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Kendriya Vidyalaya Sangathan State Bharat Scouts & Guides
(APPLICATION FOR THE RAJYA PURASKAR SCOUT / GUIDE TEST-2018)
(TO BE FILLED BY THE CANDIDATE IN HIS/HER OWN HANDWRITING IN CAPITAL LETTERS .OVERWRITING/USE
OF FLUID WILL NOT BE ACCEPTED) (TO BE FILLED IN DUPLICATE)
01. NAME OF THE DIVISION -………………………………………. (Photo in
02. NAME OF THE DISTRICT -………………………………………. S/G Uniform
03. NAME OF THE VIDYALAYA -………………………………………. attested by
04. NAME OF THE SCOUT / GUIDE -………………………………………. the Principal
05. FATHER’S NAME -……………………………………….
06. MOTHER’S NAME -.............................................................
07. DATE OF BIRTH -……………………………………….
08. ADHAR NO - ………………………………………
09. DATE OF JOINING THE UNIT -……………………………………….
10. Home Address
P.O. District State
Pin code Telephone/Mob. No.
E-mail ID _________________________________________
11. Name and address of Unit
District
Charter No. Date of Issue Date of Validity
Signature of Parents Signature of Scout/Guide
RECOMMENDED THE SCOUT / GUIDE (NAME) _____________________________________ FOR THE
RAJYA PURASKAR BADGE TEST-2018.
NAME OF SCOUT MASTER/GUIDE CAPTAIN ________________________
SIGNATURE OF SCOUT MASTER/ GUIDE CAPTAIN __________________________
QUALIFICATION OF SCOUT MASTER/GUIDE CAPTAIN__________________________________
WARRANT NO.____________________________________VALID UP TO _______________________
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Kendriya Vidyalaya Sangathan State Bharat Scouts & Guides
RAJYA PURASKAR BADGE TESTING CAMP-2018
(Information Sheet)
01. Name of the Division - ___________________________________
02. Name of the Vidyalaya - ___________________________________
03. Name of the Scout / Guide - ___________________________________
04. Father’s Name - ___________________________________
05. Mother’s Name - ___________________________________
06. Date of Birth - ___________________________________
07. Date of Joining the Unit - ___________________________________
08. Date of passing Pravesh - ___________________________________
09. Date of Investiture - ___________________________________
10. Date of Passing Pratham Sopan - ___________________________________
11. Date of Passing Dwitiya Sopan - ___________________________________
12 Date of Passing Tritiya Sopan - ___________________________________
13. Tritiya Sopan Testing Camp held at KV_________________ from _______________To____________
Certificate No____________ Date of Issue_________________
Details of the work done
Pratham Sopan
Troop/Company Service Project (as per APRO Part II/III)
a)_________________________________________________________________________________
b)Service activity (as per APRO Part II/III)
i) ___________________________________________________________________________
ii) ___________________________________________________________________________
Dwitiya Sopan
i) Detail of Proficiency Badge earned for Dwitiya Sopan as per Sl. No. 10 / (x) of APRO II / III
S.No. Name of the Badge Date of passing Examiner’s name & Designation
1
2
ii) Details of service activity done as per Sl. No. 8 / (viii) of APRO II / III
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Tritiya Sopan:
a) 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 & Designation
1
b) Name of the subject /topic taken for the talk in Troop meeting.(as per S.No.06 0f APRO II/ III)
____________________________________________________
c) Details of day hike on foot undertaken as per Sl. No. 07(b) of APRO II / III
Date of Hike Place Distance(km) Report submitted on
From To
d) Details of Proficiency Badges earned for Tritiya Sopan done under Sl. No. 10 of APRO II / III
S.No. Name of the Badge Date of passing Examiner’s name & Designation
GROUP-A
GROUP-B
Rajya Puraskar :
a) Details Ambulance Man Badge/ Ambulance Man Badge earned for Rajya Puraskar Badge as per S.N 03 /iii
of APRO part –II/III
S.N Name of the Badge Date of passing Examiner’s name &
Designation
01. Ambulance Man /Ambulance
b) Details of overnight hike undertaken as per Sl. No. 04 / (iv) of APRO II / III (10 km on foot/30 km on
cycle for Scouts and 10 km on foot/25 km on cycle for Guides)
Type of Hike Date Place Distance(km) Report submitted
on
FOOT / CYCLE From To From To
c) Work done Six month as per S.N 5/V of APRO II/III
S.N Name of Topic From To Dt of Submission of
Report
d) Details of Proficiency badges earned for Rajya Puraskar as per S.No. 8 /(viii) of APRO II / III
S.No. Name of the Badge Date of passing Examiner’s name & Designation
1
2
3
e) Details of Proficiency badges earned for Rajya Puraskar as per S.No. 9 /(ix) of APRO II / III
S.No. Name of the Badge Date of passing Examiner’s name, & Designation
1
2
Note:- All relevant records , Log Books, Proficiency Books, DOB Certificate, Badge Examiner Certificates. Copy
of Pratham Sopan, Dwitya Sopan, Traitiya Sopan Certificates, Copy of Adhar Card should be produced in the
testing camp as and when demanded.
Date of COH Resolution / Recommendation…………………………… Signature of Scout / Guide …………
Certified that the information given above is correct as per the Vidyalaya/Unit records and verified by
me.
Name of the Scout Master / Guide Captain …………………………………. Signature: ………………
Qualification in Scouting/Guiding………………Warrant No. ………………………Valid up to …………
Signature of the Principal/District Commissioner (S/G)
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Kendriya Vidyalaya Sangathan State Bharat Scouts & Guides
( ______________________ Division)
Date of Birth Certificate
(Over-writing / Cutting will not be accepted)
This is to certify that Master / Kumari ………………………………………………………………..
S/o/ D/o ……………………………………...is a student of Kendriya Vidyalaya……………………………
with admission Number ___________, studying in class………………………in the year
………………………… and his / her date of birth is (in figures) ……………………………… (in words)
………………………………………………………............. as per the Vidyalaya records.
Date: Office Seal Sig. of the Principal
COH
The 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-2018.
Members Signature Sig. of the Chairman
1. (Name of the Chairman)
2. Date:
3.
4.
Signature of SM / GC Signature of the Principal/ District Commissioner (S/G)
