APPLICATION FORM
S TATE LEVEL NATIONAL TALENT S EARCH EXAMINATION, 2015.
(For the Students Studying in Class - X)
Read the instruction carefully given on the next page before filling the application form. You
may take the help from your teacher/parent for filling up the application form
Space for the photograph
(Passport size)
: 1 st November, 2014.
: Director, State Institute of Education
Shiksha Sadan, Link Road. Port Blair
Date of Examination
Name & address of the Agency
for conducting State Level NTS Examination
The Photograph should
be endorsed by the Head
of the
Institution/Gazetted
Officer
Name of the State/UT
: Andaman & Nicobar Islands
(where the candidate is study ing in class -X as a regular student)
Name of the Examination Center *
(where the candidate is study ing in class X or likely to appear in Exam)
State Level 12 digit Roll Number
Class X Code State Code Year
11
99
Center Code
Serial No. (Office to fill)
54
Class
Date of Birth
10
Date
Month
Year
Hearing
Impaired
Visually
Impaired
1. Name of the Candidate (Do not write Miss/Master)
2. Father's Name (Do not write Mr./Dr./Prof.)
3. Mother's Name (Do not write Ms../Dr./Prof.)
4. Sex
5. Area to which candidate resides
2
Male Female
6. Category of candidate
Rural Urban
General.
2
SC
3
ST
7. Disability status.
1
Orthopedic
None
(Ple ase e nclose a copy of the relevant re servation ce rtificate in support of information at [Link]. 6 & & 7. )
8. P ostal address for correspondence (Do not write father's or your name)
P in Code
9. Name and address of the school/ institution in which studying at Class X level
Pin Code
10. Type of the institution in which studying at Class X level (see definition overleaf*)11. Area in which the school is located
1 Govt
Local
Body
Private
Aided
Private
Unaided
12. Medium of examination (a) at the State level
(b) at the NCERT Level
Rural
Urban
13 Father's education
14. Father's occupation
15. Mother's education
16. Mother's occupation
17. No. of family members living in the
house
18. Number of brothers
19. Number of sisters
20. At what number is the candidate
among his/her brother and sisters
21. P arental annual income
1
Up to 50,000
2
50,001 to 100,000
100,001 to 2,00,000
4
2,00,001 to 5,00,000
More than 5,00000.
22. Telephone
STD Code
Phone
23. E-mail address
To be filled in by the Head of the Institution/Gazetted Officer
Certified that:
(1) Master/Miss................................................................ is a regular student of this School/Institution and he/she has/secured
% marks in the
Class IX annual examination i.e. when he/she was promoted from class IX to class X. He/She has secured ........................ marks out of................
(2) The particulars given by him/her in the application form have been verified and found in order.
(3) Master/Miss.............................................. belongs to Scheduled Caste/Scheduled Tribe category as per the records maintained in the Institution (To be filled for
ST/SC candidates only )
Date: ..............................
Countersigned by
EO/DEO/AEO/ZONAL OFFICER
.....................................................................
Signature of the Headmaster/Headmistress
With Seal.
Signature of the candidate
Page 1 of 4.
(See Instructions overleaf)
Coding Plan
Read instructions caref ully bef ore f illing up the Application Form.
1.
2.
3.
4.
5.
6.
Use only Blue or Black Ball P oint P en. WRITE IN CAP ITAL LETTERS. Do not mark or write outside the boxes.
Leave one box blank between two words. Limit your name and/or address within the space provided f or it. P lease see example as given
below.
Cross () only one of the appropriate boxes in item nos. 4, 5, 6, 7, 10,11 and 21.
P lease write code number in item nos. 12, 13, 14,15 and 16 as given overleaf.
It is the responsibility of the candidates and the Principal of the school to deposit the filled in form with the State concerned Officer before the
last date. No request f or condoning delay in submission will be entertained whether it is due to the f ault of the candidate or the
Headmaster/ Principal of his/her institution.
Incomplete or defective application are liable to be rejected.
Example f or writing Name and Address
Father's Name
O
P
G
P ostal Address : Do not try to write complete address in one line. Break it appropriately as shown below.
