5/19/2017 Lakshmibai National Institute of Physical Education

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Course Applied For(

): *

B.P.Ed.(..) M.P.Ed.(..)

Final Admission Test Centre

Preliminary Entrance test Centre (Physical
(Written and Skills &
Test Centre) Jaipur Gwalior
Performance Test)
(

): *
(

) *

Choice of game for

Volleyball
entrance test: *

Personal Details( )

Applicant's Full Name Applicant's Full Name(Hindi)

*

(
)*

Father's Name Mother's Name

* *

Occupation of
Name of the Guardian(If Father is not alive) Father/Guardian
( ) /
*

Annual Income of Parents/Guardian Gender

/ *
* Male Female Transgender

Date of Birth (DD/MM/YYYY) Age as on 01.07.2017

(DD / MM / YYYY)* 01/07/2017

Marital Status

* Married Unmarried
Please see clause no. 2.4 page no. 22 of
prospectus

Category General SC ST OBC Ward Of LNIPE Staff Yes No

* (LNIPE ) *

Nationality State/U.T. of Domicile

Select
* /
*

Medium of Examination
Select
*

Mention Card no./Roll Number of Selected

Proof of Identity:
Aadhar C ard ID Card

:*



*

Are you Jammu and Kashmir Yes No

Migrants *

Have you ever been involved in any acts of crime/Gross Indiscipline/Misbehavior? Yes No
/
/
?*

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5/19/2017 Lakshmibai National Institute of Physical Education

Qualification( )

Result Status in Previous/Last Qualification

( /
) * Result Awaited Result Declared
Result Aw aited Applicants must have their results Declared by 10th July ,2017 . Else they w ill not be
Entitled for Registration

Exam ination Year of Passing ( % of Marks)

Main Subject/ Stream University/ Board Rollno Marks obtained Total Marks
Passed( ( (

( / ) ( / ) (
) (
) (

)
) ) )

Matric or Equivalent
(
)*

10 + 2 or
Equivalent
(10+2
)*

Other, If any
( , )

Sports Participation(Select any one)

Select

: - ( )

Eligibility for Direct Admission(

) *

Are you eligible for Direct Admission?

Note:All such candidates who have represented India in any International Championship such as Junior and Senior World Championships, Junior
and Senior World Cups, Junior and Senior Asian Championships, Junior and Senior Asian Cups, Common Wealth Games, Asian Games, Afro-
Asian Games, SAF Games, World School Games/World Schools Championship. Representation shall be in such games/sports which are Yes No
approved by AIU/IOA/MYAS. Such participation must be after 01 December, 2012. The candidates with such participation in Sports/Games
will be given age relaxation of 3 years (24 years). All such candidates who will fulfill above mentioned criteria are entitled or will be granted
direct admission.

Correspondence Address( )

Address()*

State/Union Territory( /

Select District( /)* Select
)*

Pincode( )* )*
Country(

Permanent Address(Same as Correspondence Address)

Permanent Address( )

Address()*

State/Union Territory( /

Select District( /)* Select
)*

Pincode( )* )*
Country(

TelePhone No.(With Std Code)

Mobile No.(
)*


( )

)*
Email Address( Select

Confirm Email Address(
) *

Please Verify Photo & Signature(

) *

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5/19/2017 Lakshmibai National Institute of Physical Education

Upload Im age s

UNDERTAKING BY THE APPLICANT( ) *

I have gone through the prospectus 2017-18 carefully and now wish to apply for admission. I solemnly declare that all the information provided and
documents furnished by me, are true to the best of my knowledge. I also undertake that at any point of time if any information is found to be incorrect / false, I
shall be liable to be rusticated from the Institute or any consequences thereof. I shall abide by the decision of the Institute.
- 2017-18 ,

/

/
















/ /







,
/

Submit Details

. .

2016

10 +,
( 1024x768)|

Chanakya

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