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REGIONAL INSTITUTE OF EDUCATION, AJMERB.Sc.B.Ed. part-I (pCM Group) 2019_20

Counseli l)a -07 tl0Provisional Waiting List Canditla te of Utlar pradesh State(Gen. - 22 OBC. l4 sc_08 sT - 04)Uttar Pradesh State Waiti ng List General - 22

) -20I9 a :OO AM

S.r_o.St t/

TJT

ApPLName Category Disability Total

Score

L]P t9059t09 24165 Aakriti Verma CEN GNwL 0l

2 2 UP 19023E21 23940 Sumit Awasthi GEN 1',|.17 GNwL 02

PWDwL 03,Against

UP 1907150.1 24240 Aditi Ranjan GEN '17 .02GN

wL 03

-l .1 UP t9058709 205 t0 Diksha Singh CEN 76.33 GN

wL 045 UP t9067170 Gautam Srivastava GEN 76.21 GN

wL 05LJP 190t958t 19766 Yash Sharma GEN '15.65 GN

wL 067 UP 190{3606 lr6l3 Vinay Kumar pandey GEN 75.t GN

wL 07I 8 UP 19498 Swati GEN

7 5.02 GNwL 08

UP r90 t t.169 t9657 Yuvraj Singh Rawat74.95 CN

wL 09l0 t0 UP t90052,19 Swasti Tripathi CEN 74.81 GN

WL IOII II UP t9032190 26452 Himadri Ojha

7 4.63 GNwL ti

I] UP 19046213 20226 Rashi Saxena GEN CNwL l2

ll t3 UP 19032526 I8II]GEN 74.17 CN

wL t3t..l t.l UP t90284t2 t483 I Vaishnavi Sharma OBC(NC 73.72

I5 I5 UP 19010709 23983 Shreshth Gupta GEN '73.57 GNwL t5

16 t6 UP 19055J66 22768 Anushka Saxena GEN CNwL t6

t7 l7 UP 19010587 10285 Radhika Sharma GEN 72.83

i8 I8 UP 190 [808 23864 Anutosh Tiwari CEN CNwL t8

l9 l9 t9062538 I1693 Aman Rai GEN 72.58 GNwL 19

:0 UP I9005221 t9577 Shatakshi Upadhyay GEN 72.3

2t 2t UP I90l t 5.13 i980i Mayank Pratap Singh oBC(Nc) 72.0s CNwL2t

OBCwL 0l

22 L]I' 190129J6 t9678 Dhatri pathakGEN 72.01 CN

wL 22

Page : l/6

Roll No.

PWDwL 02.Against

PWDwL 04,Against

5 24210

6

7

1900 ll 75

9CEN

23827

GEN

I2

74.55

Shristy Sharma

CNwL t4

72.97

GNwL l7

72.81

UP

20GN

wL20

22

l5 UP 24051 Shashank Kumar SC STwL 0t

SC

wL 0t.16 ) LJP t9018620 22592SC 59.04 ST

wL 02SC

wL 02-t7 UP l90Jl96l Pragya Bhashkar SC 58.78 STwL 03

SC

wL 03.t8 4 tJP 19006753 23838 Sanjeev Kumar SC STwL 04

SC

wL 04

UP 24057 Shashank Kumar SC SC

wL 0lST

wL 0t.18 2 UP 19018620 ?, so, Shivani Singh SC 59.04 SC

wL 02ST

wL 02i9 3 UP 19051963 20353 Pragya Bhashkar SC 58.78 SC

wL 03ST

wL 03.10 4 UP I9006751 2383 8 Sanjeev Kumar SC 58.72 SC

wL 04ST

wL 04.ll 5 UP 19052371 19442 NandiniSC 57 .64 SC

wL 05{: 6 UP 19021186 Arnit Kurnar SC 57.37 SC

wL 06ll 1 t902 t30 t t9795 Aashish Anand SC 57.t.l.l 8 UP 190 t3792 t23s5 Sh ivrarrr

s6.2 SC

wL 08

S.No.Statc/tlT

Appt.Roll No. Name Celcgorv Disabilitv Total

Score

l-1 UP l902 t5t_3 r 9801 Mayank Pratap Singh oBc(NC) OBCwL 0l

GNwL2t

2l 2 UP l 7:l2l 24214 Mohit Kumar oBC(NC) OBCwL 02

2S 190-r{{05 Suhail Khan oBC(NC) 71.82 OBCwL 03

l UP r900E29.1 23843 Ishita Daksh oBC(NC) 7t.76 OBCwL 04

27-5 UP 19010981 I t5l9 Gyan Prakash Chauhan oBC(NC) 71.63 OBC

wL 05t8 6 UP 24168 Ankit Sahu OBC(NC OBCwL 06l9 7 UP 190t8542 23894 Shrishti yadav oBc(NC) 70.85 OBCwL 07

