NATIONAL MEANS-CUM-MERIT SCHOLARSHIP &DR. SHIVANAND NAUTIYAL & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIP EXAMINATION 2017

(For the Students Studying in Class 8th)

Last date for submission of application form at Block Education office - 08 September 2016

Date of Scholarship Éxamination 2017 - 06 November 2016. (SUNDAY)

(NATIONAL MEANS-CUM-MERIT SCHOLARSHIP SCHEME) ekuo lalk/ku fodkl ea=ky; Hkkjr ljdkj ubZ fnYyh }kjkA jk"Vªh; Lrj ij % 100000 Nk=of̀Rr;k¡- mRrjk[k.M jkT; ds fy, % ;kstuk ds vUrxZr p;fur vH;FkhZa dks &d{kk 9 ls d{kk 12 rd izfr ekg :0 500-00 ¼ikWp lkS :Ik,½ Nk=of̀Rr dk Hkqxrku jk"Vªh;dr̀ cSd dh 'kk[kk esa [kqys cSad [kkrs esa =Sekfld fdLrksaesa fd;k tkrk gSA Nk=of̀Rr tkjh j[kus gsrq jktdh;@LFkkuh; fudk;@jktdh; lgk;rk izkIr fo|ky; esa v/;;ujr gksuk ,oa izR;sd o"kZ dh ijh{kkesa U;wure vgZdkjh vad izkIr djuk vko';d gSA

vkosnd mRrjk[k.M jkT; esa lapkfyr jktdh;] LFkkuh; fudk; ;k jktdh; lgk;rk izkIr fo|ky;ksa ¼dsUnzh; ,oa vkoklh; fo|ky;ksa dks NksM+dj½ dh d{kk 8 esa laLFkkxr Nk=&Nk=k ds :i esa v/;;ujr gksAd{kk 7 dh okf"kZd ijh{kk U;wure 55 izfr'kr ¼vkjf{kr oxZ ds fy, 50 izfr'kr½ vadksa ds lkFk mRrh.kZ dh gksA

ekrk&firk ;k vfHkHkkod dh okf"kZd vk; :0 1]50]000-00 ¼:Ik, ,d yk[k ipkl gtkj½ ls vf/kd u gksA

(DR. SHIVANAND NAUTIYAL SCHOLARSHIP & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIP SCHEME) fo|ky;h f'k{kk foHkkx mRrjk[k.MA MkW0 f'kokuUn ukSfV;ky Nk=of̀Rr % 11 Nk=of̀Rr;k¡ ¼6 Nk=̀fRr;ka x<oky ,oa 5 Nk=of̀Rr;ka dqeka;w e.My gsrq½AjkT; ;ksX;rk ¼Jhnso lqeu½ Nk=of̀Rr % 475 Nk=of̀Rr;k¡ ¼izR;sd fodkl[k.M gsrq 5 Nk=f̀Rr;ka½A MkW0 f'kokuUn ukSfV;ky Nk=of̀Rr ds varxZr p;fur Nk=@Nk=k dks d{kk 9 ls d{kk 12 rd izfr ekg :0 250-00 ¼nks lkS ipkl :Ik,½A jkT; ;ksX;rk ¼Jhnso lqeu½ Nk=of̀Rr ds varxZr p;fur Nk=koklh ,oa vNk=koklh Nk=@Nk=k dks d{kk 9 ls d{kk 12 rd dze'k% izfr ekg :0 200-00 ¼nks lkS :Ik,½ :0 150-00 ¼,d lkS ipkl :Ik,½ Nk=of̀Rr dk Hkqxrku jk"Vªh;d̀r cSd dh 'kk[kk esa [kqys cSad [kkrs esa fd;k tkrk gSA Nk=of̀Rrtkjh j[kus gsrq jktdh;@LFkkuh; fudk;@jktdh; lgk;rk izkIr fo|ky; esa v/;;ujr gksuk ,oa izR;sd o"kZ dh ijh{kk esa U;wure vgZdkjh vad izkIrdjuk vko';d gSA

