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Details for Course Applied & Center (Candidate can apply on more than one course )
1 Name of Post Graduate Diploma Course: * (If Candidate want to apply for regional course Like(Odia/ Urdu/ Marathi/ Malayalam) then it will choose from first option )               
2 Choice Examination Center : *     
3 Medium of Exam : * If candidate apply for more than one course with (Odiya, Urdu, Marati & Malayalam) than candidate will choose second Medium of Exam from option.     
4 Indicate preference of IIMC center for pursuing course in Journalism (English) : *
Applicant Details
5Name Of Applicant: *    
6 Date of Birth: *
7 Gender *
8 Nationality-Indian*
9 Category: *
10 Physical Handicapped: *
11 Upload Photograph of Applicant (Allowed filed size: 10-20KB, Allowed File Type: jpeg/jpg) : *
12 Upload Signature of Applicant (Allowed filed size: 10-20KB, Allowed File Type: jpeg/jpg) : *
13 Write your Name & complate mailing Address : *
Name
Address
District
State
Pin Code
14 Mobile Number (Not start with 0) *
15 E-mail id :  *
Applicant Guardian Details
16Father's / Guardian's Name : *    
16-AFather's / Guardian's Mobile No (Not start with 0): *
17Mother's / Guardian's Name : *    
17-AMother's / Guardian's Mobile No (Not start with 0): : *
18 Profession of Father / Guardian : *
19 Profession of Mother / Guardian : *
20 Annual Family Income (In Rs.) :
(Please do not use ./,().etc.)
*
Education Qualification Details
21 Graduation: *
22
Qualification Board/University Passing year Percentage
(e.g. 65.01)
Name of School/College Name of the degree
(BA/BCOM/etc)
10th *
12th *
Graduation
Post Graduate
Work Experience Details
23 Designation Name :
24 Name of Institution :
25 Duties performed :
Declarations
I do hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. in the event of any statement/information being found false/incorrect/incomplete or ineligibility being found before recruitment or after appointment, my candidature/appointment will stand automatically cancelled.