.]0 8 UP 19071462 24239 Namrata yadav oBC(NC) 70.55 OBCwL 08

-lt 9 UP t900.t060 238t6OBC(NC OBC

wL 09l2 t0 UP I905 t0 t0 20338 Karishma Kumari oBC(NC) 68.75 OBCwL l0l3 II UP 190.r 16,t3 11557 Arnan Kumar oBC(Nc) 68OBC

WL II.l.l t2 UP 19037147 194t3 Goransh Kumar oBC(NC) 67.95 OBCwL t2.ls UP 1900-] t96 I1443 Kundan Maurya oBC(NC) 67.73 OBCWL I336 l1 UP 190:l{5EJ I 1572 Indradev yadav

oBC(NC 67 .33 OBCwL 14

R.EGIONAL INSTITUTE OF EDUCATION, AJMERB.Sc.B.Ed. part_I (pCM Group) 2019-20

Provisional Waiting List Candida . eoqBselitrg Date : 23-07-2019 at 10:00 AMte of Uttar pradesh State(Gen.-22 oBC_ 14 SC -08 sT-04

Ultar Pradesh Statc Waiti ng List OBC - 14

lJttar Pratlesh State Waitin List SC - 8

)

Uttar Pradesh State Waiting List S't' - .l

Page : 2/6

19011969

60.68

Shivani Singh

203s3

58.72

72.05

71.82

UP 20026

26

19059876

70.95

Sonali Kushwaha70.44

t3

37 1904.1969

60.68

23937

UP

SC

wL 07

qa

REGIONAL INSTITUTf, OF EDUCATION. AJMERB.Sc.B.f,d. part-I (pCM Group) 2019-20

Provisional Waiting List Candidate of Rajasthan Statc(Gen. - l5 OBC - 06 sc-03 sT_ )

Ra asthan Stale W st General - l5aiting Li

Ra asthan State WaitingL ist OBC - 06

Ra asthan State Waiti

Counsel tn Date :23-07-2019 at I 0:00 AM

70 RAJ 1905.14.19 il0ll Jaya Doliya SC 'tI.3t SC

WLOI1t RAJ r90J5051 I1028 Sheetal SC SC

wL 0212 RAJ 19042555 10738 Abhishek Kadela SC 69 SC

wL 03

Stete/

trt'Appr

Roll No. Name C{tagory TotalScore I

RAJ t90550t0 2276t Chirag Lawaniya CEN CNWLOI

PWDwL 06

s0 ,|r90 t363 1 10304 Kapilendra Singh Chau GEN 78.63 CN

wL 02il RAJ 22469 Aakanksha Jaiman CEN 78.5 CN

wL 03r'l 4 RAJ 1903 r254 22526 oBC(NC) '78.46 CN

wL 04OBC

wL 0ljj 5 RAI t90t I569 2244 t Pragya Kumari78.45 CN

wL 0551 6 RAJ t90t 84 t2 21934 Sneha Punia GEN 77 .66

55 7 RAJ l90Jr98l )"t1<O Jyotsana Goutam GEN 77.t1 CNwL0'1

56 8 IIAJ t9061913 22869 Mukul Gautam GEN GNwL 08

i7 9 RAJ Vikas Nagar OBC(NC 76.84 CNwL 09

OBCwL 0258 l0 RAJ 1905902 t 22812 Ayushi Sharma GEN GN

wL t059 RAJ t9052 t97 22719 Shweta Sachdeva GEN 76.72

t2 RA.I 190{_1090 22636 Jitender Kildoliya OBC(NC 76.55 CNwL t2

OBCwL 036t ti RAJ 190t575t 22667 Bhanu Pratap Rathore CEN 76. t7 GN

wL t36) l.l RAJ 19069 t65 ))01n Bhagyashree Solanki oBC(NC)7 5.4 GN

wL i4OBC

wL 04t5 RAJ 1901,t688 r0809 Anish Jangir oBC(NC)7 5.25 CN

wL t5OBC

wL 05

6.1 RAJ l90t t 254 22s26 Tej Prakash Dhakar oBc(NC 78.46 OBCwL 0l

CNwL 0465 ) RAJ 22874 Vikas Nagar oBC(NC) OBC

wL 02CN

wL 09{r6 R,AJ I9011090 22636 Jitender Kildoliya oBC(NC) /O. JJ OBCwL 03

CNwL t267 4 RAJ t9069 t65 Bhagyashree Solanki oBC(NC)