vkosnd mRrjk[k.M jkT; esa lapkfyr jktdh;] LFkkuh; fudk; ;k jktdh; lgk;rk izkIr fo|ky;ksa ¼dsUnzh; ,oa vkoklh; fo|ky;ksa dks NksM+dj½ dhd{kk 8 esa laLFkkxr Nk=&Nk=k ds :i esa v/;;ujr gksAd{kk 7 dh okf"kZd ijh{kk U;wure 50 izfr'kr ¼vkjf{kr oxZ ds fy, 40 izfr'kr½ vadkas ds lkFk mRrh.kZ dh gksAekrk&firk ;k vfHkHkkod dh okf"kZd vk; dk dksbZ izfrcU/k ugha gSA mDr Nk=of̀Rr ;kstukvksa esa p;u gsrq jkT; LRkj ij ,l0lh0bZ0vkj0Vh0 mRrjk[k.M] nsgjknwu }kjk ,d Lka;qDr fyf[kr ijh{kk vk;ksftr dh tk,xhAijh{kk ds nks Hkkx gSaa & ekufld ;ksX;rk ijh{k.k ¼,e0,0Vh0½ ,oa Hkk"kk ;ksX;rk ijh{k.k ¼fgUnh ,oa vaxzsth½] ¼,y0,0Vh0½ ,oa 'kSf{kd ;ksX;rkijh{k.k ¼,l0,0Vh0½A iz'u cgqfodYih; oLrqfu"B izdkj ds gksaaxsA] mRrj i=d ds :i esa vks0,e0vkj0 'khV dk iz;ksx fd;k tk,xkA iz'u&i=ksa dkLrj d{kk 8 dh lkoZtfud ijh{kk ds vuq:i gksxkAHkk’kk ;ksX;rk ijh{k.k (Language Ability Test) ¼fgUnh vFkok vaxzsth½ esa U;wure vgZdkjh vad ¼lkekU; oxZ ds fy, 40% ,oa vkjf{kr oxZ fy, 32%vad½ izkIr djus okys vH;fFkZ;ksa dh muds }kjk ekufld ,oa 'kSf{kd ;ksX;rk ijh{k.k esa izkIr vadkas ds vk/kkj ij izoh.krk lwph (Merit List) rS;kj dhtkrh gSA ijh{kk vkosnu&i= fodkl [k.M f'k{kk vf/kdkjh] ftyk f'k{kk vf/kdkjh ;k ,l0lh0bZ0vkj0Vh0 mRrjk[k.M] nsgjknwu ls vFkok fo|ky;h f'k{kk foHkkx

dh osclkbV schooleducation.uk.gov.in, scert.uk.gov.in ls MkmuyksM fd, tk ldrs gSasA vkosnu i= dh QksVks izfr Hkh ekU; gSAijh{kk gsrq fdlh Hkh izdkj dk vkosnu@ijh{kk 'kqYd ns; ugha gSAiw.kZ :i ls Hkjs gq, vkosnu i= vko';d izek.k i=ksa lfgr O;fDrxr :i ls lEcfU/kr fodkl [k.M ds [k.M f'k{kk vf/kdkjh ds dk;kZy; esa tek djsaAvkosnu i= esa lHkh izfof"V;ksa dks xEHkhjrk ls HkjsaA v/kwjs ,oa =qfViw.kZ :i ls Hkjs x;s vkosnu i= fujLr dj fn;s tk;sxsAjk"Vªh; lk/ku lg ;ksX;rk Nk=of̀Rr ¼,u0,e0,e0,l0,l0½ gsrq vkosnu dj jgs vkosnd l{ke vf/kdkjh }kjk fuxZr vfHkHkkod dh okf"kZd vk; dk izek.k&i= Hkh izLrqr djsaxsAvkjf{kr ,oa fodykax Js.kh mEehnokj nkos dh iqf"V gsrq vfuok;Zr% l{ke vf/kdkjh }kjk fuxZr izek.k i= layXu djsaA vU;Fkk vH;FkZu fujLr le>k tk,xkA,u-lh-bZ-vkj-Vh-] ubZ fnYyh vFkok ,l-lh-bZ-vkj-Vh-] mRrjk[k.M] nsgjknwu ds dk;kZy; esa lh/ks izkIr vkosnu i=ksa ij dksbZ fopkj ugha fd;k tk,xkA

email : scert uk@gmail.com, scert_ua@rediffmail.com(Use Legal (8.5"x14") Size Paper For Taking Print)

