Navodaya Vidyalaya Samiti

NOTICE

Select list of students for admission to Class IX for he session 2022-23 through
Lateral entry Test has been released. The parents/guardians of selected
students may take the following steps for admission to Jawahar Navodaya
Vidyalaya:

1. Formats for submission of details may be downloaded

2. Filled in formats are to be submitted to the Principal of JNV concerned in
person.
3. Certificates from the competent authority in respect of Rural, OBC, SC, ST
and Disability as applicable are to be submitted to the JNV for
verification of documents / eligibility to confirm admission to Class IX

After verification of documents submitted, JNVs will confirm the admission, if the
candidate is found eligible as per NVS norms.

It is informed that admission will be given to the selected candidates, only after
due verification of the documents. Parents are advised not to take TC from the
previous school until the admission is confirmed by the JNV. Admission to JNVs
is done free of cost. No fee is to be paid to school authority for admission to
Class- IX. The parents/students are required to approach directly the Principal
of the JNV concerned.

Now the process of admission in JNVs is highly transparent and activities are visible
to all. Accordingly parents are advised to directly interact with JNV Principal only.
In case of any difficulty an email may be sent to respective Regional Office
addressed to the Deputy Commissioner.
 (To be filled by the Parent/Guardian of the Candidate with the help of the
Headmaster/Headmistress of the School from where the candidate passed
Class VIII Examination)

1. Name of the Candidate:

Aadhar Number:
PHOTO
Male Female TG of student
2. Gender

3. (a) Category Gen OBC SC ST

(b) Caste :

4. Date of Birth Date Month Year

Date of Birth in Words :

5. Father’s Name :

6. Mother’s Name :

7. Name of the Guardian and

Relationship with him/her, if applicable :
8. School(s) from where the candidate passed VIII.
Particulars Class VIII
(i) Month & Year of Joining
(A)
(ii) Month & Year of Passing

(i) Name of the School

(B)
(ii) Is It a recognized school? (YES/NO)
Name of the Village or Town in which
(C)
School is located.

(D) Name of the Block

(E) Name of the District

Location of the School Indicate
(F)
RURAL/URBAN

(Separate certificate is to be obtained if the candidate had studied class VIII in

different schools)
 CERTIFICATE

(BY PARENT/GUARDIAN OF THE CANDIDATE CONCERNED)

Certified that the information given above is true to the best of my knowledge
and belief. In case, any part of the information furnished by me is found incorrect, the
admission of my child/ward may be cancelled. I am ready to produce the relevant
certificates issued by Competent Authorities as and when asked for.

Signature of PARENT/GUARDIAN

Entries verified, certified and found correct.

Signature of the HEADMASTER/HEADMISTRESS

Name :

Desgn.: School Seal :

(NOTE FOR THE HEAD OF THE SCHOOL: - Following Certificate is required to be

issued in respect of candidate selected for admission in JNV in the respective
district).

CERTIFICATE BY THE HEAD OF THE SCHOOL

Certified that the information given above is found correct as per our school
records. It is also certified that Master/Kumari was
admitted in this School in Class on (date) and passed
Class VIII on (date).

Signature of the Head of Institution

last studied with School Seal

Date :
 UNDERTAKING BY THE PARENT/ GUARDIAN

Certified that the information given in the application form for admission into
Class IX in Jawahar Navodaya Vidyalaya, District:_________________for the academic
year 2022-23 for my ward is true to the best of my knowledge and belief. In case any
part of the information furnished by me is found incorrect, admission of my ward may
be cancelled at any time. I am ready to produce relevant certificates issued by the
competent authority to your office when asked in support of entries in my original
application

Signature of the parent/Guardian

Address of parent/guardian:
Name:

H.No:

Street

Village

Mandal/Block

Pin Code:

STD Code: Phone No

Mobile No:

UNDERTAKING

I, __________(Father/ Mother/ Guardian) of Kumari/Master

who got selected for admission into Class IX in Jawahar
Navodaya Vidyalaya, …………….District hereby give an undertaking that I am ready
to pay Navodaya Vikas Nidhi (Class IX to XII) every month as per norms of Navodaya
Vidyalaya Samiti.

