IIT-HOME ASE-2017 : PAST MERIT RECORD (PMR) This form is designed to judge the performance of student at School Level activities such as Olympiads, Talent Search Examinations, Science Projects etc. ASE Registration ID: 10th Board MS-State (P tick appropriate box): ASE Roll No: (For office use) CBSE School base CBSE Other-State ICSE Applicant’s Name: School Name : INSTRUCTIONS FOR FILLING PMR ? Fill the complete form using BLACK BALL PEN only. ? Write Registration ID, ASE Roll number in the box provided. ? Write Applicant’s name in capital letters. ? Students should carefully fill in the box the performance for each examination in the respective standard (i.e Std. V to Std. X), preferably with the help of Parents. ? DO NOT FILL BOX if you have not appeared for the examination. ? Students may be called for Personal Interview (PI) along with the original documents. STATE LEVEL EXAMINATION Q.1 Have you appeared for High School Scholarship exam in Standard VII ? Std. VII: Score - Out of Awarded Scholarship - SR - Yes Q.2 Have you appeared for Pravinya Examination conducted by Ganit Adhyapak Mandal? If Yes, write your score. Std. V : Score - Out of Std. VIII: Score - Out of Q.3 Pradnya Examination conducted by Ganit Adhyapak Mandal. Have you been Awarded Medal / Scholarship in Std. V : Yes Std. VIII: Yes Q.4 State if you have qualified Jnan Vigyan Pratibha Pariksha by Vijay Bhatkar (JVPP): (P tick appropriate boxes) Level : Qualified : I Yes II Yes III Yes IV Yes Q.5 If you have appeared for Abacus Vision Pune Maths Talent Search Examination write your State V VI VII VIII Rank in respective Class/Standard : State Rank : Q.6 Write your State Rank in Maharashtra Talent Search Examination (MTSE), if applicable. Standard : State Rank : VIII IX X Q.7 Have you qualified Regional Maths Olympiad (RMO) : (P tick appropriate boxes) Standard : Qualified : V Yes VI Yes VII Yes VIII Yes IX Yes X Yes NATIONAL LEVEL EXAMINATION Q.8 Have you participated in any activity such as: Participation Certificate Excellence Certificate I) National Children’s Science Congress by Bal Vidnyan Parishad Govt. of India Yes Yes II) CBSE Science Project at National Level Yes Yes Q.9 Write your All India Rank in following Science Olympiad Foundation Examinations (Level II) : if applicable Standard : VIII IX X I) International Maths Olympiad (IMO) II) National Science Olympiad (NSO) Q.10 Unified Council National Science Talent Search Examination (NSTSE) : Q.11 Association of Mathematics Teachers of India (Chennai): Level I (P tick if Yes) : Level II (All India Rank) : Q.12 International Olympiad of Mathematics (iOM) conducted by Silver Zone Olympiads: All India Rank : Q.13 Have you qualified All India Talent Search Examination conducted by CBSE:(P tick appropriate boxes) Standard : VII Qualified : Yes VIII Yes IX X Yes Yes Q.14 Have you qualified National Talent Search Examination (NTSE) in Standard VIII: (P tick appropriate boxes) Level : Qualified : I II Yes III Yes Yes Q.15 Have you qualified Junior Science Olympiad conducted by Homi Bhabha Foundation : (P tick appropriate boxes) I Level : Qualified : Yes II Yes Q.16 Have you qualified Indian National Mathematics Olympiad (INMO) : (P tick appropriate boxes) VII Standard : Qualified : Yes VIII Yes IX X Yes Yes INTERNATIONAL LEVEL EXAMINATION Q.17 Have you participated in any activity such as: Participation Excellence Certificate Certificate I) NASA’s Space Settlement Design Contest II) Australlian Chemistry Quiz : Yes Awarded Plaque : Gold Yes International Rank Yes Bronze Yes Silver Percentile Yes ANY OTHER NATIONAL / INTERNATIONAL LEVEL EXAMINATIONS If you have qualified any other National or International Maths / Science examination ONLY conducted by Govt. of India or International Board. Write name of examination below with your achievements. ASE-2017 : PAST MERIT RECORD (PMR) INSTRUCTIONS FOR FILLING FORM If the student has any remarkable achievements in any of the following competitive examinations, students should fill the following form. LIST OF COMPETITIVE EXAMINATIONS FOR PAST MERIT RECORD 1. High School Scholarship Exam in Std. VII 2. Pravinya Examination conducted by Ganit Adhyapak Mandal 3. Pradnya Examination conducted by Ganit Adhyapak Mandal 4. Jnan Vigyan Pratibha Pariksha (JVPP) by Vijay Bhatkar 5. Abacus Vision Pune Maths Talent 6. Maharashtra Talent Search Examination (MTSE) 7. Regional Maths Olympiad (RMO) by Homi Bhabha Foundation 8. National Children's Science Congress by Bal Vidnyan Parishad, Govt. of India 9. CBSE Science Project at National Level 10. International Maths Olympiad (IMO) by Science Olympiad Foundation 11. National Science Olympiad (NSO) by Science Olympiad Foundation 12. Unified Council National Science Talent Search Examination (NSTSE) 13. Association of Mathematics Teachers of India, Chennai (AMIT) 14. International Olympiad of Mathematics (iOM) conducted by Silver Zone Olympiads 15. All India Talent Search Examination conducted by CBSE 16. National Talent Search Examination (NTSE) 17. Junior Science Olympiad conducted by Homi Bhabha Foundation 18. Indian National Mathematics Olympiad (INMO) by Homi Bhabha Foundation 19. NASA Space Settlement Design Contest 20. Australian Chemistry Quiz 21. Kendriya Vidyalaya Regional Maths Olympiad 22. National Junior Science Olympiad by Indian Association of Physics Teachers If you have remarkable achievements (having All India Rank less than 1000 or equivalent) in any NATIONAL/INTERNATIONAL level competitive examination not mentioned in the above list, you may mention the details of your achievements in the PMR Form at the end of the form in the extra space provided. You will be required to submit xerox copies of supporting documents for your achievements mentioned in the PMR Form at the time of submission and original certificates will be required during Personal Interviews. IMPORTANT NOTE = Students should note that PMR is designed with a purpose to judge the merit of a student at school level. It will be of secondary importance in the ASE selection process. Student's performance in ASE 2017, and Personal Interview (if conducted) will be the primary criteria for his/her selection in IIT-HOME. = It is NOT compulsory for all ASE 2017 registered studentss to fill the PMR. Students should fill the PMR only if they have any mentionable achievements in a National/International competitive examinations. Do not submit Certificate of Participation only.
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