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INSTRUCTIONS FOR THE CANDIDATE1. Make sure that the Admit Card is not detached from the application form. It will be returned to you after the allotment of Roll

Number. It is hereby advised, that Candidate should collect the admit Card from the concerning Block Education office atleast one week before the examination.2. Report at the Examination Centre at least half an hour before the commencement of the examination and occupy the seat that

bears your Roll Number.3. DO NOT carry Mobile, Calculator, Mathematical & Physical Table or any other kind of ready reckoner in the examination hall.4. The examination will be conducted in two sessions i.e. Ist sessions (Paper Ist)- 11:00 AM to 12:30 PM, IInd sessions (Paper IInd)- 01:15 PM to

02:45 PM. on 06 November 2016 (Sunday)5. Details regarding questions papers are as follows :

(i) Paper I: Part I is confined to Mental Ability Test (MAT) consisting of 50 compulsory questions and Part II is Language Ability Test Hindi or English (SAT) consisting of 50 compulsory questions(ii) Paper II : Is confined to Scholastic Aptitude Test (SAT) consisting of 100 compulsory questions from eight subjects (History,

Geography, Civics, Economics, Physics, Chemistry, Biology and Mathematics)6. Each question carries 1 (one) mark. there is no negative Marking.7. Write your Eight (08) digits Roll Number, as given in the Admit Card, on the Answer Sheet and on the cover page of the

Question Booklet in the space provided. DO NOT write your name in any part of the Question Booklet or Answer Sheet.8. All questions in the booklet are of objective type. For each question four possible answers are given, but only one is the correct answer. Darken the

circle of your choice in the OMR Answer Sheet.9 . Follow Instruction for OMR sheet. Use only Blue/Black Ball Point Pen for darkening the most correct Answer and for

filling informations.10. If you will darken more than one circle or circle is half darken then your answer will not be considered.Example :Q 1. Golden Temple is situated –A – Bhopal B- Amritsar. C- Hissar. D- Dehradun.Ans. The correct response of this question is ‘B’ therefore blacken the circled space as-

A B C D

11. During the Examination follow the instructions of the invigilator strictly.12. Hand over the OMR answer sheet to the Invigilator before leaving the examination hall.13. After examination to take home your Question booklet and carbon copy of OMR with you14. Extra time of 30 minutes will be given to the Visually impired candidate.

1- vH;FkhZ ;g lqfuf'pr dj ysaa fd izos'k i= dks vkosnu i= ls vyx u fd;k tk;A izos'k i= vkidks [k.M f'k{kk vf/kdkjh ds }kjk vuqØekadvkoafVr djus ds ckn fn;k tk;sxkA vH;FkhZ ;g lqfuf'pr djsa fd og viuk izos'k i= lacaf/kr [k.M f'k{kk vf/kdkjh ls ijh{kk frfFk ls ,dlIrkg iwoZ izkIr dj ysaA

2- ijh{kk dsUnz ij vk/kk ?k.Vk iwoZ igq¡puk lqfuf'pr djsa rFkk ijh{kk nsus gsrq vkoafVr vuqØekad okys LFkku ij gh cSBsA3- ijh{kk d{k esa eksckby] dSydqysVj] xf.krh; ,oa HkkSfrd Vscy ;k fdlh Hkh izdkj ds vuqfpr lk/kuksa dk iz;ksx oftZr gSA4- dks nks l=ksa esa vk;ksftr dh tk;sxhA izFke l= ¼izFke iz'u i=½ 11%00 am ls 12%30 pm, f}rh; l=