7 5.4OBC

wL 04CN

WL i468 5 RAJ i90.11688 10809 Anish Jangir 0BC(NC)7 5.25 OBC

wL 05CN

WL I56 RAJ t90068 t9 t0241 Sakshi Kunwar OBC(NC 40.5 OBC

wL 06ng List SC - 03

Page : 3/6

Disabilitl

78.? t

RAJ

I902.19E9

Tej Prakash Dhakar

CEN

CNwL 06

76.9t

I906J6.10 22874

76.7 5

IIGN

wL60

6-l

l

t9065640

'76.84

22920

I

2

70.5

\2-

REGIONAL INSTITUTE OF EDUCATION, AJMERB.Sc.B.f,d. part-I (pCM Group) 2019-20

Provisional Waiting List Candidate of Pun.iab State(Gen. - l0 oBC-05 sc_ sT_ )

Pu ab Sta te Waiti List General - l0

Pu a b State Waitin List OBC - 05

Counsolin Date .23-07- 9a l0:0020

Haryana ShteST. )

eral - l0

AM

Provisional Waiting List Candidate of(Gen. - l0 OBC _ 0S SC -

Ha na State Waitin List Gen

Stsfe/trt'

AppLRoll \o. Name ('ategor! Total

Score13 Ptl 17793 Kamni66.27 CN

wL 0l11 ) PB t90t855J t7724 Amanpreet Kaur Goray GEN 64.86 CNwL 0275 PB t9552 Pratibha Patra )t 6t.2t CNwL 0316 4 PB 190.tl]]I 17782 Sahil Arora CEN 60.37

77 5 PB 1901J2.15 17773 Barbika CEN 59.88 CNwL 0578 6 PB 19006:rE6 17706 Arju OBC(NC 58.12 CNwL 06

OBCwL 0t19 7 PB 1 39789 Nidhi Sharrna CEN 56.46 CN

wL 0780 8 PB 19041690 17795 Arashpreet Kaur oBC(NC) 56.18 CNwL 08

OBC

wL 02IJI I PB 190041t9 Aradlrana CEN 54.6 CNwL 0982 t0 PB t9021974 23043 Parth Saini

54.58 ON

wL l0oBc

wL 03

8.1 PB 190063E6 17706 Arju oBC(NC) 58. I2 OBC

wL 0tCN

wL 068.1 2 Ptl 190.1.1690 l,7795 Arashpreet Kaur oBC(NC) 56. I8 OBCwL 02

GN

wL 088-i Pti t9023974 23043 Parth Saini oBC(NC) 54.5 8oBc

wL 03CN

wL t086 4 Ptl 1907t965 17861OBC(NC 23.73 OBC

wL 04lt7 5 Pli 19007558 17709 Deepti oBC(NC) OBCwL 05

S.No. StslG/

tiTAppt.

Roll \o. Name Disability TotalScoreslt HR t90119t7 20168 Ritika Arya oBC(NC) 74.56 CN

wL 0tli9 19044087 Kriti Malik GEN CNwL 02IJR lq)o29lt 17906 Digvijay Singh Matik GEN 73.5 CNwL 039l 4 IIR t9010670 19649 Preeti GEN 12.'t CNwL 04s2 5 IIR t 9000187 24413 Vikash Yadav OBC(NC 72.57 OBC

WL OI6 HR 19054000 17822 Mohit Singh CEN 7 t.56 CNwL 069.1 7 HR t9005.186 Sh ivani

7t.29 CNwL 0795 8 ltR t90.18001 2027 t Aayushi CEN 7t.t5 CNwL 089 HR t9002460 19522 Ritik Arya oBc(NC) 70.85 CNwL 09

OBC

wL0297 l0 t910452J7 20202 Saurabh70.52 CN

wL t0

98 HR 24413 Vikash yadavOBC(NC 72.57 CN

wL 0599 ) HR t9002460 19522 Ritik Arya OBC(NC 70.85 OBCwL 02

GNwL 09t00 IIR t9079651 70794 Bhawna oBC(NC) 10.45 OBC

wL 03t0l .l HR 19012-1t.t 20132 Ekta oBC(NC) 70.25 OBCwL 04t02 5 HR 19017828 1972t Rohit OBC(NC 70.t3 OBCwL 05

Haryana Staie Waiting List OBC - 05

Page : 4/6

DisabiliryI

I 19044408GEN

19004 t97Pool SC

wL 02GN

wL 04

17779

17703

oBC(NC)

Abhinav Saini

23.07

Cs tegory

HR 2017374.54

CNwl. 0s9-l

17705CEN

HRGEN

19000187

OBCwL 0t

\v-

REGIONAL INSTITUTE OF EDUCATION, AJMERB.Sc.B.Ed. part_I (pCM Group) 2019_20

Counse lin Date:23-O7 -2019 aProvisional Waiting List Candidate of Delhi State(Gen. - 05 OBC _ SC.

