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Application Form


Application for Language Journalism Course 2020-21

 

For Office Use Only:              

(to be filled by office)

Unique Registration No:

 

 

 

 

Affix a recent photograph

of the

candidate

Malayalam

Marathi

Odia

Urdu

*Please tick mark the selected column and strike off the rest

 

 

 

 

 

Name of the Candidate in Capital Letters

 

 

 

 

Age (as on 1st Aug. 2020)

Date of Birth (DD/MM/YY)

Gender

Nationality

 

 

Male

Female

Others

 

Category

General

SC

ST

OBC

EWS

Differe-ntly abled

 

Address for Correspondence

 

 

 

 

 

                    

 

State

 

PIN Code

 

 

 

 

 

 

Mobile Phone No:

 

Email ID

 

 

Scanned signature of the Candidate

 

Areas of Interest

 

 

 

Name of Father/Guardian

 

 

Relationship with Guardian

 

Father/Guardian’s occupation

 

Father/Guardian’s Mobile No.

 

Father/Guardian’s Email ID

 

 

Name of Mother

 

 

Mother’s occupation

 

 

Mother’s Mobile No.

 

 

Mother’s Email ID

 

 

Annual Family Income

 

 

Educational Qualifications*

(Copies of Certificates and Mark Sheets should be attached along with the Application Form)

Names of Board/Degree Examination passed

10th

12th

Bachelor’s Degree

(if appearing please mention the semester/year)

Any other

Marks obtained 

 

 

 

 

Out of (Total Marks )

 

 

 

 

Percentage

 

 

 

 

Year of Pass

 

 

 

 

Name of the Board/University along with name of college

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Experience

(if any)

Organization

Designation

Period

 

 

 

 

 

 

Course Details for which the candidate is applying for

Name of the Course applied for

 

Fee Details

Rs 1000

Rs.750

Name of Bank:

Transaction ID:

Date of Transaction:

 

Declaration

I do hereby declare that all the information provided above are true, complete and correct to the best of my knowledge and belief and in the event of any statement/information being found false/ incorrect/incomplete or on ineligibility before recruitment or admission, my candidature/admission will stand automatically cancelled.

 

 

 

 

Date

 

 

 

 

Signature of the Candidate

 

                                     

 

 

*Those who are appearing in the final semester/year examination or appeared but result is awaited should fill the Application Form with their marks/percentage up to second year/fifth semester of Graduation.

**The marks mentioned by the candidate in the application form and supported by the attached mark sheet will be treated as final.

***The photocopies of certificates, mark sheets, proof of work experience should be provided/emailed along with the application form. The original certificates should be produced at the Institute for verification at a later stage and IIMC reserves its right to verify eligibility at various stages of the selection process.