fodkl foHkkx] ftyk fk{kk ,oa izfk{k.k laLFkku DIET] layXu ijh{kk dsUnzkas esas
Hkstk tk pqdk gSA bldk PHOTO COPYdk mi;ksx fd;k tk ldrk gSA
C vkosnu ,oa izosk i= fo|ky; esa tek djus dh vafre frfFk 25 vxLr 2015 % ijh{kkFkhZ iw.kZ Hkjs gq,
vkosnu i= lg izek.k i=ksa ,oa izosk i= vius v/;;ujr~ fo|ky; ds izkpk;Z@iz/kkuk/;kid ds ikl fnukad 25
vxLr 2015 rd tek djsaA vko;d izek.k i= & 1- NTSEgsrq d{kk 9 oha mRrh.kZ vad lwph] rglhynkj }kjk
tkjh tkfr izek.k i=] ftyk fpfdRLkk cksMZ }kjk tkjh fodykaxrk fu%'kDrrk izek.k i=
2- NMMSEgsrq d{kk 7
oha mRrh.kZ vad lwph] rglhynkj l{ke vf/kdkjh}kjktkjh tkfr ,oa vk; izek.k i=] ftyk fpfdRLkk cksMZ }kjk
tkjh fodykaxrk fu%'kDrrk izek.k i=A
D ijh{kk izosk i= &ijh{kkFkhZ
dks izosk i= muds ftys ds fy, fu/kkZfjr ijh{kk dsUnz ds dsUnzk/;{k }kjk fn;k
&
tk,xkA fo|ky; ds izkpk;Z@iz/kkuk/;kid fu/kkZfjr ijh{kk dsUnz ds dsUnzk/;{k ls ijh{kkfFkZ;ksas ds izos k i= izkIr dj
lacaf/kr ijh{kkFkhZ dks iznku djsaxsA

ukfeuy jksy] vkosnu i= ,oa izosk i= ijh{kk dsUnz

nz esa tek djus dh vafre frfFk 05flrEcj 2015 %

fo|ky; ds laLFkk izeq[k izkIr vkosnu i= ,oa izek.k&i= dks izekf.kr djsaA NTSE ,oa NMMSE ds fy,
i`Fkd&i`FkdlayXu&ukfeuy jksy izk#i esa pkgh xbZ tkudkfj;k Hkj dj vkosnu i= lg izek.k i= ,oa izosk i= ds
lkFk lacaf/kr ijh{kk dsUnz ds dsUnzk/;{k ds ikl 05 flrEcj 2015 rd tek djsaA foyEc dh fLFkfr esa izfrHkkxh ;fn
mDr ijh{kk ls oafpr gksrk gS rks lacaf/kr laLFkk izeq[k ftEesnkj gksaxsA
F

dsUnzk/;{k }kjk ,dhd`r ukfeuy jksy

Gizu i= &NTSErFkk

NMMSE

SCERT,Raipurdks

tek djus dh vafre frfFk 15flrEcj 2015

nksuksa ijh{kkvksa ds fy, nks&nks izu i= gksaxsA

izu&i= %iz
%izFke
Hkkx I -ckSf)d ;ksX;rk ijh{k.k (MAT)Hkkx
LCT) %Hkk"kk fgUnh ;k Hkk"kk vaxszth

NTSE
NMMSE

ckSf)d ;ksX;rk ijh{k.k

II -Hkk"kk

NTSE,oa
NMMSE

vad

le;

50

50

izkr% 10-00

50

50

ls

100

100

11-30 rd

dqy izu

vad

le;

cks/k ijh{k.k

(MAT)

izu&i= % f}rh;
'kSf{kd ;ksX;rk ijh{k.k

dqy izu

& xf.kr
& foKku HkkSfrd] jlk;u] tho foKku

20

20

nksigj
12-30

40

40

ls

& lkekftd foKku bfrgkl] Hkwxksy] ukxfjd kkL=] vFkZ 'kkL=

40

40

2-00 rd

(SAT)

ijh{kk kqYd & bu ijh{kkvksa ds fy, fdlh Hkh izdkj dk kqYd ugha gSA

ijh{kk dk ek/;e &fgUnh

vFkok vaxzsthA
&

ijh{kk dsUnz dk uke o dsUnz dk dksM uEcj

dsUnz dk uke
izks- ts-,u-ik.Ms 'kk-cgq-m-ek-fo-] jk;iqj
ts- vkj-nkuh 'kk-dU;k m-ek-fo-] jk;iqj
I;kjsyky ;kno 'kk- fgUnq m-ek-fo-] jk;iqj
ek-lq-'kk-dU;k-m-ek-fo-]pkScs dkyksuh] jk;iqj
ih-th-mekBs 'kk-dU;k-m-ek-fo-]'kkafruxj] jk;iqj
ts-vkj-uk;Mw 'kk-m-ek-fo-] jfoxzke] jk;iqj
'kk-mPp-ek?;-fo|ky;-] egkleqUn
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fko flag oekZ 'kk-dU;k m-ek-fo-] /kerjh
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ekWMy bafXy'k mPp-ek/;-fo|ky;] /kerjh
loksZn; mPp-ek/;-fo|ky;-] /kerjh