¼f}rh; iz'u i=½ 1%15 pm ls 2%45 pm rd5- iz'u i= laca/kh funsZ'k fuEufyf[kr gS %&

i . izFke iz'u i= % izFke Hkkx & ekufld ;ksX;rk dk gS ftlesa 50 vfuok;Z iz'u gksrs gSaA f}rh; Hkkx & Hkk"kk ijh{kk ¼fgUnh vFkok vaxzsth½ dk gS blesa 50 vfuok;Z iz'u gksrs gSaA

ii. f}rh; iz'u i= % 'kSf{kd vfHkof̀Ùk dk gS blesa Hkh 100 vfuok;Z iz'u ¼bfrgkl] Hkwxksy] ukxfjd 'kkL=] vFkZ 'kkL=] HkkSfrdh] jlk;u] tho foKku rFkk xf.kr½ ds gksaxsA

6- izR;sd iz'u ,d vad dk gSA xyr mRRkj ij _.kkRed vad ugha fn;s tk;saxs ¼mRrj xyr gksus ij vad ugha dkVs tk;saxs½A7- mÙkj i=d vkSj iz'u iqfLrdk ds doj ist ij fn;s x;s LFkku ij izos'k i= esa fn;s x;s 08 vadksa dk vuqØekad fy[ksaA iz'u iqfLrdk ,oa mÙkj

i=d ds fdlh Hkkx ij viuk uke u fy[ksaaA8- iz'u iqfLrdk esa lHkh iz'u oLrqfu"B gSaA izR;sd iz'u ds fy, laHko pkj mÙkj fn;s x;s gSa ysfdu muesa ls dsoy ,d mÙkj gh lgh gSA lgh

mÙkj ij fpg~u yxkdj vks0,e0vkj0 'khV ij ckWy iSu ls xksyk cukb,A9- vks0,e0vkj0 'khV ij fn;s x;s funsZ'kksa dk ikyu djsaA lgh mÙkj nsus vkSj lwpuk,a Hkjus ds fy, dsoy uhyh@dkyh iSu dk gh iz;ksx djsaA10- ,d ls vf/kd xksyksa dks Nk;kafdr djus ;k vk/kk xksyk Nk;kafdr djus ij vad ns; ugha gksaxsA

iz'u 1- Lo.kZ efUnj fLFkr gS&¼v½ Hkksiky ¼c½ ver̀lj ¼l½ fglkj ¼n½ nsgjknwumRrj& bl iz'u dk lgh mÙkj c gS] vr% c dks Nk;kafdr fd;k x;k gSA

v c l n

11. ijh{kk vof/k esa d{k fujh{kd ds funsZ'kksa dk ikyu djsaA12- ijh{kk d{k NksM+us ls igys vks0,e0vkj0 'khV dks d{k fujh{kd dks lkSai nsaA13- ijh{kksijkUr vH;FkhZ iz'u iqfLrdk rFkk vks0,e0vkj0 dh dkcZu dkWih dks vius lkFk ys tk ldrs gSA14- dsoy nf̀"V ckf/kr vH;fFkZ;ksa dks nksuks l=ksa dh ijh{kk esa 30 feuV dk le; vfrfjDr ns; gSaA15. OMR Sheet ij vuqØekad lko/kkuh ls HkjsaA vadks ds fy[kus ds lkFk mlh vad esa xksys

dks Nk;kafdr djsaA Fill up Roll No on OMR Sheet carefully .