1
4
5
/
6
M
O
U
N
T
R
O
A
D
C
Medium of Examination
(Refer to item 12)
Medium of Examination
Code
Assamese
Bangla
English
Gujarati
Hindi
Kannada
Marathi
Malayalam
Oriya
11
12
13
14
15
16
17
18
19
P unjabi
Tamil
Telugu
Urdu
20
21
22
23
P IN
Education of Father or Mother
(Refer to item Nos. 13 & 15)
Education
Code
Father's/Mother's Occupation
(Refer to item Nos. 14 & 16
Occupation
P rofessional
Executive and Managerial
Clerical
Business
Agriculture, Fishery
P roduction and Transport
Operators and Labourers
Not employed
No formal Education
Up to P rimary
Upper P rimary
Secondary
Senior Secondary
Graduation
P ost Graduation
Doctoral
P rofessional Degree (Engineering,
Law, Medicine, MCA, MBA, etc.)
1
2
3
4
5
6
7
8
9
5
Examination Centre**
GSSS, Boys, P ort Blair
GSSS, School Line School
GSSS, Garacharma
GSSS, Wimberlygunj
GSSS, Oralkatcha
GSSS, Havelock
GSSS, Neil
GSSS, Long Island
GSSS, Rangat
GSS, Webi - Mayabunder
GSSS, Kalighat
GSSS, Diglipur
GSSS, Hut Bay
GSSS, Lapathy
GSS, Kamorta
GSSS, Kapanga
GSSS, Bengali, Teressa
GSSS, Campbell Bay
Code
0001
0002
0003
0004
0005
0006
0007
0008
0009
0010
0011
0012
0013
0014
0015
0016
0017
0018
Code
1
2
3
4
5
6
7
8
* TYPE OF SCHOOL/INSTITUTION (Refer to item No. 10)
Government
A Government School is that which is run by the State Government or Central Government or Public
Sector Undertaking or an Autonomous Organisation completely financed by the Government.
Local Body
A Local Body School is that which is run by Panchayati Raj and Local Body institutions such as Zila
Parishad, Municipal Corporation, Municipal Committee, Notified Area Committee and Cantonment Board.
Private Aided
A Private Aided School is that which is run by an individual or a private organisation and receives grant
from government or local body.
Private Unaided
Private Unaided School is that which is managed by an individual or a private organisation and does not
receive any grant either from government or local body.
Students Eligibility for appearing in Selection Test:
The students should have minimum 55% marks or equivalent Grade in class IX examination for appearing in selection test for
award of scholarship (Relaxable by 5% for SC/ST).
Page. 2 of 4.
STATE LEVEL NATIONAL TALENT SEARCH EXAMINATION 2015.
(For the students studying in class X)
Name of the S tate/UT
Andaman & Nicobar Islands
(Which will conduct the Examination)
ADMISSION CARD
To be filled in by the applicant
Affix passport
size photograph
attested by the
Head of the
School
M aster/M iss.........................................................................
S/o/D/o................................................................................
of (School)..........................................................................
of (District/Centre).............................................................
is permitted to appear for the above said examination.
Full Postal Address: .................................................................................................................
..................................................................................................................
......................................................................PIN CODE..........................
Phone No. (If any)....................................................................................
She/He is allocated 12 digits Roll Number:
Class X Code
State Code
Year
Date of Examination
Center Code
Serial No. ( to be filled by the Office )
5
:
1st November, 2014 Time 10 A.M. to 1 P.M.
Venue of Examination Centre.......................................................................................
Signature of the Head of the School
With office seal
Scrutinized by
(office staff)
Office seal
Signature of Nodal Officer
Authorised for State Level NTS Examination
Signature of the invigilator
at the examination centre
Signature of the
candidate in the presence of
Invigilator
M AT : ............................
SAT : ...............................
Language: .........................
(PTO for instructions)
Page 3 of 4.
INS TRUCTIONS TO THE CANDIDATE
1.
