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JAWAHAR NAVODAYA VIDYALAYA SELECTION TEST - 2018 APPLICATION FORM Last date of submission of application form in the office of Jawahar Navodaya Vidyalaya is 25 th November 2017

Affix Passport size photo of the candidate

Certified that the information given below are correct in respect of _________________________(Name of Student) who is studying in Class V in _________________________________________(Name of School) and interested to apply for Jawahar Navodaya Vidyalaya Selection Test 2018

Name of Candidate (IN BLOCK LETTERS) Father’s Name (IN BLOCK LETTERS) Mother’s Name (IN BLOCK LETTERS) Name of the Guardian and relationship, if any. Date of Birth In figure D D M M Y Y Y Gender Please put () mark

Boy

Girl

Y

Transgender

In words ………………………………………………………………………… ………………………………………………………………………… Category Gen. SC ST OBC

Nature of disability, if any. Please put () mark against the respective category

Physically handicapped

Visually impaired

Hearing impaired

Identification mark ………………………………………………………………………………………………….. Present Postal Address Mobile No. ………………………… Email…………………………….. Nationality …………………………… Religion ………………………….. Medium of Examination …………………….. (Please indicate one language out of 21 languages given in the prospectus) Particular

Class-III

Class-IV

Class-V

Name of the School (studied – III & IV and studying V) and village Category of School (Recognized/ Not Recognized) School Location : Rural / Urban Month and Year of Joining Month & year of Passing -Name of the Block Name of the District Name of the State I understand that even if the candidate has studied in urban area for a day out of classes III, IV & V , the student will be treated as urban candidate and If any of the information provided is found to be wrong the candidature of my ward will be forfeited at any stage. Signature of the candidate Signature of the Parent

Note: In respect of NIOS students, area will be decided on the basis of residence of the candidate. Verified from School records and found correct. For JNV Office use only Roll No. allotted Signature of Head Master with Seal

Centre :

NAVODAYA GUIDELINE.pdf

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