If Candidates Roll No is 10853059 then darken the circle as given)

1 0 8 5 3 0 5 90 0 0 0 0 0 0 01 1 1 1 1 1 1 12 2 2 2 2 2 2 23 3 3 3 3 3 3 34 4 4 4 4 4 4 45 5 5 5 5 5 5 56 6 6 6 6 6 6 67 7 7 7 7 7 7 78 8 8 8 8 8 8 89 9 9 9 9 9 9 9

Rol l Nu m be r

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APPLICATION FORM NATIONAL MEANS-CUM-MERIT SCHOLARSHIP &

DR. SHIVANAND NAUTIYAL & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIP EXAMINATION 2017(For the Students Studying in Class VIII )Read the instructions carefully given on the next page before filling the application form.You may take the help from your teacher/parent for filling up the application form.- Date of Examination- ¼ijh{kk frfFk½ 06 November 2016 (Sunday)- Name & address of the Agency for conducting NMMSSE S.C.E.R.T. (UK.), Dehradun- Application fee, if any(write NIL, if there is no fee)---------NilSt at e level 08 digi t Roll Number (to be filled by the B.E.O office)

1. vH;FkhZ dk uke ¼Jh o dq0 u fy[ksa½ Name of the Candidate (do not write Miss/Master)

2. firk dk uke ¼Jh@MkW@izks0 u fy[ksa½ Father’s Name (Do not write Mr./Dr/Prof)

3. ekrk dk uke ¼Jherh@MkW@izks0 u fy[ksa½ Mother’s Name (Do not write Mrs./Dr/Prof)

4.

8. i= O;ogkj dk irk ¼viuk vFkok firk dk uke u fy[ksa½ Postal address for correspondence (Do not write father’s or your name)

9. ftl laLFkku easa d{kk 8 esa i<+ jgsa gSa mldk uke o irkA Name and address of the institution in which studying at Class VIII level

10. d{kk vkB esa i<+us okys fo|ky; dk izdkj ¼nwljs i"̀B ij ifjHkk"kk ns[kdj djsa½ 11- fo|ky; dgkW fLFkr gSType of the institution in which studying at Class VIII level Area in which the school is located

12.Medium of exam Father’s education Father’s occupation

15. Mother’s education Mother’s occupation No. of family members18. HkkbZ;ksa dh la[;k 19. cguksa dh la[;k 20. HkkbZ&cguksa ds chp vH;FkhZ dk Øe Number of brothers Number of sisters Birth order of the candidate among

his/her brothers and sisters21. vfHkHkkod dh okf"k Zd vk;] ¼mi;qDr ij djsa½ Parental annual income ( appropriate box)

22. nwjHkk"k@eksckbZy ua0 Telephone (With STD code) 23- bZ&esy E-mail address

24- d{kk 7 dk izkIrkad izfr'kr Percentage of class VII 25. Nk=koklh Boarder vNk=koklh Non BoarderTo be filled in by the Head of the InstitutionCertified that:(1) Master/Miss……………...............……………..is a regular student of this School/Institution and he/she has secured %marks in the class VII annual examination i.e. when he/she was promoted from class VII to class VIII. He/She hassecured ………………marks out of ………………(2) The parental income from all sources is Rs. ................................ (In word Rs......................................................................)(3) The School where the candidate is studying is a Govt./Local Body/Govt Aided School.(4) Master/Miss ……….................…………belongs to Scheduled Caste/Scheduled Tribe/Other Backward Class/Physicallydisabled category as per the records maintained in the Institution. (to be filled for Reserve category Candidates only).(5) The particulars given by him/her in the application form have been found correct and verified.

Date ...................................................................................(Signature of the Candidate) Signature of the Principal with office seal

Signature of the B.E.O with office seal

Space for thePhotograph (Passport

size and black &white).Photograph

should be attested bythe Head of the

Institution

ijh{kk dksM ftyk dksM dsUnz dksM Ø-la- ¼ch0bZ0vks0 dk;kZy; }kjk Hkjk tk;sxk½ d{kk tUe frfFkExam Code District Code Centre code Serial No. (to be filled by the B.E.O office) Class Date of Birth