Delhi Stale Wai ting List General - 05

Provisional Waiting List Candidate of Jammu antl Kashm tr, Uttarakhand,Himachal pratles h, Chandigarh State pOOLED GEN Category - l0(Gen. -l0 OBC- SC. ST-

Provisional Waiting List Candidate of Delhi, Jammu and Kashmir, U arakhantlHimachal pradesh, Chandigarh State pOOLED OBC Category - t0(Gen. - OBC. IO SC sT-

I0:00 AIt

)

S.\o. Strt./UT

appl.Roll \o. Name (l.tegor) Disabilit) Total

Scorel0l Delhi 19035E41 20048CEN 79.68 GN

wL 0tr0+ Delhi 20061 Riya Angira GEN 78.63 CNwL 02t05 J t90.t I t99 20122 Sutnit Saroha GEN 77 22 GN

wL 0lt06 4 19684 Vibhor GEN CNwL 04lo7 5 Dclhi l90 t:r562 19685 Megha GEN 756 GNwL 05

S.No.Strte/uT

ApplRoll No- Name Categoe. Disability Total

ScoreItlS ltP 190.13655 17789 Vani14.86 Pool cN

wL0tt09 2 UKD i90 t99 t, t?73 t Anshul Sharma GEN ?4 82Pool CNwL 020 3 UKD t905841I 19453

CEN 74.22 Pool CNwL 03lI .l 19016097 t9430 Jyoti GEN Pool CNwL 04|2 5 HP 19015 t t:1 23048 Himanshu patial

73.42 Pool GNwL 053 6 UKD 1906J Il7 19463 Akanksha Rawat GEN 73. t5 Pool CNwL 06I t.l 7 UKD t9046607 Yaduvendra Shah GEN 73.1 Pool CNwL 07|5 8 HP 190J1902 28726 Aryan Bhatia

7r.38 Poo, GNwL 08lr6 9 UKD 190J0963 20336 Harshita Joshi GEN 67.A2 Pool CNwL 09lt7 TJKD t9020E93 t9375 Shikhar Shiv

67.63 Pool CNWL IO

S.No. Saete/

TITAppt

Roll No- Name Celegory Disnbility TotalScoreI I{i 19017E90 19726 Sudhanshu yadav

OBC(NC 68.1I Pool OBCwL 0l9 2 Dclhi l90l9l6E 201 0l Anubhav panwar oBC(NC) 65 88

Pool OBC WL02t20 Dclhi 19026645 1988 I Savita Prasad OBC(NC 6-i I

Pool OBC WL0lt:t .l HP 28723 oBC(NC) 61 9q

t2) Delhi r9028922 i99t8 Mayank oBC(NC) 631 Pool OBCwL 05r2J 6 Dclhi 19509 Anjali Shaw oBC(NC) 62.5 Pool OBC WL

06lll 7 UKD 19019711 t9370 Labiba Fatima56.99

125 8 t9052508 20377 Shilpi oBC(NC) s6.12 Pool OBC WL089 UKD r9062218 r 9458 Abhishek Sernwal oBC(NC) 56 05

Pool OBC WL09127 i0 Delhi 22058 Yatender OBC(NC i5 62

Pool OBC WLl0

Page : 5/6

I SakshiPWD

wL 05t9016106

D€lhi

Delhi 1901529

76.82

sr- )

CEN

Ankesh Bhatt

UKD

73.{8

GEN

20239

SC

l0oBC(C)

Delhi

19029r28 Aastha Lakhanpal Pool OBC WL04

5

t9002037

oBC(NC) Pool OBC WL01

Delhi

r26

REGIONAL INSTITUTI OF EDUCATION, AJI\{ERB.Sc,B.Ed. part-I (pCM Group) 2019_20

ounselin Da te : 23-0 7-2019 arl0Provisional Waiting List Candidate of punjab, Haryana, Delhi, Jr--u ,nd Kashmir.Uttarakh and, Himachal pradesh. Chandigarh State POOLED SC Categolv - I0(Gen. - OBC - SC - IO ST.

