STATE TALENT SEARCH EXAMINATION IN SCIENCE AND MATHEMATICS FOR THE TRIBAL STUDENT OF CLASS X (200 -200 ) STUDENTS APPLICATION FORM 1. Name of the student in full (in Block Letters) 2. Age on the 1st Jan., 200_ 3. Home Address in full 4. Address for communication with Pin code 5. Father's Name 6. Occupation (In case of Govt. Servant, please give his designation) 7. Community to which you Belong Khasi/Garo/Jaintia (please attach attested copy of S.T. Certificate). 8. Educational level of : Mr/Miss ................ ....................: ...................: ................... .................... ................... : ................... ................... ................... : ................... : ................... : ................... : Father ...... Mother ........ 9. In case Father does not support you in School Education or otherwise (a) Please give Guardian's : .................... full name and address .................... (b) Your relation to i) (a) above : .................... ii) Occupation of (a) above : .................... 10. Annual Income of Parents/ : ................... Guardian 11. Name and Address of the : .................... School in which you are ..................... Reading in Class X during .................... 200_ .................... 12. (a) Are you receiving any : Yes/No ............... Scholarship/Stipend During the year 200_? (b) If Yes, state clearly the : .................. type of scholarship/ ................... stipend you receive per month 13. Percentage of Marks obtained in the following subjects in the last Annual Examination of Class IX and Class X: Class IX Class X (Annual Examination) (Annual Examination) a) Mathematics ....................... b) Science ...................... 14. State in brief what is your : ................. future plan of study ................ 15. Mention the Centre* of Examination according To your choice: Shillong/ : ................ Tura/ Jowai. I declare that the entries above are correct to the best of my knowledge and belief Dated ........... Signature of the Applicant. I certify that the candidate is studying in Class X in this School during the session 200_ . Dated ....... Signature and seal of the Head of the Institution where the Candidate is Studying. * Strike out whichever is not applicable Note: Please check that all the entries are completed before submitting the form. The completed Application Form should be sent so as to reach the Director, Directorate of Educational Research & Training, Aubuthnot Road, Nongrimmaw, Laitumkhrah, Shillong - 793011