8

P in code

P in code

5- vH;FkhZ dk vkoklh; {ks= 6- vH;FkhZ dh tkfr

Caste category of candidate1 2 1 2 1 2 3 4 1 2 3 4

iq:"k L=h xzkeh.k 'kgjh lk- v-tk- t-tk- fi-tk- Ortho Hear Visually NoneFemale Rural Urban GEN SC ST OBC pedic ing Impaired

fy ax

Sex Area where candidate res ides

Male

Disability s tatus of candidate7- fodykaxrk dh fLFkfr

ljdkjh LFkkuh; fudk; izkbosV ,MsM xzkeh.k 'kgjh

1 2 3 4 5Up to 50,000 50,001 to 150,000 More than 5,00,000 2,50,001 to 5,00,000 1,50,001 to 2,50,000

1 2

ijh{kk dk ek/;e 13. firk dk 'kSf{kd Lrj 14. firk dk O;oLkk;

Govt.1 2 Local Body 3 Private Aided 1 Rural 2 Urban

ekrk dk 'kSf{kd Lrj 16. ekrk dk O;oLkk; 17. ifjokj ds lnL;ksa dh la[;k

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Last date for submission of application form at BEO Office is 08 September 2016.Coding PlanRead Instructions carefully before filling up the Application Form1. Use only Blue or Black Ball Point Pen. Write in CAPITAL LETTERS. Do not mark or write outside theboxes.2. Leave one box blank between two words. Limit your name and address within the space provided for it.Please see example as given below.3. Tick only one of the appropriate boxes in item nos. 4,5,6,7,10,11, 21 & 24.4. Write code number in item nos. 12, 13, 14, 15 and 16 as given overleaf.5. It is the responsibility of the candidate and the Principal of the school to submit the filled in form to theconcerning Block Education Office before the last date. No request for condoning delay in submissionwill be entertained whether it is due to the fault of the candidate or the Post office/Headmaster/Principal of his/her institution.6. Incomplete or defective applications forms are liable to be rejected.7. Examination Scheme Code -8. Filling of Distt. and Centre code e.g., If Distt is Dehradun, code 05 and the centre is G.I.C. Kalsi, centre

code 30 then Distt. and Centre code will beExample for writing Name and AddressCandidate Name:Father’s Name:Mother’s NamePostal Address : Do not try to write complete address in one line. Break it appropriately as shown below.

0 5 3 0

GOVERNMENT : A Government School is that which is run by the State Government or CentralGovernment or Public Sector Undertaking of an Autonomous Organization completelyfinanced by the Government.

LOCAL BODY : A Local Body School is that which is run by Panchayati Raj and Local bodyinstitutions such as Zila Parishad, Municipal Corporation, Municipal Committee,Notified Area Committee and Cantonment Board.

PRIVATE AIDED : A Private Aided School is that which is run by an individual or private organizationand receives grant from government or local body.

TYPE OF SCHOOL/ INSTITUTION (Refer to item No.10)

R E K H A N E G IO P N E G IG E E T A N E G I

Education Code Occupation Code

No Formal Education 1 Professional, Technical and Re lated Worker 1

Up to Primary 2 Administrative , Executive and Managerial Worker 2

Upper Primary 3 Clerical and re lated Worker 3

Secondary 4 Business/ Service Worker 4

Senior Secondary 5 Farmer, Fisherman and re lated worker 5

Graduation 6 Production and re lated worker, Transport 6

Post graduation 7 Operators and Labourer Worker not classified by 7

Doctoral 8 Not employde 8Professional degree (Engg, Medicine, MCA, MBA, etc.)

9

Father's/Mother's Occupation(Re fer to item Nos. 14 &16)

Education of Father or Mother(Re fer to item Nos. 13 &15)

Medium CodeEnglish 13Hindi 15

Medium of Examination

(Refer to item12)Medium of

ExaminationCode

NMMSS Dr.S.N. Nautiyal & State Merit (Sridev Suman) Scholarship For Both1 2 3

1 4 5 / 6 M O H I N I R O A DD E H R A D U N 2 4 8 0 0 1PIN

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NATIONAL MEANS-CUM-MERIT SCHOLARSHIP &DR. SHIVANAND NAUTIYAL & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIP EXAMINATION 2017VERIFICATION FORM