Provisional Waiting List Candirla te of Rajasthan, punjab, Ha ryana, Delhi,Jammu and Kashmir, Uttarakhand, Himachal pradesh, Cha ndigarh StatePOOLE D ST Category - l0(Gen. - OBC - SC- sT- l0)

Provisional Waiting Candidate List of pWD Category - I0Gen. - l0 OBC - SC- ST-

C:OO AM

)

S.No.Strtc/IIT

ApPLRoll No. Name CrtegorJ* Disabilit-y Total

Scorei28 TIP t9053902 Aryan Bhatia SC 7t.38) PB I9004197 19552 Pratibha Patra SC 6t .21

Pool SC

wL 02CN

wL 0lJ HR Ankush Kumar Gagat SC 6t.t3 Pool SC

wL 03t-r I 4 I It' t9041819 28724 Rohit Bansal SC 60.t8 Pool SC

wL 045 HR 1900:1659 t9567 Ashish Kumar SC 59.85 Pool SC

wL 05t-r.l 6 Delhi t9059590 20524SC 58._.17

Pool SC

wL 06l.t.l 7 Delhi 1902J651 r987t Ansh Vikas Meshram SC s'7 .36 Pool SC

wL 07B5 8 IIR I9010981 20il8 Sumit Saroliya SC 56.23 Pool SC

wL 08B6 9 HR 190077r1 l96t I Laxrni SC 55.75 Pool SC

wL 09ll7 IO HR t9078203 20770 AkshaySC 55.73 Pool SC

wL r0

S,No. SlIlte/IT

ApprNamc Category Disabitity Total

Scoret3lt RAJ I9030-1,t7 Harish Kumar Meena ST 68.t7 Poo, STwL 0tti9 ,|

RAJ 19014191 I t357 Manisha Meena D/o G ST 68.15 Pool STwL 02l]0 J Dclhi 19018:t t 7 1974t Anuradha Meena ST 65. t9 Pool STwL 0ll.l I 1 RAJ l900l7,lJ 22304 Manisha Meena D/o M ST

j.l2 5 RAJ I904J561 22665 Dipesh Meena ST 63.22 Pool ST

w_ 05tJl 6 RAJ 1901?115 2258t Devendra Kumar Meen ST 6l .8 Pool STwL 06it.l 7 RAJ 190{ t654 22617 Diksha Meena ST 6 I ..18

Pool STwL 07t.l5 8 RAJ r90.r6J80 22675 Praveen Kumar Meena ST 60.88 Pool STwL 08I.l6 9 RAJ 19007332 Saroj Meena

60.09 Pool STwL 09l.t 7 l0 RAJ 22888 Meet Kumar Meena ST 59.16 Pool STwL t0

S.\o. Stste/IIT

ApprRoll \o. Name Category Disabilitv Total

Score IIt8 lrR t9022021 19807 Rahul Tanwar GEN

AulismSpeclrunl

Disorder44.01 PWD

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Atul Chaudhary

Roll No,

22518

64.s2 Pool STwL 04

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I9066139

Sumit Awasthi

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No

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EiSf r,laNCGiRT

l. Name of Student (ln Capital letters)

2. Mother's Name

3. Father/Guardian's Name

4. Date of Birth

5. Category (GEN/OBC/SC/ST/PWD)

6. Aadhar Card No.(A photocopy must be attached)

7. State from which you lrave beenselected for admission

8. Residence Address

REGIONAL INSTITUTE OF EDUCATION, AJMER(Natiotral Council of Educational Research & Training)

(NAAC accredited with A+ Grade Institution of NCERT)

Performa for checking oforiginal documents and depositing fees etc.

Affixlatestphoto

Session 2019 - 2020

Progranrme

Reg./Appl. No....................................

Mob.No

E-mail

Mob.No.

E-mail

Mob.No.

E-mail

State.................................. Pin9. Name of Home-Town

10. Nearest Railway Station

I l. Nearest Bus Station(For of Railway/Bus Concession)

12. Are you employed ?(Ifemployed, give the name &address of the Employer)

I 3. Teaching Experience (Certificateto be enclosed duly contersignedby the Inspector of School/District Education Officer/BDO)

14. Name ofthe Board/Universili last attended

15. Name ofthe Institution last attended.

16. In case you have already been enrolled in theMDS University, Ajmer please mention yourEnrolment Number

I 7. Whether Hostel accommodation is required?

18. Whether Police verification certificate is enclosed?

Yes / No

Yes / No

P.T.O.

Examination Passed Year DivisionMABKS Percentage

of marksobtained

Subject OfferedMaximum Obtained

Sr. Sec./lnter/+2

B. A./B.Com./B.Sc.

M.A.iM.Com./Ir4.Sc.

B.Ed./8.T./L.T.

M.Ed.

Other

-2-

I 9. Academic Records

Date Full Signature of the student

FOR OFFICE USE ONLY

original documents have been checked by me and found correct. self Attested/Attested copies ofnecessary documents along with the original Transfer certificate/college Leaving certificate/RelievingletterNo objection ce(ificate fiom the organization/lnstitution last served/serving are enclosed in theoriginal Application Form.