NTSE-NMMSE ds

dksM
0101
0102
0103
0104
0105
0106
0201
0301
0302
0303
0304
0305
0306
0307

fy, ftysokj dqy 72 dsUnz

dsUnz dk uke
'kk- mPp-ek/;-fo|ky;] nUrsokM+k
'kk-cgq-mPp-ek/;-fo|ky;] txnyiqj
'kk-cgq- mPp-ek/;-fo|ky;] fcykliqj
,e-,y-ch 'kk-cgq-dU;k m-ek-fo-] fcykliqj
'kk-cgq mPp-ek/;-fo|ky;] is.Mk] fcykliqj
'kk-cgq-mPp-ek/;-fo|k-] ekad&2] tkWtxhj
'kk- mPp-ek/;-fo|ky;] dksjck
'kk- dU;k mPp-ek/;-fo|ky; lkMk]dksjck
kk-ekWMy m-ek-fo-] ckydks uxj] dksjck
kk-m-ek-fo-] teuhikyh,u-Vh-ih-lh-]dksjck
'kk-cgq- mPp-ek/;-fo|ky;] vfEcdkiqj
'kk- vkn'kZ ckyd m-ek-fo-] lwjtiqj
'kk-vkn'kZ jkekuqt m-ek-fo-]cSdq.Biqj]dksfj;k
'kk- mPp-ek/;-fo|ky;] cyjkeiqj

dksM
0901
1001
1101
1102
1103
1201
1301
1302
1303
1304
1401
1501
1601
1701

State Council of Educational

Research & Training, Chhattisgarh
Shankar Nagar, Raipur
0771-2443596 Fax-0771-2443496

jkT; 'kSf{kd vuqla/kku vkSj

izfk{k.k ifj"kn~
ifj"kn~] Nkhlx<+]
'kadj uxj] jk;iqj

Website: www.scert.cg.gov.in Email: scertcg@gmail.com

jkT; Lrjh; jk"Vh; izfrHkk [kkst ijh{kk (NTSE) d{kk 10oha esa v/;;ujr~~
jk"Vh; lk/ku lg izkoh.; Nk=o`fk ijh{kk (NMMSE) d{kk 8oha esa v/;;ujr
l= 2015 & 2016

ijh{kk lapkyu funsZk

ijh{kk frfFk & 08uoEcj 2015 jfookj
ijh{kk lapkyu funsZk %

A.

fo|ky; izeq[k }kjk lR;kfir fd;k x;k vkosnu i= gh Lohdkj djsaA vko;d izek.k
i= ;Fkk&d{kk 7 ohsa@d{kk 9 oha mRrh.kZ vad lwph] tkfr] fodykaxrk] vk; izek.k i=
ds fcuk vkosnu i= Lohdkj u djsaA

dsUnzk?;{k fcuk izek.k i=ksa ds vkosnu i= Lohdkj u djsaA dsUnzk/;{k ,dhd`r ukfeuy
jksy layXu izk#i esaaNTSE,oa NMMSEds fy, vyx&vyxrS;kj djsaA jksy ua- esa ljy
dz- Serial No- 001 ls dzek% 999 rd gh vkcafVr fd;k tkuk gSA lacaf/kr fo|kFkhZ ds
izosk i= esa Hkh Roll No.vafdr dj lacaf/krfo|ky;ksa dks iznku djsaA