State level 08 digit Roll Number (to be filled by the B.E.O office)

1. vH;FkhZ dk uke ¼Jh o dq0 u fy[ksa½ Name of the Candidate (do not write Miss/Master)

2. firk dk uke ¼Jh@MkW@izks0 u fy[ksa½ Father’s Name (Do not write Mr./Dr/Prof)

3. ekrk dk uke ¼Jherh@MkW@izks0 u fy[ksa½ Mother’s Name (Do not write Mrs./Dr/Prof)

4. tUe frfFk Date of Birth

9. i= O;ogkj dk irk (viuk vFkok firk dk uke u fy[ksa) Postal address for correspondence (Do not write father’s or your name)--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

10. ftl laLFkku easa d{kk 8 esa i<+ jgsa gSa mldk uke o irkA Name and address of the institution in which studying at Class VIII level-------------------------------------------------------------------------------------------------------------------------------------------------

11. ijh{kk dk ek/;e dksM lfgr (Medium of exam) ................................................

Signature of the Candidate Signature of the Block Education Officer with datewith Office seal

Signature of the Invigilator MAT ------------------------- Signature of the Candidate MAT -------------------------at the examination Centre SAT ------------------------- in the presence of Invigilator SAT -------------------------

NATIONAL MEANS-CUM-MERIT SCHOLARSHIP &DR. SHIVANAND NAUTIYAL & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIP EXAMINATION 2017Name of the State/UT: UTTRAKHAND

ADMIT CARD To be filled in by the applicant)

vkosnd dk uke % ____________________________

firk dk uke Jh % _________________

Name of the applicant Father's Name Srifo|ky; dk uke %

__________________________________ tuin dk uke % __________________

Name of School Name of districtdks mDr ijh{kk esa lfEefyr gksus dh vuqefr nh tkrh gSA (Is permitted to appear for the above said Examination)i= O;ogkj dk iwjk irk % _________________________________________________________________________Full Postal Address _______________________________________________________PIN code__________Date of Examination : 06 November, 2016 (Sunday)Time of Examination : 1- MAT & LAT (Language Test) - 11:00 A.M to12:30 P.M 2- SAT - 01:15 P.M.to 02:45 P.M.Venue of Examination centre (Given By B.E.O. Office) ___________________________________________________

Signature of the Block Education Officer with Office Seal

RECEIPTRECEIVED WITH THANK THE APPLICATION FORM OF NATIONAL MEANS-CUM-MERIT SCHOLARSHIP & DR.

SHIVANAND NAUTIYAL & STATE MERIT SCHOLARSHIP EXAMINATION 2017 (For the Students Studying in ClassVIII) of Master/Miss ................................................................................... S/o/D/o ............................................................... ondate .........................................................

Signature of the Block Education Officer with Office Seal

Space for thePhotograph (Pass-port size and black

&white).Photographshould be attestedby the Head of the

Institution

ijh{kk dksM ftyk dksM dsUnz dksM Ø-la- ¼ch0bZ0vks0 dk;kZy; }kjk Hkjk tk;sxk½ d{kkExam Code District Code Centre code Serial No. (to be filled by the B.E.O office) Class

8

5- vH;FkhZ dk vkoklh; {ks= 6- vH;FkhZ dh tkfr

Caste category of candidate1 2 1 2 1 2 3 4 1 2 3 4

iq:"k L=h xzkeh.k 'kgjh lk- v-tk- t-tk- fi-tk- Ortho Hear Visually NoneFemale Rural Urban GEN SC ST OBC pedic ing Impaired

fy ax

Sex Area where candidate res ides

Male

Disability s tatus of candidate7- fodykaxrk dh fLFkfr

State level 08 digit Roll Number (to be filled by the B.E.O office)

Space for thePhotograph (Pass-port size and black

&white).Photographshould be attestedby the Head of the

Institution

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DISTRICT AND CENTRE CODEFOR NMMSS, DR. SHIVANAND NAUTIYAL & STATE MERIT (SRIDEV SUMAN) SCHOLARSHIPEXAMINATION 2017

