WHILE SENDING DOWNLOADED APPLICATION, THE INSTRUCTIONS GIVEN IN THE ADVERTISEMENT MODE III SHOULD BE FOLLOWED

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1 FORM : 1 MADHYA PRADESH BHOJ (OPEN) UNIVERSITY Raja Bhoj Marg (Kolar Road) Bhopal, Application Form For Admission (B.Ed. Special Education Distance Education Programme (B.Ed. - SEDE) FORM No. B.Ed SEDE : K10 1. Programme Code B. Ed. - SEDE 2. Programme Fee DD Details Affix your latest passport size photograph (4cm x 5cm) duly attested by you DD No. DD Date Date Month Year DD Amount (in Rs.) Issuing Bank Name & Code Rs. 15,000/- 3. State Code : 4. Study Centre Code in order of preference in which the 1 st candidate wants admission :(Select that Study Centre where the opted Disability Area is offered as chosen in Item 6) 5. Codes of School Subjects which the SS-1 : 0 1 or 0 2 Candidate wants to be offered :Tick ( ) SS-2 : 0 4 or 0 5 or Disability Area in which the Candidate wants to specialize : Code No.: Code Name: 7. Name 2 nd 3 rd 8. Father's/Husband's Name/ Mother's Name (strike out whichever is not applicable) 9. a) Address for correspondence (Do not give Box No. address. Leave a blank box between each unit of address like House No., Street Name, P.O., etc Pin Code

2 Telephone / Mobile No. (if any) b) Fax No. (if any) c) No. (if any) 10. Date of Birth Date Month Year 11. Nationality 12. Country of Residence 13. Sex Code 14. Category Code 15. Educational Qualifications : (Please attach attested photocopies of certificates/degrees along with marksheet) Examination Passed 1. Matriculation 2. Higher/Sr.Secondary 3. Graduation 4. Post- Graduation 5. Research Degree 16. I fulfill following Eligibility Criteria(s) Year of Completion Subjects (1) I have a Bachelor Degree from a recognized University; and (2) I fulfill the following condition(s) (Tick whichever applicable) (i) parent of disabled child*, (ii) disabled person*, (iii) possess a Diploma in Special Education of RCI (iv) have undergone Bridge Course of RCI, % of Marks Obtained (v) have completed RCI-MPBOU Foundation Course (FC-SEDE), (vi) Bachelor Degree on or before 2007 Board/University *Note: The Eligibility Condition (i) / (ii) should be accompanied by a certificate issued by a competent authority as per PWD Act norm. (In case of parent the certificate of the Disabled Child should be submitted) Date : Signature of the Candidate

3 FORM : 2 Certificate of Employment (To be given on a Letter Head of the Registered Standard Institution serving in Disability Area) Name of the Candidate : Employment Specifications : 1. Name of the employing Institution : 2. Nature of Institution : Educational/Hospital/NGO/ 3. Registration No. (if NGO) : 4. Nature of work of the Institution : 5. Period of service experience : From To 6. Kind of Work Experience gained by the applicant in Disability Area : This is to certify that above statement is correct to the best of my knowledge. Checked and forwarded Signature of the Coordinator of the Study Centre Date: Signature of Administrative Officer* of the Institution Date: Seal * This certificate can be signed by District Education Officer (DEO)/Disabled Welfare Officer/Social Welfare Officer/District Rural Development Officer/Block Development Officer/Head of any Institute recognized by RCI, NGO receiving major grants from the State Government or the Government of India and engaged in the work based on the disability. Seal

4 FORM : 3 Category Certificate (For SC/ST/OBC/PH candidates) This is to certify that Mr./Ms. Son/daughter/wife of Shri of Village Town District State/U.T. belongs to caste category which is recognised as a Scheduled Caste/Scheduled Tribe/OBC under the Constitution (Scheduled Caste Part C States) Order 1951 read with the SC/ST lists (Modification) Order, Mr./Ms. and his/her family reside in village Town District State/U.T. Signature of Tehsildar/Commissioner/District Magistrate Place : Date : Name Seal/Stamp FORM : 4 DECLARATION BY APPLICANT I hereby by declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfil the minimum eligibility criteria and have provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the university at any time and I shall not be entitled to refund of any fee paid by me to the university. Date : Signature of Candidate

5 MPBOU-RCI B.Ed.-SEDE Entrance Test 2010 Application Form No.B.Ed.-SEDE : K10 Enrollment No. ADMIT CARD (A) Name : Affix your latest passport size photograph (4cm x 5cm) duly attested by you Father s/husband s Name :... Address:.. Signature of the Candidate FOR OFFICE USE ONLY Date of Examination Session.. Centre Address... Signature of the Invigilator

6 Instructions for the Candidates 1. You will NOT be allowed to carry any book/paper/mobile phone/electronic item inside the examination hall. 2. Any attempt of unfair means during the examination will render you liable to disciplinary action by the University authority according to University rules. 3. The exam invigilator will help you find your seat in the exam hall and you are advised to follow his/her instructions carefully. 4. The question papers will be in English as well as in Hindi. You will have to choose either Hindi or English. 5. The duration of exam is one and a half hours. Indications will be given as per the fixed schedule. 6. You are advised to reach the examination hall at least 30 minutes before the commencement of the examination time. 7. You are required to carry any one additional photo ID card (for e.g. Driving Licenses/Voter ID card/passport/pan card/photo Credit card etc.) along with this Admit Card. 8. Please do not write anything on your Admit Card. If you need rough sheets, ask the invigilator for it and hand it over to him/her before you leave the examination hall. (A) Marked copy to be sent to the candidate

7 MPBOU-RCI B.Ed.-SEDE Entrance Test 2010 Application Form No.B.Ed.-SEDE : K10 Enrollment No. ADMIT CARD (B) Name : Affix your latest passport size photograph (4cm x 5cm) duly attested by you Father s/husband s Name :... Address:.. Signature of the Candidate FOR OFFICE USE ONLY Date of Examination Session.. Centre Address... Signature of the Invigilator

8 Instructions for the Candidates 1. You will NOT be allowed to carry any book/paper/mobile phone/electronic item inside the examination hall. 2. Any attempt of unfair means during the examination will render you liable to disciplinary action by the University authority according to University rules. 3. The exam invigilator will help you find your seat in the exam hall and you are advised to follow his/her instructions carefully. 4. The question papers will be in English as well as in Hindi. You will have to choose either Hindi or English. 5. The duration of exam is one and a half hours. Indications will be given as per the fixed schedule. 6. You are advised to reach the examination hall at least 30 minutes before the commencement of the examination time. 7. You are required to carry any one additional photo ID card (for e.g. Driving Licenses/Voter ID card/passport/pan card/photo Credit card etc.) along with this Admit Card. 8. Please do not write anything on your Admit Card. If you need rough sheets, ask the invigilator for it and hand it over to him/her before you leave the examination hall. (B) Marked copy to be sent to the University