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WestBengalStateUniversityBerunanpukuria, P. O. Malikapur, PIN
700126
Barasat, North 24 Paraganas(Do not send any document with this
application form)
Application form for Registration in B. ED Course for session
2020...
Registration number (Instruction to fill up this number is given
at the end of page 3)
1 0 1
Name of the student:
Father/Mother/Husband/Guardian's name:
Present Address
Permanent Address
Date of Birth
Nationality
College code(3-digit code. Verify from the CollegeAuthority)
Subject code(3-digit code. Verify from the list provided) 1 4
1
Gender(Please Tick)
Male(1)
Female(2)
Religion(Please Tick)
Hindu(1)
Muslim(2)
Christian(3)
Others(4)
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Reservation Status (PleaseTick)
SC(1)
ST(2)
OBC(3)
General (4) PH(5)
Others (6)
Challenged
Category
General
(0)
Physically
Challenged(1)
Hearing
Impaire(2)
Visually
Challenged(3)
Cerebral
Palsey(4)
Others
(5)
Economically Challenged
Category
General
0
BPL Card Holder
1
APL Card Holder
2
Telephone Number(Preferably Mobile)
Course of Study
Subject of Study:
General Paper-I (Write Abbreviation)
General Paper-II (Write Abbreviation)
General Paper-III (Write Abbreviation)
Method Paper-IV (Write Abbreviation)
Method Paper-V (Write Abbreviation)
Special Paper-IV (Write Abbreviation)
LAST EXAMINATION PASSED: UNIVERSITY/BOARD
Name of the University/Board
Roll No. Year Division
Subject Total
Full
Marks
MarksObtained
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Declaration: Statements made above are true and correct and the
documents furnished along withthe form are genuine to the best of
my knowledge and belief. In case any of the documents
issubsequently detected to be fake or false, my Registration with
the University shall be liable to be
canceled. I, also declare that I shall obey the rules related to
attendance and anti ragging programme
framed by the University/College/UGC, otherwise disciplinary
action will be taken against me.
I understand that the Registration Fee to be received by the
University is Rs.100/- (One hundred)only.
Date:
.............................................................Signature
of the Applicant (In Full)
____________________________________________________________________________
(For College Use Only)Statements made above verified and found
to be correct
Date:. ..
.
Signature of the Principal
____________________________________________________________________________
How to fill up the entries in the Registration number?First 3
digits (digit position 1,2 and 3) College CodeNext 2 digits (digit
position 4 & 5) Year of admission (Here 09)
Next 3 digits (digit position 6,7 & 8) Subject code (should
start with 1)Next 1 digit (digit position 9) Gender (either 1 or
2)
Next 1 digit (digit position 10) Religion (either 1, 2, 3 or
4)Next 1 digit (digit position 11) Reservation (1, 2, 3, 4, or
5)Next 4 digits (digit position 12, 13, 14 & 15) Student's
serial number as assigned by the College.Next 1 digit (digit
position 16) Challenged Category (0,1, 2, 3, 4, or 5)
Next 1 digit (digit position 17) Economically Challenged
Category (0,1 or 2)
This is NOT the roll number of the candidates. Each student
should be assigned a unique numberby the College, starting from
0001 and running continuously without break
