(Application for the RAJYA PURASKAR SCOUT / GUIDE AWARD TEST-2013)
(Fill
in duplicate)
|
01. Name of the
Division -……………………………………….
02.
Name of the District -……………………………………….
03.
Name of the Vidyalaya -……………………………………….
04.
Name of the Group -……………………………………….
05.
Registration No. of the Group -……………………………………….
06.
Name of the Scout / Guide -……………………………………….
07.
Father’s Name -……………………………………….
08.
Mother’s Name -.....................................................
09.
Date of Birth -……………………………………….
10.
Date of Joining the Unit -……………………………………….
11.
Date of Passing Pravesh -……………………………………….
12. Date of Investiture -……………………………………….
13.Date of Passing Pratham Sopan -……………………………………….
14. Date of passing Dwitiya Sopan -……………………………………….
15. Date of passing Tritiya Sopan -…………………… Certi. No……..
16. Details of Rajya Puraskar Proficiency
Badges
|
S.No.
|
Name
of the Badge
|
Date
of passing
|
Examiner’s
name, designation & address
|
|
1
|
|
|
|
|
2
|
|
|
|
|
3
|
|
|
|
|
Group-A
|
|
|
|
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Group-B
|
|
|
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Date of C.O.H Resolution recommendation-
…………………………………………
Signature of the Father/ Guardian Signature of Scout /
Guide
Dated: Dated:
Recommended the Scout / Guide (name)
-----------------------------------------------------------for the Rajya Puraskar Award Test-2013.
Signature of the Scout Master/ Guide
Captain
Name of the Scout Master/Guide
Captain--------------------------------------------------------
Certificate No. Adv./ HWB/ALT/LT
--------------------------------------------------------
Warrant No.
------------------------------------------------------------Valid
upto-------------------
Recommended the Scout / Guide (name) -----------------------------------------------------------
for
the Rajya Puraskar Award Test-2013
Dated:
District Commissioner (S/G)
(Page-2)
Kendriya Vidyalaya Sangathan State Bharat Scouts & Guides
RAJYA PURASKAR TESTING CAMP-2013
(Information Sheet to be filled in duplicate)
(Please fill up
the details carefully, over-writing will not be accepted)
01.
Name of the Division -
02.
Name of the District -
03.
Name of the Vidyalaya
-
04.
Name of the Group -
05.
Registration No. of the Group -
06.
Name of the Scout / Guide -
07.
Father’s Name -
08.
Mother’s Name -
09.
Date of Birth -
10.
Date of Joining the Unit -
11.
Date of passing Pravesh -
12. Date of Investiture -
13. Date of Passing Pratham Sopan -
14. Date of passing Dwitiya Sopan -
15. Date of passing Tritiya Sopan - Certi.
No……………………
Details of the work done
Pratham Sopan
i)
Work done under
sl. no. 12 / 11 of APRO II / III
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ii) Sl.No. 13 / 12 of APRO II / III ( any
two)
a)
------------------------------------------------------------------------------------------------------------
b)
------------------------------------------------------------------------------------------------------------Dwitiya
Sopan
i)
Proficiency Badge
as per Sl. No. 10 / 12 of APRO II / III
|
S.No.
|
Name
of the Badge
|
Date
of passing
|
Examiner’s
name, rank,designation & address
|
|
1
|
|
|
|
ii) Details of patrol sustained activity
done for a month as per Sl. No. 11 / 09 of APRO II / III
---------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------
(Page-3)
ii)
Details of any two activities done as
per Sl. No. 12 / 13 of APRO II / III
a)
----------------------------------------------------------------------------------------------------------
b)
----------------------------------------------------------------------------------------------------------
Tritiya
Sopan
i)
Swimming or Proficiency Badge as per
Sl. No. 02 of APRO II / III
|
S.No.
|
Name
of the Badge
|
Date
of passing
|
Examiner’s
name, rank,designation & address
|
|
1
|
|
|
|
ii)
Details of Hike
undertaken as per Sl. No. 08 of APRO II / III
|
Nature
of Hike
|
Place
|
Date
of Hike
|
Report
submitted on
|
|
|
|
From
|
To
|
|
|
|
|
|
|||
iii) Details of Proficiency Badges done under
Sl. No. 13 of APRO II / III
|
S.No.
|
Name
of the Badge
|
Date
of passing
|
Examiner’s
name, designation & address
|
|
Group-A
|
|
|
|
|
Group-B
|
|
|
|
iii)
Details of (any
one) activity done as per Sl. No. 14 of APRO II / III
---------------------------------------------------------------------------------------------------------------------
Details
of Rajya Puraskar Proficiency Badges
|
S.No.
|
Name
of the Badge
|
Date
of passing
|
Examiner’s
name, designation & address
|
|
1
|
|
|
|
|
2
|
|
|
|
|
3
|
|
|
|
|
Group-A
|
|
|
|
|
Group-B
|
|
|
|
Date
of COH Resolution Recommendation………………………………………
Signature of the Scout Master / Guide
Captain Signature
of Scout / Guide
Name: Dated:
Qualification in Scouting/Guiding…………………………….......... Certificate No.
Adv./HWB/ALT/LT………………………………..
Warrant
No. ………………………………………………………...Valid upto……………….
(Page-4)
(Lucknow
Date
of Birth Certificate
(Over Writing / Cutting will not be accepted)
This is to certify that Master /
Kumari ……………………………………………. S/o –D/o ………………………………………………is the student of Kendriya
Vidyalaya………………………………….studying in class………………………in the year ……………and his / her
date of birth is (in figures) ……………………………… (in words)
………………………………………………………............. as per vidyalaya record.
Date: Office
Seal Sig.
of the Principal
COH
The specimen of COH of
………………………………..Scout Troop / Guide Company of KV …………………………….met at (place)
……………………………..at (time)……………………….am/pm on (date) ……………………and resolved to
recommend the Scout / Guide………………………………………………for the Rajya Puraskar Test-2013.
Members Signature Sig. of the Chairman
1. (Name
of the Chairman)
2. Date:
3.
4.
Signature of SM / GC Signature of District
Commissioner (S/G)
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