PROSPECTUS 2016-17
Original (AI Coordinator’s Copy)
APPENDIX A
TELANGANA STATE OPEN SCHOOL HYDERABAD
Application form for Admission to SSC
* Before filling up the Application form read the instructions in the Prospectus carefully.
(To be filled by AI Coordinator as per Sl.No. assigned in Admission Register) AI Code No……………………………)
AI Code No: Admission Sl. No.
Fee Particulars:
Application cum Registration Admission Fees Other Fees, if Total Fee (in
Fee (in Rs.) (in Rs.) any (in Rs.) Rs.)
To be filled by the candidate
1. Name of the Accredited Institution with Address : __________________________
Paste
________________________________________________________________
Latest Passport
2. Name of the Candidate in full (in Block Letters) : Size Photograph
(Colour)
Surname:
Name :
3. Father’s Name: Even married woman also should enter only Father’s Name Candidate’s Signature
4. Mother’s Name: (Proof should be enclosed)
Category of Candidate 1. Neo literate 2. School Drop-out 3. House Wife
4. Inservice 5. Ex. Service Men 6. Others
Item No. 5 & 6 Put tick mark (✓)
5. Sex : Male Female 6. Marital Status: Married Unmarried
7. Date of Birth In Figures Date Month Year
8. Community: OC BC (A) BC (B) BC (C) BC (D) BC (E) SC ST Minority
Put tick mark (✓)
(MRO Certificate
Be enclosed)
(a) Name of the Sub caste in case of Other than OC : …………
9. (a) Annual Family Income: Rs……….… (b) Adhaar Card No:
10. Nationality : Religion: State : Mother Tongue:
11. Differently Abled(DA) : Put tick mark (✓)
(If deformity is 40% or more 1) Visually impaired 2) Deaf, Deaf and Dumb
Enclose certificate) 3) P.H 4) Dyslexia
41
PROSPECTUS 2016-17
12. Identification Marks:
1 …………………………………………………………………………………………………………………
2 …………………………………………………………………………………………………………………
13. Previous Educational Qualifications: ____________________________
(only passed class shall be mentioned and enclose certificate)
14. If already Studied & failed in SSC of any other Board give details:
Sl. Hall Ticket Year of Name of the Board Medium No. of subjects Marks
No. No. Appearance & Address passed obtained
1
2
3
4
* Candidates who appeared Intermediate Examinations on or after March 2012 are only eligible to claim TOC.
** Please refer Prospectus for List of Recognized Boards.
15. Transfer of Credit (TOC) of Two subjects for which exemption claimed:
Subject-1: Code Subject-2 : Code
16. Subjects Selected for study in SSC (APOSS):
Sl.No Group Code No Subject
1.
2.
3.
4.
5.
6.
7.
17. Medium of Instruction : ……………………
18. Postal Address: Present Permanent
Mobile No:
Declaration:
I hereby solemnly affirm that all the particulars and information furnished by me in this application form
are true. If any information is found false and /or if any document / enclosure is found fraudulent, I may be
liable for any action by the Director, TOSS /Government besides canceling my admission / performance in
the examination at any stage. I have carefully gone through the prospectus booklet of TOSS and have
become fully conversant with the eligibility conditions to be satisfied for appearing at SSC (TOSS) exams and
I further declare that I have sufficient knowledge and I am capable of studying Class X.
——————————————
Signature of AI Coordinator with Seal Full Signature of the candidate
42
PROSPECTUS 2016-17
Original (AI Coordinator’s Copy)
APPENDIX B
TELANGANA STATE OPEN SCHOOL HYDERABAD
Application form for Admission to Intermediate
* Before filling up the Application form read the instructions in the Prospectus carefully.
(To be filled by AI Coordinator as per Sl.No. assigned in Admission Register)
Accredited Institute (AI) Code Admission Sl. No.
SSC Hall Ticket ...................................... Year of Passing ...............
Fee Particulars:
Application cum Registration Admission Fees Other Fees, if Total Fee (in
Fee (in Rs.) (in Rs.) any (in Rs.) Rs.)
To be filled by the candidate
1. Name of the Accredited Institution with Address : __________________________ Paste Latest
________________________________________________________________ Passport Size
Photograph
2. Name of the Candidate in full (in Block Letters as in SSC Records) : (Colour)
Surname:
Name :
3. Father’s Name: Even married woman also should enter only Father’s Name Candidate’s Signature
4. Mother’s Name: (Proof should be enclosed)
Category of Candidate 1. School Drop-out 2. House Wife 3. Inservice
4. Ex. Service Men 5. Others
Item No. 5 & 6 Put tick mark (✓)
5. Sex : Male Female 6. Marital Status: Married Unmarried
7. Date of Birth In Figures Date Month Year
8. Community: OC BC (A) BC (B) BC (C) BC (D) BC (E) SC ST Minority
Put tick mark (✓)
(MRO Certificate
Be enclosed)
(a) Name of the Sub caste in case of Other than OC : …………
9. (a) Annual Family Income: Rs……….… (b) Adhaar Card No:
10. Nationality : Religion: State : Mother Tongue:
11. Differently Abled(DA) : Put tick mark (✓)
(If deformity is 40% or more 1) Visually impaired 2) Deaf, Deaf and Dumb
Enclose certificate) 3) P.H 4) Dyslexia
43
PROSPECTUS 2016-17
12. Identification Marks (as in SSC):
1 …………………………………………………………………………...……………………….……
2 …………………………………………...…………………………………………………………....
13. SSC Pass Details: H.T.No ……………………………….... Year of Passing:………………………………
Subjects studied in SSC : (i) ………………..….... (ii) ………….....……. (iii) ………….…..………
(iv) ………...…………… (v) ………………….. (vi) ………………………
14. If already studied and failed INTERMEDIATE of any Recognized (**) Board give details:
Sl. Hall Ticket Year of Name of the Board Medium No. of subjects Marks
No. No. Appearance & Address passed obtained
1
2
3
4
* Candidates who appeared Intermediate Examinations on or after March 2012 are only eligible to claim TOC.
** Please refer Prospectus for List of Recognized Boards.
15. Transfer of Credit (TOC) of Two subjects for which exemption claimed:
Subject-1: Code Subject-2 : Code
Hall Ticket Number : ..................................... Year of first Appearance : .............................
16. Subjects Selected for study in INTERMEDIATE (TOSS) (English Compulsory):
Sl.No Group Code No Subject
1. A 3 0 2 English
2. B
3. M.P.C Bi.P.C C.E.C H.E.C M.E.C
Others: 1. Code : ……………. Subject : ………………
2. Code : ………….… Subject: ……….………
3. Code : ………….… Subject: ………………
4. C 1. Code : ………….… Subject: ………………
5. Additional Subject: Sixth Subject: Code:………. Subject : …………
17. Medium of Instruction : ……………………
18. Postal Address: Present Permanent
Mobile No: Mobile No:
Declaration:
I hereby solemnly affirm that all the particulars and information furnished by me in this application form
are true. If any information is found false and /or if any document / enclosure is found fraudulent, I may be
liable for any action by the Director, TOSS /Government besides canceling my admission / performance in
the examination at any stage. I have carefully gone through the prospectus booklet of TOSS and have
become fully conversant with the eligibility conditions to be satisfied for appearing at SSC (TOSS) exams and
I further declare that I have sufficient knowledge and I am capable of studying Intermediate Course.
——————————————
Signature of AI Coordinator with Seal Full Signature of the candidate
44
