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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 : *      
1-a Indicate preference of IIMC centre for pursuing course in Journalism (English) : * 1- 2- 3-

4- 5- 6-
2 Choice of Examination Centres: *     
2 Medium of Examination: *     
Applicant Details
2Name of Applicant: *    
3 Category: *
4 Are you Diffrently Abled/Divyang: *
5 Date of Birth (dd/mm/yyyy): *
6 Gender *
7 Nationality*
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
11Father’s / Guardian’s Name : *    
12Father’s / Guardian’s Mobile No. (Don’t Start with 0) : *
13 Father's / Guardian's E-mail id :*
14Mother's / Guardian's Name : *    
15Mother'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 : *
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 :