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 )
---Select---
Advertising and Public Relations
Journalism(English)
Journalism(Hindi)
Radio & TV Journalism
Odia Journalism
Urdu Journalism
Marathi Journalism
Malayalam Journalism
---Select---
Advertising and Public Relations
Journalism(English)
Journalism(Hindi)
Radio & TV Journalism
---Select---
Advertising and Public Relations
Journalism(English)
Journalism(Hindi)
Radio & TV Journalism
---Select---
Advertising and Public Relations
Journalism(English)
Journalism(Hindi)
Radio & TV Journalism
2
Choice Examination Center :
*
------Select-------
AHMEDABAD
AIZWAL
BANGALORE
BHOPAL
CHENNAI
GUWAHATI
HYDERABAD
JAMMU
KOLKATTA
LUCKNOW
MUMBAI
NEW DELHI
PATNA
RAIPUR
RANCHI
SRI NAGAR
DEHRADUN
DHENKANAL
AMRAWATI
KOTTAYAM
------Select-------
AHMEDABAD
AIZWAL
BANGALORE
BHOPAL
CHENNAI
GUWAHATI
HYDERABAD
JAMMU
KOLKATTA
LUCKNOW
MUMBAI
NEW DELHI
PATNA
RAIPUR
RANCHI
SRI NAGAR
DEHRADUN
DHENKANAL
AMRAWATI
KOTTAYAM
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.
------Select-------
Hindi
English
Odia
Urdu
Marathi
Malayalam
------Select-------
Hindi
English
4
Indicate preference of IIMC center for pursuing course in Journalism (English) :
*
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
Select
Aizawl
Amrawati
Dhenkanal
Jammu
Kottayam
New Delhi
Applicant Details
5
Name Of Applicant:
*
6
Date of Birth:
*
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
MM
1
2
3
4
5
6
7
8
9
10
11
12
YYYY
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
7
Gender
*
-----------Select------------
Male
Female
8
Nationality-Indian
*
-----------Select------------
INDIAN
NRI
9
Category:
*
-----------Select------------
General
Scheduled Caste
Scheduled Tribe
Other Backward Class
10
Physical Handicapped:
*
-----------Select------------
Yes
No
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
16
Father's / Guardian's Name :
*
16-A
Father's / Guardian's Mobile No (Not start with 0):
*
17
Mother's / Guardian's Name :
*
17-A
Mother'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:
*
-----------Select------------
Passed
Appearing
Result Awaited
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.