,dhd`r ukWfeuy jksy NTSE,oaNMMSEds fy, i`Fkd&i`Fkd jkT; 'kSf{kd vuqla/kku

vkSj izfk{k.k ifj"kn (SCERT)jk;iqj] Nkhlx<++] izdks"B izHkkjh dks 15 flrEcj 2015
rd vfuok;Zr% tek djsaAfoyEc dh fLFkfr esa ;fn izfrHkkxh ijh{kk ls oafpr gksrk gS ,oa
izek.k i=ksa ds vHkko esa p;u ls oafpr gksrk gS rks dsUnzk/;{k Lo;a ftEesnkj gksaxsA

p;u lwph fuekZ.k esa ijh{kkfFkZ;ksa ls lacaf/kr vko;d tkudkfj;k vkids }kjk izsf"kr
,dhd`r ukfeuy jksy ls fy;k tkosxkA vr% ,dhd`r ukfeuy jksy cukus esa foks"k
lko/kkuh j[ksaA
vkosnu i= ijh{kk dsUnz esa gh j[ksaAfnukad 09 uoEcj 2015 dks jkT; 'kSf{kd vuqla/kku
,oa izfk{k.k ifj"kn~ (SCERT)jk;iqj] Nkhlx<++dks tek djsaA
vkids dsUnz ds fy, ;fn midsUnz dh vko;Drk gksa rks lacaf/kr ftyk fk{kk vf/kdkjh
ls lEidZ djsaA
dk;kZy;SCERT, Raipur (C.G)dks le; lhek rd dsUnzk/;{k }kjk izsf"kr ukWfeuy jksy esa
ntZ fo|kfFkZ;ksa dks gh ijh{kk esa cSBus dh ik=rk gksxhA

5
6
7
8

dsUnz ls izkIr ukWfeuy jksy esa ntZ la[;k ds vuq#i gh izu i= ,oa
forfjr fd;k tkosxkA lkefxz;ka izkfIr i'pkr la[;k tkap ysosaA