M ake sure that the Admit Card is not detached from the application form. Admit cards will be sent to
the Centre Superintendent of the examination centre after allotting the Roll Numbers .Candidate can
collect the Admit Card from the Centre Superintendent of the examination centre at least one week
before the examination.
2.
Reach the examination centre at least half an hour before the commencement of the examination and
occupy the seat that bears your Roll No.
3.
DO NOT take mobile phones, calculator, mathematical & Physical table or any other kind of ready
reckoner to the examination hall.
4.
The examination will be conducted in three sessions on the same day.
5.
You have to take the examination as per details given below:
- M ental Ability Test (M AT) for 90 minutes.
- Scholastic Aptitude Test (SAT), which includes tests in language comprehensive and Aptitude
separately.
Test Type
M arks
M ental Ability
Language
Scholastic Comprehensive Test
Test
Aptitude Test
[Link] Items
50
50
40
90
40
90
Duration
(in minutes)
45
45
90
The applicants are requested to refer/consult State Liaison Officer for the composition of test.
6.
Each question carries 1(one) mark.
7.
Write your Roll Number, as given in the Admit Card, on the Answer Sheet and on the cover page of the
Question Booklet in the space provided.
8.
All questions in the booklets are objective type. For each question FOUR possible answers are given,
but only one is correct. Your task is to find out the correct answer and mark your choice in the Answer
Sheet against the corresponding question number.
9.
Record your answer using Ball Point Pen only. You have to indicate your answer on the answer sheet
as advised by the State/UT.
10.
During the Examination follow the instructions of the invigilator strictly.
11.
Hand over your Question booklet and Answer sheets to the invigilator before you leave the Examination
Hall.
12.
Hand over the admission card to the invigilator before leaving the examination hall.
Full Postal Address of the candidate for dispatch of admission letter:
-------------------------------------------------------------------------------------------------------------------------------------------------------- PIN ---------------
Page 4 of 4.
APPLICATION FORM
S TATE LEVEL NATIONAL MEANS -CUM-MERIT S CHOLARS HIP S CHEME: 2015.
(For the Students Studying in Class VIII of Govt./Local body/Govt. Aided Schools)
Read the instruction carefully given on the next page before filling the application form. You
may take the help from your teacher/parent for filling up the application form
Space for the photograph
(Passport size)
: 1 st November, 2014.
: Director, State Institute of Education
Shiksha Sadan, Link Road. Port Blair
Date of Examination
Name & address of the Agency
for conducting State Level NMMSS Examination
The Photograph should
be endorsed by the Head
of the
Institution/Gazetted
Officer
Name of the State/UT
:Andaman & Nicobar Islands
(where the candidate is study ing in class VIII as a regular student)
Name of the Examination Center *
(where the candidate is study ing in class VIII or likely to appear in Exam)
State Level 12 digit Roll Number
NMMSS Code State Code Year
3
2
11
99
Center Code
Serial No. (Office to fill)
Class
54
Date of Birth
8
Date
Month
Year
1. Name of the Candidate (Do not write Miss/Master)
2. Father's Name (Do not write Mr./Dr./Prof.)
3. Mother's Name (Do not write Ms../Dr./Prof.)
4. Sex
5. Area to which
candidate resides
1
2
Male Female Rural Urban
6. Category of candidate
1
Genl. SC
7. Religion
2
8. Disability status.
4
ST OBC. Muslim sikh Budhist Christian others Orthopedic Hearing Blind Low
Impaired
Vision
None
(Ple ase enclose a copy of the re le vant re se rvation ce rtificate in support of information at [Link]. 6 & 8. )
9. P ostal address for correspondence (Do not write father's or your name)
Pin Code
10. Name and address of the institution in which studying at Class VIII level
Pin Code
11. Type of the institution in which studying at Class VIII level (see definition overleaf*)
1 Govt
Local
Body
Private
Aided
Private
Unaided
13. Medium of examination at the State level
12 Area in which school is located.
[Link]'s education
Rural
Urban
15. Father's occupation
16. Mother's education
17. Mother's occupation
18. No. of family members living in the
house
19. Number of brothers
20. Number of sisters
21. At what number is the candidate
among his/her brother and sisters
22. P arental annual income
1
Up to 50,000
2
50,001 to 100,000
100,001 to 1, 50,000
23. Telephone
STD Code
Phone
To be filled in by the Head of the Institution/Gazetted Officer
23. E-mail address
Certified that:
(1) Master/Miss................................................................ is a regular student of this School/Institution and he/she has/secured
% marks in the
Class VII annual examination i.e. when he/she was promoted from class VII to class VIII. He/She has secured ........................ marks out of................
