RAJYAPURASKAR PROFORMA-2014

Kendriya Vidyalaya Sangathan State Bharat Scouts & Guides

(Application for the RAJYA PURASKAR SCOUT / GUIDE AWARD TEST-2014)

(Fill in duplicate)

(Photo in S/G Uniform attested by the Principal

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
Group-B

     

      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-2014.

      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-2014

     

      Dated:                                                                                                                    District Commissioner (S/G)