izFke izu i=&

i= izkr% 10%00 ls 11-30 cts rdA

OMR

mRrj i=d

f}rh; izu i=&

i= nksigj 12-30 ls 2-00 cts rdA
10

ijh{kkfFkZ;ksa dh cSBd O;oLFkk dk pkVZ uksfVl cksMZ ij ,d fnu iwoZ pLik djsaA

11

izR;sd 20 ijh{kkFkhZ ij ,d d{k i;Zos{kd j[kk tk,A

12

ijh{kkfFkZ;ksa }kjk

OMRmRrj

i=d esa xksys dks dkyk vFkok uhyk MkV isu ds}kjk iw.kZ #ils (

)Hkjk tk,A d{k i;Zos{kdOMR mRrj i=d esa bldh tkp vo; djsaA
13
14
15
16

17

18

19
20
21
22
23
24

25
26
27

d{k i;Zos{kd ijh{kk d{k esa izFke izu i= ds fy,& izkr% 9%30 cts ,oa
f}rh; izu i= ds fy,&nksigj 12%00 cts igqp tk,A
ijh{kkfFkZ;ksa dk izosk i= ij yxs QksVks ls feyku dj ijh{kk d{k esaizosk nsaA
ijh{kk izkjaHk izFke isij&10%00 cts ,oa f}rh; isij&12%30cts ds15 feuV ckn
vkusokys ijh{kkfFkZ;ksa dks ijh{kk gsrq vuqefr u nh tk,A ijh{kk izkjaHk gksus ls
ijh{kk lekfIr rd ijh{kkFkhZ dks ijh{kk d{k ls ckgj tkus dh vuqefr u nh tk,aA
OMR mRrj i=d ,oa izu&i= dk forj.k %
ijh{kkFkhZ gsrq
izFke izu&i=
f}rh; izu&i=
ijh{kk d{k esa izosk
izkr% 9%30 cts
nksigj 12%00 cts
OMR mRrj i=d dk forj.k
izkr% 9%45 cts
nksigj 12%15 cts
izu&i= dk forj.k
izkr%10%00 cts
nksigj 12%30 cts
dsUnzokj ijh{kkfFkZ;ksa dks dsUnzk/;{k }kjk vkcafVr jksy uaEcj OMRmRrj i=d esa
Nik PRINT jgsxkA vr% ijh{kk d{k dks vkcafVr jksy uaEcj ds vuqlkj gh OMR
mRrj&i=d lacaf/kr ijh{kkFkhZ dks fn;k tk,A bl ckr dk foks"k /;ku j[ksaA nwljs
jksy uaEcj vkcafVr ijh{kkFkhZ dks feyus ij d{k i;Zos{kd ,oa dsUnzk/;{k tokcnkj gksaxsA
ijh{kkFkhZ }kjk OMR mRrj i=d esa mlls lEcfU/kr lHkhizfof"V;klEcfU/kr xksys dks
iw.kZ#i ls ( ),oa lgh Hkjk x;k gksAd{k i;Zos{kd bldh tkp dj fu/kkZfjr LFkku ij
gLrk{kj djsaA ijh{kkFkhZ ls lacaf/kr viw.kZ ,oa xyr izfof"V ds dkj.k@xyr OMR mkj
i=d fn, tkus ds dkj.k ;fn izfrHkkxh p;u lwph ls oafpr gksrk gS rks d{k i;Zos{kd
ftEesnkj gksaxsA
iz;qDrOMR mRrj i=d ds fufpr LFkku ij dsUnz ekad dhlhy vfuok;Z :i ls
yxkbZ tkosA
SIGNATURE ROLLesavuqifLFkr ijh{kkfFkZ;ksa ds gLrk{kj LFkku ij dkyk@uhyk L;kgh
lsABST fy[kk tkosaA
ijh{kk d{k esa dSydqysVj] eksckbZy] gsM Qksu ,oa fdlh Hkh izdkj dh udyLkkefxz;ksa
dkmi;ksx oftZr gSAjQ dk;Z ds fy;ss izu i= ds var esa yxs gq, dksjs dkxt dk
ijh{kkfFkZ;ksa }kjk mi;ksx fd;k tk ldrk gSA
;fn izu i= esa fdlh Hkh izdkj dh =qfV gks rks lakks/ku u djok;k tk,A bldh
lwpuk ifj"kn~ dks nh tk,A
ijh{kk gsrqOMR mRrj i=d dh Nk;kizfr PHOTO COPY ekU; ugha gksxkA
ijh{kkFkhZ dks vkcafVrOMR mRrj i=d [kjkc gksus dh fLFkfr esas nwljk
OMRmRrji=ddsUnzk/;{k dh vuqefr ij gh fn;k tkosA dsUnzk/;{k ds izfrosnu esa
ijh{kkFkhZ dk jksy ua- ,oa nksuksa OMR mRrj i=d dk uaEcj o [kjkc gksus dk dkj.k
fy[ksA [kjkcOMRmRrj i=d ij [kjkc gksus dk Vhi vafdr dj vyx fyQkQk esa tek
djsaA
ijh{kksijkUr ijh{kkfFkZ;ksa ls izu i= okil u fy, tkosaA
ijh{kk lapkyu gsrq vkcafVr jkfk esa ls O;; dh x;h jkfk;kWa] leLr OgkmplZ rFkk
ikfjJfed ns;d vkfn Lohd`r njksa ds vuqlkj iw.kZ dj vkWfMV ds fy;s vius fjdkMZ esa
j[ksaA
ijh{kk dsUnz esa 'ks"k cps izu i=ksa dks vius ,oa fudV ds fo|ky;ksa esa forfjr dj

State Council of Educational Research and Training ,Chhattisgarh,Raipur

APPLICATION FORM
State Level NATIONAL TALENT SEARCH EXAMINATION (NTSE) 2015-2016
(For the Students Studying in Class X)
Last date -25 August 2015 (Submit in your School) Exam Date -08Nov.2015
dsUnz }kjk vkcaafVr
Space for the
Roll No.

State Code
3
3

Date of Birth

Year
1
6
Date

Centre Code

Serial number

Class

X
Month

Year

Photograph
passport size Black
& White
photographs
should be
endorsed by Head

(Write In Capital Latter)

1- Name of the Candidate(Do not Write Miss/Mister)
2- Fathers Name (Do not Write Dr/Pro/Mr.)
3- Mothers Name (Do not Write Dr./Prof/Mrs.)
WriteCrass [X] only one of the appropriate box 4, 5,6,7,10, 11 and 21
4- Sex
5- Residential Area
6- Cast category
Male 1
Rural 1
GN/OBC 1
Female 2
Urban 2
SC
2
ST
3

7- Disability Statues/fodykaxrk dk izdkj

Orthopedic/vfLFk ckf/kr
1
Hearing Impaired/Jo.k ckf/kr
2
Visually Impaired/n`f"Vckf/kr
3
Blind/n`f"Vghu
4

*Attach certificates if you belong to SC/ST and Sr. No. 7

8- Postal address for correspondence : (Do not Fathers and your Name)9- Name & address of School in which studying at VIII level

