Application for Language Journalism Course 2020-21
For Office Use Only:
(to be filled by office)
Unique Registration No:
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Affix a recent photograph
of the
candidate
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Malayalam
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Marathi
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Odia
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Urdu
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*Please tick mark the selected column and strike off the rest
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Name of the Candidate in Capital Letters
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Age (as on 1st Aug. 2020)
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Date of Birth (DD/MM/YY)
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Gender
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Nationality
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Male
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Female
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Others
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Category
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General
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SC
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ST
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OBC
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EWS
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Differe-ntly abled
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Address for Correspondence
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State
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PIN Code
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Mobile Phone No:
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Email ID
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Scanned signature of the Candidate
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Areas of Interest
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Name of Father/Guardian
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Relationship with Guardian
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Father/Guardian’s occupation
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Father/Guardian’s Mobile No.
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Father/Guardian’s Email ID
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Name of Mother
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Mother’s occupation
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Mother’s Mobile No.
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Mother’s Email ID
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Annual Family Income
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Educational Qualifications*
(Copies of Certificates and Mark Sheets should be attached along with the Application Form)
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Names of Board/Degree Examination passed
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10th
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12th
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Bachelor’s Degree
(if appearing please mention the semester/year)
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Any other
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Marks obtained
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Out of (Total Marks )
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Percentage
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Year of Pass
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Name of the Board/University along with name of college
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Work Experience
(if any)
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Organization
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Designation
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Period
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Course Details for which the candidate is applying for
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Name of the Course applied for
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Fee Details
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Rs 1000
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Rs.750
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Name of Bank:
Transaction ID:
Date of Transaction:
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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.
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Date
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Signature of the Candidate
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*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.