Signature of the parent/Guardian

Note: This is not applicable to SC/ST categories and all girl students and the parents
whose Income is below poverty line.
JAWAHAR NAVODAYA VIDYALAYA: DISTRICT:_

MEDICAL FITNESS CERTIFICATE

01.
Name of the candidate :

02. Father’s name :

03. Address: :___________________________________

___________________________________

___________________________________

___________________________________

04. Date of birth

05. Height _ __ _ _ _ _ __ _ _ _ __

06. Weight _ __ _ _ _ _ __ _ _ _ __

07. Abdomen _ __ _ _ _ _ __ _ _ _ __

08. Chest _ __ _ _ _ _ __ _ _ _ __

09. Vision LEFT RIGHT

10 Ears _ __ _ _ _ _ __ _ _ _ __

11. Throat _ __ _ _ _ _ __ _ _ _ __

12. Locomotor system _ __ _ _ _ _ __ _ _ _ __

13. State of vaccination _ __ _ _ _ _ __ _ _ _ __

14. Skin _ __ _ _ _ _ __ _ _ _ __

15 Blood Group

16 Dental Hygiene

17. Remarks of Medical Officer : Recommended/not recommended for

admission/Recommended to C.M.O for
Verification if any.

PHOTO OF THE
STUDENT
_ __ _ _ _ _ __ _ _ _ __

CIVIL SURGEON
 MEDICAL ANTECEDENTS

UNDERTAKING
We, Shri. _______________ (father) &Shrimati ________________
(mother), the parents of Master/Miss ________________________ , do
hereby declare that our ward doesn’t suffer from any of the medical
ailments listed below.

1. Head Injuries
2. Puo- Intermittent
3. CHD- Congenital Heart Disease
4. AA – Acute appendicitis
5. Epliepsy – Convulsions (Injury, Fever)
6. Blood Disorders (Sickle cell Anemeia, Haemophillia)
7. Communicable Diseases (TB, Hepatitis A & B)
8. Skin Disease.

We further declare that our ward Master/Miss ____________ doesn’t have any previous
medical history which required/still requires prolonged or intermittent periods of medical
confinement either in a hospital/nursing home or in our house.

Certified that the information furnished above is true to the best of our knowledge. Any
wilful suppression or false informationon the medical antecedents revealed later, would
make the admission of our ward invalid and liable for actions as deemed fit by the
Vidyalaya and Navodaya Vidyalaya Samiti.

PLACE: FATHER’S SIGN

DATE: NAME:

MOTHER’S SIGN:

NAME:

ADDRESS:
 DISABILITY CERTIFICATE

If the candidate is Divyang (differently abled), he/she shall submit the

certificate issued by the competent authority.

CATEGORY/COMMUNITY CERTIFICATE
(OBC/SC/ST)

Community certificate in the prescribed format from the competent authority

is to be submitted by the candidate, wherever necessary.

RURAL CERTIFICATE

(To be issued by the Revenue Officer of concerned Block)

This is to certify that Master/Kumari

Son/daughter of Shri _______________________________________studied class VIII
In ____________________________________________________(Name of the school)
of block and the school
is located in the village which belongs to rural
area of District_________________ State___________________.

(Signature of the Revenue Officer)

Block:

District.

Office Seal:

Dated:
 RESIDENCE CERTIFICATE

(To be furnished by the parents of the qualified children at the time of

admission to JNVs)

As per Jawahar Navodaya Vidyalaya, District ,

State letter No: dated: my ward
Master/Kumari has qualified the entrance exam for admission to
Class IX at JNV, District , State during the session
2022-23

I am residing along with my ward mentioned above at the

following address:

District
Village:
Town:
District:
State:

Pin Code:

*The area of residence falls under the Rural /Urban area of the district
Certified that the information furnished by me is true and no fact has
been concealed.

Signature of the parent

Full name:

Address:

*Applicable for the students who seek admission through the studies in NIOS.
 CERTIFICATE

(TO BE FILLED UP BY THE DISTRICT AUTHORITIES AND ISSUED UNDER THE SIGNATURE OF
TEHSILDAR TO THE PARENTS OF THE CHILD SELECTED FOR ADMISSION TO CLASS IX IN
JNVS THROUGH LATERAL ENTRY TEST)

This is to certify that the above information furnished by

Shri/Smt Father/Mother of Master/Kumari
a candidate for admission to class IX in JNV, District has been verified
from the records and is found to be correct.

*The area where residence is located falls under (Rural/Urban) area of the
district .

Signature of Tehsildar

(With Seal)

*Applicable for the students who seek admission through the studies in NIOS.