District District Code Centre Name Centre

Code District District Code Centre Name Centre

CodeG.G.I.C. Almora 01 G.I.C. Chailusain 48G.I.C. Bhakuna 02 G.I.C. Dhoomakot 49G.I.C. Bhikyasain 03 G.I.C. Deuli 50G.I.C. Chaukhutiya 04 G.I.C. Jaiharikhal 51G.I.C. Daniya 05 G.I.C. Kaljikhal 52G.I.C. Devayal Salt 06 G.I.C. Kot 53G.I.C. Dhoulchhina 07 G.I.C. Kotdwar 54G.I.C. Dwarahat 08 G.I.C. Naugounkhal 55G.I.C. Lamgada 09 G.I.C. Pauri 56G.G.I.C. Ranikhet 10 G.I.C. Pabau 57G.I.C. Syalde 11 G.I.C. Pokhra 58G.I.C. Bageshwar 12 G.I.C. Rikhnikhal 59G.I.C. Garud 13 G.I.C. Sri Nagar 60G.I.C. Kapkot 14 G.I.C. Syunsi 61G.I.C. Deval 15 G.I.C. Thalisain 62G.I.C. Gairsain 16 G.I.C. Berinag 63G.I.C. Ghat 17 G.I.C. Dharchula 64 G.I.C. Gopeshwar 18 G.G.I.C. Didihat 65G.I.C. Joshimath 19 G.I.C. Gangolihat 66G.I.C. Karanprayag 20 G.I.C. Kanalichhina 67G.I.C. Nagnath Pokhri 21 G.I.C. Munsyari 68G.I.C. Narayanbagad 22 G.I.C. Pipalkot 69G.I.C. Tharali 23 G.I.C. Pithoragarh 70G.I.C. Barakot 24 G.I.C. Gupatkashi 71G.I.C. Champawat 25 G.I.C. Ramashrya 72G.I.C. Lohaghat 26 G.I.C. Rudraprayag 73G.I.C. Pati 27 G.I.C. Anjnisain 74G.G.I.C. Rajpur Road 28 G.I.C. Baurari 75G.I.C. Chakrata 29 G.I.C. Chhaam 76G.I.C. Kalsi 30 G.I.C. Ghoometidhar 77S.B.M.I.C. Rishikesh 31 G.I.C. Hindolakhal 78G.I.C. Selakui 32 G.I.C. Kirtinagar 79A.R.V.I.C. Vikasnagar 33 G.I.C. Lambgaun 80G.G.I.C. Jwalapur 34 G.I.C. Narendra 81G.I.C. Roorkee 35 G.I.C. Thatyur 82K.B.I.C. Laksar 36 G.G.I.C. Bajpur 83N.K.I.C. Khanpur 37 G.I.C. Gadarpur 84N.R.I.C. Manglor 38 G.G.I.C. Jaspur 85R.N.I.C. Bhagwanpur 39 G.G.I.C. Kashipur 86G.I.C. Betalghat 40 A.N.G.I.C. Rudrapur 87G.I.C. Dhanachuli 41 G. I.C. Sirarganj 88G.G.I.C. Haldwani 42 G.I.C. Tharu, 89G.I.C. Kotabag 43 G.I.C. Chinyalisaur 90G.I.C. Nainital 44 G.I.C. Dunda 91G.I.C. Aukhalkanada 45 G.I.C. Mori 92G.I.C. Ramgarh 46 G.I.C. Naugaun 93

G.I.C. Purola 94G.I.C. Uttarkashi 95

10Champawat

Dehradun Tehri

03

04

09Chamoli

Pauri 08

05

U.S. Nagar

Uttarkashi

01

Haridwar

02

Rudraprayag

Pithoragarh

Almora

Bageshwar

Nainital 07

G.I.C. Ram Nagar 47

13

06

11

12

(6)