Application Form for Academic Session 2020-21
Details for Course Applied & Campus preference
(Candidate can apply in more than one course)
1
Name of Courses :
*
---Select---
Journalism (English)
Journalism (Hindi)
Radio & TV Journalism
Advertising and Public Relations
Journalism(Odia)
Journalism(Urdu)
Journalism(Marathi)
Journalism(Malayalam)
---Select---
Journalism(English)
Journalism(Hindi)
Radio & TV Journalism
Advertising and Public Relations
Journalism(Odia)
Journalism(Urdu)
Journalism(Marathi)
Journalism(Malayalam)
---Select---
Journalism(English)
Journalism(Hindi)
Radio & TV Journalism
Advertising and Public Relations
Journalism(Odia)
Journalism(Urdu)
Journalism(Marathi)
Journalism(Malayalam)
---Select---
Journalism(English)
Journalism(Hindi)
Radio & TV Journalism
Advertising and Public Relations
Journalism(Odia)
Journalism(Urdu)
Journalism(Marathi)
Journalism(Malayalam)
1-a
Indicate preference of IIMC centre for pursuing course in Journalism (English) :
*
1-
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
2-
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
3-
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
4-
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
5-
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
6-
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
2
Choice of Examination Centres:
*
------Select-------
AHMEDABAD
AIZWAL
AMRAWATI
AURANGABAD
BANGALORE
BHOPAL
CALICUT
CHANDIGARH
CHENNAI
DEHRADUN
DHENKANAL
DELHI
GUWAHATI
HYDERABAD
JAIPUR
JAMMU
KOLKATTA
KOTTAYAM
LUCKNOW
PATNA
PUNE
RAIPUR
RANCHI
SRI NAGAR
------Select-------
AHMEDABAD
AIZWAL
AMRAWATI
AURANGABAD
BANGALORE
BHOPAL
CALICUT
CHANDIGARH
CHENNAI
DEHRADUN
DHENKANAL
DELHI
GUWAHATI
HYDERABAD
JAIPUR
JAMMU
KOLKATTA
KOTTAYAM
LUCKNOW
PATNA
PUNE
RAIPUR
RANCHI
SRI NAGAR
2
Medium of Examination:
*
------Select-------
Hindi
English
------Select-------
Hindi
English
Applicant Details
2
Name of Applicant:
*
3
Category:
*
-----------Select------------
General
SC
ST
OBC
EBC/ EWS
4
Are you Diffrently Abled/Divyang:
*
-----------Select------------
Yes
No
5
Date of Birth (dd/mm/yyyy):
*
DD
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MM
1
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YYYY
2021
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1923
1922
6
Gender
*
-----------Select------------
Male
Female
Transgender
7
Nationality
*
-----------Select------------
INDIAN
NRI
8
Upload photograph of the applicant
(Allowed filed size : 10-50 KB, Allowed File Type: jpeg/jpg.)
*
9
Upload scanned signature of the applicant
(Allowed filed size : 10-50 KB, Allowed File Type: jpeg/jpg)
:
*
8
Address for correspondence (with pincode)
*
Name
Address
District
State
Pin Code
9
Mobile Number
(Don’t Start with 0) (10 digits)
*
10
E-mail id :
*
Applicant's Guardian Details
11
Father’s / Guardian’s Name :
*
12
Father’s / Guardian’s Mobile No.
(Don’t Start with 0)
:
*
13
Father's / Guardian's E-mail id :
*
14
Mother's / Guardian's Name :
*
15
Mother's / Guardian's Mobile No.
(Don’t Start with 0)
:
*
16
Mother's / Guardian's E-mail id :
*
17
Profession of Father / Guardian :
*
18
Profession of Mother / Guardian :
*
19
Annual Family Income (In Rs.) :
(Please do not use the characters like ./,().etc.)
*
Educational Qualification Details
20
Graduation :
*
-----------Select------------
Passed
Appearing
Result Awaited
21
Qualification
Board/University
Passing year
Percentage
Subjects
Name of School/College
Name of the degree
(BA/BCOM/etc)
10th
*
12th
*
Graduation
Post Graduate
Work Experience Details
22
Designation:
23
Name of organisation :
24
Period :
From :
To :