The student Ms./Mr.

aftemoon of ........................... .

reported in lhe forenoon/

CHECKING OFFICER

Fees may be accepted/not accepted.

CONVENORHEAD OF DEPARTMENT/CT{AIRPERSON ADMISSION COMMITTEE

PRINCIPAL

Hostel accomodation allowetl/not allowed.

CHIEF WARDEN

FOR ACCOUNTS SECTION USE ONLY

Ms./Mrhas deposited her/his fees amounting

to Rs. ............................ vide Receipt No.

Dated

dated

Signature of Cashier

(l)..........

No.REGIONAL INSTITUTE OF EDUCATION AJMER

(National Council of Educational Research & Training)(NAAC accredited with A+ crade Institution of NCERT)

Aonlication for Hostel Admission

Session 2(l l9-2020

Affixlatestphoto

E{fr*r'tANcGRT

l. Name of Student

2. Aadhar No.

3. Mother's Name

4. Father/Husband,/Guardian's Name

5. Permanent Home Address

with Phone/l\4obile No.

7. Programme/Course Admitted to

8. Date of Admission

9. Fee Receipt No.: ...and Date

l0.Name and Address of Persons to be contacted in emergency :

(2)....Mobile No

Mobile No

I I .Declaration: (i) The above information is correct to the best of my knowledge and belief.(ii) I have read and fully understood the rules and regulations ofthe hostel. I shall abide by them(iii) In case I fail in the University Main Examination, I shall immediately vacate rhe hostel.

Date Signature of the Student

Remarks of the Head of the Department : Recommended,Not reconrrnended for admission.

Date:Signature of HOD

ORDI,]R

Ms./l\4r D/o W/o S/o

is hereby provisionally allotted Room No.................. in .

Her/His admission is subject to her/his good conduct during the stay in the hoster

Warden

Hostel w.e.f. ....

Chief War-den

ACKN DGEIU EN'TowL[

I have occupied Room No........... of.............................. Hostel. I have taken possession ofthe following articles which are in good condition. The safe custody ofthese articles is ml ,i.i"n.iuirity.lfl am found involved in any activity reading to damage to the hoster property, r *irr u"u.ii" J*p"nr", orthe damage.

Table- l,Chair- l ,

Cot- 1,

Place: Ajmer

Ceiling Fan-1,Complete Tube Light- I

Signature of the Hosteler

Date:

This form should be submittetl to the lloste Clerk

6. Local Guardian and Address (ifany) : ................

REGIONAL INSTITUTE OF EDUCATION, AJMER(National Council of Educational Research and Training)

(NAAC accredited A+ Grade Institution of NCERT)

MEDICAL CERTIFICATE

D/o S/o Shri

Sex Height: Weight

Affixlatestphoto

q.6 f rrt aNCGRT

Name

Age

Vision : Distance:

N

Color vision

(Inability to distinguish between principal colours)

Congenital or other diseases : ........................

Hearing:

(Whether defective, must be corrected)

Pregnancy (Female candidate): yes / No

* I hereby certily that I have examined Ms./Mr

a candidate for admission to Four year B.A.B.Ed./ Four year B.Sc.B.Ed./ Two year B.Ed.i rwoYear M'Ed. Programme/ Diploma course of Guidance and Counselling (DCGC) in the RegionalInstitute of Education (NCERT), Ajmer (Rajasthan) and could not discover that she/he has anvdesease except

I do not consider that her/his will hamper her&is studies for the above mentionedprogramme/course.

Date

Place

MEDICAL OFFICER

SEAL

* This certificate is to be given by a Medical Officer of aof Medical College,4lospital in the State.

District Govt. Hospital or Superintendent

DECLARATION / UNDER'TAKING

I, Ms./Ii1r. . D/o W/o S/o Shriin the light ofSupreme Courtjudgment hereby solemnly declare that:

No complaint/FlR has been lodged against me by any authority of previous rnstitution in which rstudied.

Date

Signature of the student

Name

Class

My latest address is:-

Signature ofthe parents/G uard ian

Name

Relation with the student

I have never indulged in any incident of ragging nor I will indulge in such kind ofact in future. If I anrfound indulged in such activities ofragging, my admission will be automatically stand canceled.

I have gone through all the rules and regulations ofthe Institute and I agree to abide by the same. I rvilladhere to all the rules pertaining to discipline of the hostel and the InJitute. In previlus

"tur."l I *u,

not involved in any,act ofindicipline. I shall not indulged in any indicipline activities l"ualn! io a1,,ug.of HosteUlnstitute furniture, cCTV Camera's etc. I al;o declare that I ihall submit the hoste] admissionform in the stipulated time. I shall not take any part in the unauthorised occupancy in tt

" t ort"i .oor. t

also declare that I am not working in any government/semi government/autonomous/private institution.

