FORM : 1
MADHYA PRADESH BHOJ (OPEN) UNIVERSITY
Raja Bhoj Marg (Kolar Road) Bhopal, 462023
Application Form For Admission
(B.Ed. Special Education Distance Education Programme (B.Ed. - SEDE)
1. Programme Code B. Ed. - SEDE
2. Programme Fee DD Details
DD No. DD Date
Date Month Year
DD Amount
(in Rs.)
Issuing Bank
Name & Code
Rs. 15,000/-
3. State Code :
4. Study Centre Code in order of preference in which the 1st
candidate wants admission :(Select that Study Centre where the 2nd
opted Disability Area is offered as chosen in Item 6) 3rd
5. Codes of School Subjects which the SS-1 : 0 1 or 0 2
Candidate wants to be offered :Tick (  ) SS-2 : 0 4 or 0 5 or 0 6
6. Disability Area in which the Candidate wants to specialize : Code No.: Code Name:
7. Name
8. Father's/Husband's Name/
Mother's Name
(strike out whichever is not applicable)
9. a) Address for
correspondence
(Do not give Box No.
address. Leave a blank
box between each unit
of address like House No.,
Street Name, P.O., etc
Pin Code
Affix
your latest
passport size
photograph
(4cm x 5cm)
duly attested
by you
FORM No. B.Ed – SEDE : K10
WHILE SENDING DOWNLOADED APPLICATION, THE INSTRUCTIONS
GIVEN IN THE ADVERTISEMENT MODE III SHOULD BE FOLLOWED
Telephone / Mobile No. (if any)
b) Fax No. (if any)
c) E-Mail No. (if any) _________________________________________________________________
10. Date of Birth
Date Month Year
11. Nationality
12. Country of Residence
13. Sex Code 14. Category Code
15. Educational Qualifications : (Please attach attested photocopies of certificates/degrees along with marksheet)
Examination Passed Year of
Completion
Subjects % of Marks
Obtained
Board/University
1. Matriculation
2. Higher/Sr.Secondary
3. Graduation
4. Post- Graduation
5. Research Degree
16. I fulfill following Eligibility Criteria(s)
(1) I have a Bachelor Degree from a recognized University; and
(2) I fulfill the following condition(s) (Tick  whichever applicable)
(i) parent of disabled child*,
(ii) disabled person*,
(iii) possess a Diploma in Special Education of RCI
(iv) have undergone Bridge Course of RCI,
(v) have completed RCI-MPBOU Foundation Course (FC-SEDE),
(vi) Bachelor Degree on or before 2007
*Note: The Eligibility Condition (i) / (ii) should be accompanied by a certificate issued by a competent authority as
per PWD Act norm. (In case of parent the certificate of the Disabled Child should be submitted)
Date : ______________________ ____________________
Signature of the Candidate
WHILE SENDING DOWNLOADED APPLICATION, THE INSTRUCTIONS
GIVEN IN THE ADVERTISEMENT MODE III SHOULD BE FOLLOWED
FORM : 2
Certificate of Employment
(To be given on a Letter Head of the Registered Standard Institution serving in Disability Area)
Name of the Candidate : ____________________________________________
Employment Specifications :
1. Name of the employing Institution : ____________________________________________
2. Nature of Institution : Educational/Hospital/NGO/ ______________________
3. Registration No. (if NGO) : ____________________________________________
4. Nature of work of the Institution : ____________________________________________
5. Period of service experience : From __________________ To __________________
6. Kind of Work Experience gained by
the applicant in Disability Area : ____________________________________________
____________________________________________
This is to certify that above statement is correct to the best of my knowledge.
Signature of Administrative Officer*
of the Institution
Date: ________________
Seal
Checked and forwarded
Signature of the Coordinator
of the Study Centre
Date: ______________
Seal
_________________________________________________________________________________
This certificate can be signed by District Education Officer (DEO)/Disabled Welfare Officer/Social Welfare Officer/District Rural Development Officer/Block Development Officer/Head of any Institute recognized by RCI, NGO receiving major grants from the State Government or the Government of India and engaged in the work based on the disability.
WHILE SENDING DOWNLOADED APPLICATION, THE INSTRUCTIONS
GIVEN IN THE ADVERTISEMENT MODE III SHOULD BE FOLLOWED
FORM : 3
Category Certificate
(For SC/ST/OBC/PH candidates)
This is to certify that Mr./Ms. _________________________________________________________
Son/daughter/wife of Shri ____________________________________ of Village _____________________Town _________________________ District ____________________ State/U.T. _____________________belongs to ___________________________________________ caste category which is recognised as a Scheduled Caste/Scheduled Tribe/OBC under the Constitution (Scheduled Caste Part C States) Order 1951 read with the SC/ST lists (Modification) Order, 1956.