(2) The particulars given by him/her in the application form have been verified and found in order and certified that he/she is belonging to economically weaker
section and his/her parental income is less than Rs. 1,50,000/- (One lakh fifty thousand only)
(3) Master/Miss............................................................ belongs to ST/OBC category as per the records maintained in the Institution (To be filled for ST/OBC
candidates only )
Date: ..............................
.....................................................................
Countersigned by
Signature of the Headmaster/Headmistress
EO/DEO/AEO/ZONAL OFFICER
With Seal.
Signature of the candidate
Page 1 of 4.
(See Instructions overleaf)
Coding Plan
Read instructions carefully before filling up the Application Form.
1.
2.
3.
4.
5.
6.
Use only Blue or Black Ball P oint P en. WRITE IN CAP ITAL LETTERS. Do not mark or write outside the boxes.
Leave one box blank between two words. Limit your name and/or address within the space provided for it. P lease see example as given below.
Cross () only one of the appropriate boxes in item nos. 4, 5, 6, 7,8, ,11,12 and 22.
P lease write code number in item nos 13, 14,15,16 and 17 as given overleaf.
It is the responsibility of the candidates and the Principal of the school to deposit the filled in form with the State concerned Officer before the
last date. No request for condoning delay in submission will be entertained whether it is due to the fault of the candidate or the Headmaster/
P rincipal of his/her institution.
Incomplete or defective application are liable to be rejected.
Example f or writing Name and Address
Father's Name
O
P
G
P ostal Address : Do not try to write complete address in one line. Break it appropriately as shown below.
1
4
5
/
6
M
O
U
N
T
R
O
A
D
C
Medium of Examination
(Refer to item 13)
Medium of Examination
Code
Assamese
Bangla
English
Gujarati
Hindi
Kannada
Marathi
Malayalam
Oriya
11
12
13
14
15
16
17
18
19
P unjabi
Tamil
Telugu
Urdu
20
21
22
23
P IN
Education of Father or Mother
(Refer to item Nos. 14 & 16)
Education
Code
Father's/Mother's Occupation
(Refer to item Nos. 15 & 17)
Occupation
P rofessional
Executive and Managerial Worker
Clerical
Business
Agriculture, Fishery
P roduction and Transport
Operators and Labourers
Not employed
No formal Education
Up to P rimary
Upper P rimary
Secondary
Senior Secondary
Graduation
P ost Graduation
Doctoral
P rofessional Degree (Engineering,
Law, Medicine, MCA, MBA, etc.)
1
2
3
4
5
6
7
8
9
5
Examination Centre**
GSSS, Boys, P ort Blair
GSSS, School Line School
GSSS, Garacharma
GSSS, Wimberlygunj
GSSS, Oralkatcha
GSSS, Havelock
GSSS, Neil
GSSS, Long Island
GSSS, Rangat
GSS, Webi - Mayabunder
GSSS, Kalighat
GSSS, Diglipur
GSSS, Hut Bay
GSSS, Lapathy
GSS, Kamorta
GSSS, Kapanga
GSSS, Bengali, Teressa
GSSS, Campbell Bay
Code
0001
0002
0003
0004
0005
0006
0007
0008
0009
0010
0011
0012
0013
0014
0015
0016
0017
0018
Code
1
2
3
4
5
6
7
8
*TYPE OF SCHOOL/INSTITUTION (Refer to item No. 11)
Government
A Government School is that which is run by the State Government or Central Government or Public
Sector Undertaking or an Autonomous Organisation completely financed by the Government.