I was never_ charged ofany misbehaviour/crime and neither I have been released on bail in mafier ol-any criminal act and no criminal case in pending against me in any Court of law.

')

l

-l

5

6

7

8

I am well aware ofthe University rules regarding g0% aftendance in each subject, which is compursary,failling which I shall be debarred_ from ta[ing ttre examination. If I remain ausent *ittrouiinil,nltion roth^e Institute continuousry for l5 days or morJ from the Institute fo. any .eason, *v ""r"lr,rii'i" ,t",.1ofautomatically from the students roll.

I shall attend classes regularly in the lnstitute and my admission can be cancelled if I continuousll,remain absent without the permission^of principar for a period of fifteen auy, o. *or".'ii,"au" t"shortage of attendance, I am detained from appearing in the university e*urln"uti- tir" ."rpo'".iuirirywould be of my own.

I.he.reby undertake that I shall participate in all the celebrations hosted by the Institute positively andabide. by. all_ the. rures and regurations of the Institute. In .r." or *y unsatisfactof ""ri*'i, "ra ",outside the Institute, my adntission may be cancelled and I may be expelled from the Hostel and orInstitute.

I declare that all the enteries in my admission form are true and correct to the best ofmy knowredge andbelief' In case anything is found wrong/incorrect my admission wiI automaticalry stani ";;i;:In case any relevant information is found to be suppressed by me, my admission can be canceled at any

I shall abide the rules and regulations mentioned in ordinance ot'Maharshi Dayanand SarasrvatiUniveristy, Ajmer.

I

t0

I agree to abide by the declaration/undertaking given by my ward.

Emergency contact number __

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GBY STUDENT

(name of student) Dio S/o

do hereby undertake that in case my phasewise attendance is found short (as

per M.D.S.U., Ajmer norms) in R.l.E., Ajmer for the (Session/Semester) in

c lass my admission from this Institution or Hostel or both may

be cancelled.

Signature of the Student....

Name of the Student..............

Session 20......- 20......

G BY PARENTS/GUARDIAN

I

I (name of parent) (Relation)

of

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attendance rules (M.D.S.U., Ajmer) and cancellation of admission due to shortage in atlendance.

ln case the shortage ofthe attendance of my ward (name of

student), herihis admission may be cancelled from the Institute or Hostel or both.

Signature of the Parents/Guardian..'.......'...

Name of the Parents/Guardian.....

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copy of th€ UGC Regulatiom oh Curbrng thc lvlenace of Ragging rn l{igher Edruttuul lnstitutlons. 2009.(hcreirurftrr called the "ReBulitrons")- catrd'ullv rcad and t'ullr Lrnderstorxl the provisrons conulinc{j rn tlrc saidRcgulatiorsl) l.luve, in panicular, pcrused clause 3 oI the Resulutr.,ns arrd an auarc a; to *,hat constttutL* rag$nt?l I lnve also, in Partrcular, Pcrusod clause 7 and clause 9 I of the Regulitrons and anr I'ullv aware ot thepenal and administrative action lhat is liable to be taken agaimt mv rxard rn ci-u;c he/slre rs lirunrl ..:url6 of orabating ragging actively o, passrvely, or betng pa,l oIa consprrac\, to promot" ragg,ng3) I hercby solemnly arer and undertake thata) My uard will not indulge in an1'behaviour or act that may be constituted as rag-s.tng under cla$e ] ol thcRegulations.b) Ir'ly rmrd will not Participale tn or abet or propagate lkough ar\ acl of comnissiuu or onrrssion thal mav hcconstituted as ragging under clause 3 ofthc Rcgulations.4) t hercby athrm that, if found guiltv of ragging mv rl"rd is lrable for purlshment accord,ng ta clalsc 9 I

of the Regulations, without prejudice to any othdl criminal actroo th.rt may be taken agi}nst my r.ranl untler rnvpenal larv or arry law lbr the time bcing in folcc5) | hereby declarc that my uard has not hd'en expslled or debarred tiom admission in any institution in thccolntry on aocurnt of being tbund guitty ot, abetting or being part of c ctxspiracv to pri)mote. ragging: andftrltrr affirm that, in cast thc declaraturn is found to be untruc. the adrnission of my uarri is liable to hccarNclled.6) Along with the ahove mentioned ptiints I do hereby declare th:x

a) My ward will ohry thc codc oleonduct rrf the mstitule und do not indulBe rn anv kind of in-disuplrncdactivity while in ad off thc institution canrpus.

b) My ward will bc solelv resporsible for any kind ot'accidenUmishap coused on accorrnt of tJ:c ahrvementioncd clause (6.a).

