PROGRAMME MED  
NAME (IN CAPITAL LETTER) NAME (IN HINDI)
DATE OF BIRTH
/ /
GENDER
FATHER's/HUSBAND's NAME MOTHER's NAME
MOBILE NO NATIONALITY
AADHAR NO RELIGION
EMAIL ID
CATEGORY SUB CATEGORY
क्या बीएड उपाधि VBSPU से प्राप्त की है IDENTIFICATION MARK
CORRESPOMDING ADDRESS
ADDRESS 1
PERMANENT ADDRESS
ADDRESS 2
Educational statement (HIGH SCHOOL TO P.G.)
Detail Board/University Subject Year Grade Obt. Marks/Max Marks 
SECONDARY
   
/
Sr. SECONDARY
   
/
Graduation
   
/
Post Graduation
   
/
B.Ed.(50%)
   
/
B.A.B.Ed./B.Sc.B.Ed.(50%)
   
/
D.EL.ED(50%)+GRADUATION(50%)
   
/
CANDIDATE PHOTO CANDIDATE SIGNATURE