Pin Code

Pin Code

10- Type of School in which studying at class X

11- School located :
Government@kkldh;
1
Private aided @vkk- vuqnku izkIr
3
Rural@xzkeh.k 1
Local Body@ uxjh; fudk; 2
privateUnaided@vkk- xSj vuqnku izkIr
4
Urban@kgjh 2
*For filling in boxes in Sr. No. 12 to 16 see Code No. Mentioned below
12- Medium of examination (A) State Level
(B) NCERT Level
13- Fathers education
14- Fathers occupation
15-Mothers education:
16- Mothers occupation
17-No. of family members living in the home
18- No. of Brothers
19- No. of Sister
20-At what number is the candidate among his/her brother and sister HkkbZ] cguksa esa ijh{kkFkhZ dk e la[;k &
21- Parental annual Income: Up to 50,000 (1)
1,00,001 to 2,00,000 (3)
More than 5,00,000 (5)
50,001 to 1,00,000 (2)
2,00,001 to 5,00,000 (4)
22- Mobile No.
E-mail address
To be filled in by the Head of the Institution
Certified that1.Mister/Miss .. Son/Daughter of Sri/Smt. . is regular student
of Class X in this School/Institution and he/she has secured
% mark in the class IX annual examination, i.e. when he/she
was promoted from class IX to class X. he/she has secured marks out of .
2. The particulars given by him/her in the application from have been verified and found in order.
3. Mister/Miss .. Belongs to scheduled cast/scheduled tribe category as per the records maintained in
Institution (To be filed for SC/St candidates only) .
Date ..

Signature of Candidate

----------------------------Signature of the Head Master/Head Mistress/

Gazette Officer with Seal

Coding Plan
Read instruction carefully before filling up the Application Form1- Use only Blue or Black Ball point pen, WRITE IN CAPITAL LETTERS .Do not marks or write outside the boxes.
2- Crass[x] only one of the appropriate boxes in items4, 5,6,7,10,11 and21.
3- Please write code number in items nos.12, 13, 14, 15and16 as given overleaf.
4- It is the responsibility of the candidate and principal/Head of the school to deposit the filled in form with the State
concerned officer before the last date no request for condoning delay in submission will be entertained whether it is due to
the fault on the candidate or Headmaster/Principal of his/her institution .
5- Incomplete or defective applications are liable to be rejected.
Code No. to be fills in boxes Sr. No. 12 to 16
MEDIUM OF EXAMINATIONCODE :- EnglishEDUCATIN OF FATHER OR MOTHER
No formal Education
Up to Primary
Upper Primary
Secondary
Senior Secondary
Graduation
Post-Graduation
Doctoral
Professional Degree
(Engineering, Medicine, Law, MCA, MBA, etc)

Code 13,Hindi- Code 15

Code FATHERs OR MOTHERs OCCUPATION[ Refer to items code 14&16]
1
2
OCCUPATION
Code
3
Professional,
1
4
Executive and Managerial
2
5
Clerical
3
6
Business
4
7
Agriculture/ Fishery
5
8
Production, transport
6
Operators and laborers
7
9
Not employed
8

[Refer to item no.10]

Government
A government school is completely financed by the government.
Local Body
A local body school is that which is run local body institutions such as panchyat,
municipal corporation municipal committee notified area committee cantonment Board ate.
Private Aided
A private aided school is that which is run by an individual or private organization and receives grant from
government or local body.
Private Unaided
A private unaided school is that which is managed by an individual or a private organization and does not
Receive any grant from government or local body.

State Council of Educational Research and Training ,Chhattisgarh,Raipur

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(NTSE) 2015-2016
(State Level NATIONAL TALENT SEARCH EXAMINATION 2015-16)
(For the Students Studying in Class X)

ADMISSIOM CARD

TO be field in by the applicant

Roll No.

:
3

Space for the

Photograph passport
size Black & White
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be endorsed by

Head

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State Code
3

Year
6

Centre Code

Serial number

Miss/Mister

..

S/o /D/o Sri

Of (School)

Of District Center

Is permitted to appear for the above said examination

Full Postal Address ..
.
Pin..
Date of Examination

TO be field at the Authorized for

08.11.2015
State Level Examination

Venue of Examination Center

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(With Office Seal)

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(Office Staff)

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Signature of Liaison Officer/District Level

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At the examination
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State Council of Educational Research and Training ,Chhattisgarh, Raipur

APPLICATION FORM
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State Council of Educational Research and Training, Chhattisgarh, Raipur

jk"Vh; lk/kulg&izkfo.; Nk=o`fk ijh{kk (NMMSE) 2015-2016
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[seprate sheet NTSE AND NMMSE]

Candidates Name

Fathers Name

Date of
Birth

Categary Male /
Gn/Obc Female
/Sc/St/
PHY

Block.

Pls- Nominal Roll Make in English Excel Sheet Font Arial and size 10

Roll No.

S.N.

Cener code.

School Name

10

Signature with seal

Type of school AriaGovt./Local

Rular/
body/PrivateAdied/ Urbon
Private Unadied

11

Parental
annual
Income

Dist

Center Name.

Nomial Roll NTSE - NMMSE Exame 2015-16