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SXC – B.ED. APPLICATION FORM 2015-20
2016.
Application received on ……………
Application Number
Qualification
Category
RC
XT
GEN
PH
CU
SC
ST
OBC
OTHER
University
T. XAVIER’S COLLEGE
ST.
Deputed /
Fresher
30, MOTHER TERESA SARANI, KOLKATA – 700 016
[AUTONOMOUS]
If Deputed,
Teaching
Experience
till 31/01/15
DEPARTMENT OF EDUCATION
Affiliated to Calcutta University,
Recognised by N.C.T.E.
&
Accredited by NAAC
Affix a recent passport
size photograph, and
get it attested by the
principal / headmaster
of school / college or
a gazetted officer.
APPLICATION FOR ADMISSION TO THE B. ED. COURSE
The Application Form has two sections A & B. Deputed-Teachers
Deputed Teachers have to fill in both
Sections A & B. Others need to fill in only Section A.
PLEASE NOTE (a)
Before filling in this form, every candidate is advised to read the prospectus carefully.
(b)
This form, duly filled in, should be submitted to St. Xavier’s College from 02-02-2015
02
to 06-02-201
2015 between 9:30 am and 12:00 noon.
(c)
Recognised by NCTE, accredited by NAAC and affiliated to CU, guidelines of NCTE
will be adhered to for selection.
Documents required at the time of submission of filled in application form (duly
duly attested Xerox copies to be
submitted and originals to be presented for verification):
a. Mark sheets for all stages of examinations passed.
b. Age verification certificate.
c. University registration certificate.
d. Certificate for reserved category.
e. Baptism certificate
ficate for Christian candidates and approval letter from the local Parish Priest.
f.
Approval of DI of schools for deputed candidates.
g. Xerox Copy of M. C. Resolution for deputed candidates countersigned by DI/ADI of school.
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SXC – B.ED. APPLICATION FORM 2015-2016.
Section – A (To be filled in by all applicants).
I : Personal.
1. Name of candidate in full _____________________________________________________________
(in Block Letters)
Title / Surname
Middle Name
Name
2. Male /Female/Transgender (Please Tick)
3. Date of Birth ________________________________ Age on 1st July, 2015 ___________________
4. Address for correspondence (in Block Letters).
Permanent home address________________________________________________________________
(in Block letters)
Post Office:
Pin Code:
Rural
State:
Urban
District:
Country:
Place a tick
Kolkata address______________________________________________________________________
(in Block letters)
___________________________________________________________________________________
Phone : _________________ Mobile ______________ E-mail _________________________________
5. Whether domiciled in West Bengal? ________________________ Married / Single_____________
6. Father’s / Mother’s Name ___________________ Spouse’s Name __________________________
7. Father’s / Mother’s / Spouse’s Occupation ______________________________________________
8. Family Income __________________________ per month
9. Nationality __________________________ Religion (RC/XT/OTHER) _______________________
10. Category (SC/ST/OBC/PH/GENERAL)________________________________________________
11. Medium of instruction preferred in teaching (English / Bengali) _____________________________
II : Academic & Professional.
12. Academic record (cancel which are not applicable)
a) Passed MADHYAMIK/ICSE/CBSE(X) or Equivalent Examination
in the __________________ Division from _______________ School in the year_____________
b) Passed HS/ISC/CBSE(XII) or Equivalent Examination in the ______________________Division
from _________________________ in the year _________________ with the following Subjects
______________________________________________________________________________
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SXC – B.ED. APPLICATION FORM 2015-2016.
c) Passed B.A. / B.Sc. Examination of _________________________________________ University
from ___________________________________________________________________ College,
in the year ____________________________ with ________________________________ Class
Honours in _____________________
Pass Subjects___________________________________
d) University Roll No. of B.A. /B.Sc. ___________________________________________________
e) Passed M.A./M.Sc. Examination of ___________________________________________________
University with __________________ Class, in the year ________________ Subject ___________
f) Other Examination or Course of study followed since ____________________________________
_______________________________________________________________________________
g) Prizes, Merit scholarships or other distinctions _________________________________________
_______________________________________________________________________________
h) Name and Registration No. of last University attended with year ___________________________
i) Roll No. of last Examination: _______________________________________________________
13. If employed, since leaving College,
a) in teaching post, details of employment ______________________________________________
_________________________________________________________________________________
b) in non-teaching post, details of employment ___________________________________________
14. Write two method subjects studied at Graduation level (refer to combination of subjects given in the
prospectus) : Subjects will be finalised at the time of interview.
1. _________________________________ 2. ____________________________________
15. Compulsory Elective Paper (tick the appropriate box) :
Guidance and Counseling.
Measurement and Evaluation in Education.
16. Did you apply for admission to B. Ed. Course at St. Xavier’s earlier ?
If yes, mention year and application number.
1. _______________________________________
2. _______________________________________
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SXC – B.ED. APPLICATION FORM 2015-2016.
17. For 2015-2016, have you applied elsewhere for B.Ed.? Yes / No
If yes, Name of the Colleges : 1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________
18. Academic Record
Exam. Passed.
Board/Univ.
Subjs. taken
Marks obtd.
Total Marks
Percentage
of Marks
Madhyamik / ICSE
or equivalent
H.S. / I.S.C.
or equivalent
Degree Hons.
Pass Subjects
1.
2.
Post Graduate
M. Phil / Ph. D
NET/SET
SSC
Degree/Diploma in
Computer
19. Academic Achievements (University/State/National level) : ________________________________
___________________________________________________________________________________
20. Co-curricular Achievements (University/State/National level) : _____________________________
___________________________________________________________________________________
21. Special Achievements and Hobbies (if any) :____________________________________________
___________________________________________________________________________________
22. For Priests, Religious or Seminarians: Name and address of Bishop / Superior :
I declare that information given above are true to the best of my knowledge. I am aware that if found
incomplete / untrue / incorrect, my application is liable to be cancelled.
Date
Signature of the Candidate
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SXC – B.ED. APPLICATION FORM 2015-2016.
Section – B (To be filled in by Deputed Teachers only and submitted.)
Particulars to be furnished by the Headmaster of the School Or the Secretary if the Candidate is Headmaster
1. Designation : Headmaster / Headmistress / Assistant Teacher
2. Name and full postal address of the School where the candidate is now serving :
3. Date of appointment of permanent post in this School: Subjects taught and classes:
4. Teaching Experience as a permanent teacher as on 31-01-2015:______________________________
5.
Previous teaching experience, if any: (mention School or Schools, year of service, dates of
appointment.)
6. Whether deputed by the school for undergoing training ____________________________________
7. Number of teachers from the School seeking admission to training College this year ? ____________
8. Number of teachers from the School seeking admission to St. Xavier’s College this year ? _________
Certified that the above statements are true.
Date:
Seal of the School
Signature of the Head of the Institution.
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SXC – B.ED. APPLICATION FORM 2015-20
2016.
ST. XAVIER’S COLLEGE
[AUTONOMOUS]
30, MOTHER TERESA SARANI (PARK STREET), KOLKATA – 700 016
DEPARTMENT OF EDUCATION
ADMIT CARD FOR INTERVIEW
(To be collected by the candidate at the time of form submission)
Affix a recent passport
size photograph, and get it
attested by the principal /
headmaster of school /
college or a gazetted
officer.
Application Number
Name
Address
Phone No :
Mobile :
Email :
Method Subjects :
Compulsory Elective Paper :
Date:
Signature of candidate