ANNEXURE IIAFFIDAVTT BY PARENT/GUARDIAN

l. Mr./Mrs./lvls. ( litllmme of parent/guardian) l'attEr/moiherlguardian of , (tirll name of student with ljnivcrsitv Ii.oll Nurnber) . luvinsbccn admrttcd to nanle of'lhe irlstitrfiton) - tnvc rccerved or do$nloadcd I

I)cr;larerl this of_ month of year

Srgn.rturc (!l del()ncnlNnrnc.r\ddrcss

Tclcphoner Mobile No.vuRtl'lcA1-toN

Vcrilied that thc contcnts ol this allidavrt are lru(r to thc best ol'my knorvlcdge and nrr part o he allidl\ it ts hlscand nothing has bcen concealed or misstatsd thercrn

Verified at (place) on this the (dav) of(monrhi , (_vear )

Signature ol' dcpon!.ntSolernnll, allirmed and srgncd ln my pr!-scncc on this thc (da\ )oi (month),_(1'ear) afler reading the contents of this allidavit

()A I I I ( t )i\1NllSSl()NI:t(!\ole: L ir nandatot't to suhuit this allidattt in thc ubotc Ji,t iktt. tl .rok destr! to rcgi\to-.lil. t h.

forlh<'on i ng acadt m t.' sc.t.\ t t)u.

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ANNEXURE IAFFIDAVIT BY THE STUDENT

|'1fulltrameofstudentrvithllrsiltutcRollN1Irnller)s/o r:1,/o Mr.,/Mrs./Ms.been admrned to name ofthe rnslitution) . havc

S ignature of deponentNamc:

VERIFICATIONVerified that tlre contents ofthts amdavit are true to thc besl ofmy knowledgc and no part ofthe aftidavit is talscand rdhing has b€en conceald or mis$ated thcreio

Venlicd at placc) on this thc --------(day) of -------tmonth) , ------(year )

Signrlure ol'deponentSolemnly aflirmcd and siSned in nrv pr!'seoce on this the duv) of month) ,

---------(ycar ) atler reading thc contcnls r)[ lhis irll]davrt

OA I Il ( l( )i\ll\llSSI( )N l.l{

Nole : It is mandalory lo submit this tdfic*.n'ir in the above Jirrnu , i-frou desirc to regislerJrr the

fonhcoming acadc mi c sc ss ion.

___,_. kaving

rcceived or downloadcd a copy ofthe UGC Regulations on Curbrng th€ MerEce of Ra€€ing in HlghcrEducatronal lnstitutions, 2009, (hereinafter called the "Regulatrons") carefull.v read and fi.illy u.derstood theproyrsrons contarned in the said Regulationsl) I have. in partisular. peruscd clause 3 ofthe Rcgulations and am a$are as to ivhat conslitutss rngging2) I tnve also, in parlicular. perused clause 7 and clause I t ofthe Regulatrons and am firlly- a\\,ure ol thcpenal and admtnistrative action that is liable to be taken agrirst mc in cas!. t am li,und gulltv of o, aberrlDsragglnB actlvely or passivgly, or being part ofa co[spracy to promote r3Bgrng.ii) I hercby solemnly aver ond undcnake thata) I will nol indulge in any behavrour or act that mav be constituled as ragging undtr clausc i ol'thcRegulations.b) I will not pariicipate in or abet or propaElate though nv aca of co[[nission or omissron that ma! hcconstitutcd as ragging under clause 3 ofthe Regulations4) I hereby afrm that. if lbund Builty of ragging, I am lrable tbr pu'xshment acctxdilrg to clausc r) I {,t' thcRegulaltoru, wilhout Prcjudtce to llnv oth$ cnminal action ihrt ma-'- be taken agMst mc undcr any.penal lau,orany law for the time being in t'olce.5) I hueby delare ttnt I hnve nc{ be€n expell:rlor debarred liom admission in aoy rnstitgtror ln thc e()untr.,on tccuunt 0l'being tbund guilty oi abclting or bcing part ofa conspirae-v to promotc. ragging, arrd furthcr utl'umthal, in case th€ declaration is lound to be untrug I am a\rare that my admission is liable to bc c.rncellcd.6l Aloflg with thc abovc mcntioned points I do hcrehy derlare that

a).I will obey the culc olconduct ofthc institute and do nff indulge in any kind ol in-d isciplincd ircrrvttJwhile in and offthe institution campus.

b. I wili bc solcly responsible for any kind of accidentrmishap crustd on accr'runt (,1'rhr: irbovr rncntroncdclause (6.a).

Dcclared this _day of _ month of year.

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