Local Body
A Local Body School is that which is run by Panchayati Raj and Local Body institutions such as Zila
Parishad, Municipal Corporation, Municipal Committee, Notified Area Committee and Cantonment Board.
Private Aided
A Private Aided School is that which is run by an individual or a private organisation and receives grant
from government or local body.
Private Unaided
Private Unaided School is that which is managed by an individual or a private organisation and does not
receive any grant either from government or local body.
Students Eligibility for appearing in Selection Test:
[Link] students should have minimum 55% marks or equivalent Grade in class VII examination for appearing in selection test
for award of scholarship (Relaxable by 5% for SC/ST).
[Link] parental annual income should not exceed Rs.1,50,000/[Link] income certificate from Revenue Authority not below the rank of Tehsildar/DDO concern (For [Link]).
[Link] in applications with supportive documents will be accepted upto 31st August,2014 only.
Page. 2 of 4.
S TATE LEVEL NATIONAL MEANS -CUM-MERIT S CHOLARS HIP S CHEME: 2015-16.
(For the Students Studying in Class VIII of Govt./Local body/Govt. Aided Schools)
Name of the S tate/UT
Andaman & Nicobar Islands
(Which will conduct the Examination)
ADMISSION CARD
To be filled in by the applicant
Affix passport
size photograph
attested by the
Head of the
School
M aster/M iss.........................................................................
S/o/D/o................................................................................
of (School)..........................................................................
of (District/Centre).............................................................
is permitted to appear for the above said examination.
Full Postal Address: .................................................................................................................
..................................................................................................................
......................................................................PIN CODE..........................
Phone No. (If any)....................................................................................
She/He is allocated 12 digits Roll Number:
NMMSS Code
State Code
Year
Date of Examination
Center Code
Serial No. ( to be filled by the Office )
5
:
1st November, 2014 Time 10 A.M. to 1 P.M.
Venue of Examination Centre.......................................................................................
Signature of the Head of the School
With office seal
Scrutinized by
(office staff)
Office seal
Signature of Nodal Officer
Authorised for State Level NTS Examination
Signature of the invigilator
at the examination centre
Signature of the
candidate in the presence of
Invigilator
M AT : ............................
SAT : ...............................
(PTO for instructions)
Page 3 of 4.
12. Area in which the school is located
INS TRUCTIONS TO NMMS S CANDIDATE.
1. M ake sure that the Admit Card is not detached from the application form . The Admit cards will be sent to
the Superintendent of the examination centre after allotting the Roll Numbers .Candidate can collect the
Admit Card from the Head of the institution at least one week before the examination.
2. Reach the examination centre at least half an hour before the commencement of the examination and
occupy the seat that bears your Roll No.
3. DO NOT take calculator, mathematical & Physical table or any other kind of ready reckoner to the
examination hall.
4. The examination will be conducted in two sessions on the same day.
5. You have to take the examination in TWO PARTS:
(i) Part I: M ental Ability Test (M AT) for 90 minutes.
(ii). Part II: Scholastic Aptitude Test (SAT) . The SAT will consists items from Science, Social Studies
and from M athematics.
The applicants are requested to refer/consult State Liaison Officer for the composition of test.
6. Time for Part I is 90 minutes and Part II is 90 minutes.
7. Each question carries 1(one) mark.
8. Write your Roll Number, as given in the Admit Card, on the Answer Sheet and on the cover page of the
Question Booklet in the space provided.
9. All questions in the booklets are objective type. For each question FOUR possible answers are given, but
only one is correct. Your task is to find out the correct answer and mark your choice in the Answer Sheet.
10. Record your answer using Ball Point Pen only. You have to indicate your answer on the answer sheet as
advised by the State/UT.
11. During Examination follow the instructions of the invigilator strictly.
12. Hand over your Question booklet and Answer sheet to the invigilator before you leave the Examination
Hall.
13. Hand over the admission card to the invigilator before leaving the examination hall.
Full Postal Address of the candidate for dispatch of admission letter.
..........................................................................................................
.. ...........................................................................................................
.................................................. PIN Code...........................................
Page 4 of 4.