Mr./Ms. ______________________________________________ and his/her family reside in village Town ______________________________________ District _____________________ State/U.T. _____________
Signature of Tehsildar/Commissioner/District Magistrate
Place : _______________________ Name ______________________________________
Date : ________________________ Seal/Stamp __________________________________
________________________________________________________________________________________
FORM : 4
DECLARATION BY APPLICANT
I hereby by declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfil the minimum eligibility criteria and have provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the university at any time and I shall not be entitled to refund of any fee paid by me to the university.
Date : ______________________________________________________________
Signature of Candidate
WHILE SENDING DOWNLOADED APPLICATION, THE INSTRUCTIONS
GIVEN IN THE ADVERTISEMENT MODE III SHOULD BE FOLLOWED
MPBOU-RCI B.Ed.-SEDE Entrance Test 2010
Application Form No.B.Ed.-SEDE : K10
ADMIT CARD (A)
Name :…………………………………………………………………………
Father’s/Husband’s Name : ………………………………………………...
Address: ……………………………………………………………………..
……………………………………………………………………… Signature of the Candidate
-------------------------------------------------------------------------------------------------------------------------------
FOR OFFICE USE ONLY
Date of Examination …………………………………………………………………
Session ………………………………………………………………………………..
Centre Address ……………………………………………………………………….
………………………………………………………………………………………….
………………………………………………………………………………………….
Signature of the Invigilator
Enrollment No.
Affix your latest
passport size
photograph
(4cm x 5cm)
duly attested by you
WHILE SENDING DOWNLOADED APPLICATION, THE INSTRUCTIONS
GIVEN IN THE ADVERTISEMENT MODE III SHOULD BE FOLLOWED
Instructions for the Candidates
1. You will NOT be allowed to carry any book/paper/mobile phone/electronic item inside the examination hall.
2. Any attempt of unfair means during the examination will render you liable to disciplinary action by
the University authority according to University rules.
3. The exam invigilator will help you find your seat in the exam hall and you are advised to follow
his/her instructions carefully.
4. The question papers will be in English as well as in Hindi. You will have to choose either Hindi or
English.
5. The duration of exam is one and a half hours. Indications will be given as per the fixed schedule.
6. You are advised to reach the examination hall at least 30 minutes before the commencement of the
examination time.
7. You are required to carry any one additional photo ID card (for e.g. Driving Licenses/Voter ID
card/Passport/PAN card/Photo Credit card etc.) along with this Admit Card.
8. Please do not write anything on your Admit Card. If you need rough sheets, ask the invigilator for it
and hand it over to him/her before you leave the examination hall.
(A) Marked copy to be sent to the candidate
WHILE SENDING DOWNLOADED APPLICATION, THE INSTRUCTIONS
GIVEN IN THE ADVERTISEMENT MODE III SHOULD BE FOLLOWED
MPBOU-RCI B.Ed.-SEDE Entrance Test 2010
Application Form No.B.Ed.-SEDE : K10
ADMIT CARD (B)
Name :…………………………………………………………………………
Father’s/Husband’s Name : ………………………………………………...
Address: ……………………………………………………………………..
……………………………………………………………………… Signature of the Candidate
-------------------------------------------------------------------------------------------------------------------------------
FOR OFFICE USE ONLY
Date of Examination …………………………………………………………………
Session ………………………………………………………………………………..
Centre Address ……………………………………………………………………….
………………………………………………………………………………………….
………………………………………………………………………………………….
Signature of the Invigilator
Enrollment No.
Affix your latest
passport size
photograph
(4cm x 5cm)
duly attested by you
WHILE SENDING DOWNLOADED APPLICATION, THE INSTRUCTIONS
GIVEN IN THE ADVERTISEMENT MODE III SHOULD BE FOLLOWED
Instructions for the Candidates
1. You will NOT be allowed to carry any book/paper/mobile phone/electronic item inside the
examination hall.
2. Any attempt of unfair means during the examination will render you liable to disciplinary action by the University authority according to University rules.
3. The exam invigilator will help you find your seat in the exam hall and you are advised to follow his/her instructions carefully.
4. The question papers will be in English as well as in Hindi. You will have to choose either Hindi or English.
5. The duration of exam is one and a half hours. Indications will be given as per the fixed schedule.
6. You are advised to reach the examination hall at least 30 minutes before the commencement of
the examination time.
7. You are required to carry any one additional photo ID card (for e.g. Driving Licenses/Voter ID
card/Passport/PAN card/Photo Credit card etc.) along with this Admit Card.
8. Please do not write anything on your Admit Card. If you need rough sheets, ask the invigilator for
it and hand it over to him/her before you leave the examination hall.
(B) Marked copy to be sent to the University