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Application Form


Annexure I

 

Application for Language Journalism Course 2020-21

 

For Office Use Only:              

(to be filled by office)

Unique Registration No:

 

 

 

 

Affix a recent photograph

of the

candidate

Malayalam

Marathi

Odia

Urdu

*Please tick mark the selected column and strike off the rest

 

 

 

 

 

Name of the Candidate in Capital Letters

 

 

 

 

Age (as on 1st Aug. 2020)

Date of Birth (DD/MM/YY)

Gender

Nationality

 

 

Male

Female

Others

 

Category

General

SC

ST

OBC

EWS

Differe-ntly abled

 

Address for Correspondence

 

 

 

 

 

                    

 

State

 

PIN Code

 

 

 

 

 

 

Mobile Phone No:

 

Email ID

 

 

Scanned signature of the Candidate

 

Areas of Interest

 

 

 

Name of Father/Guardian

 

 

Relationship with Guardian

 

Father/Guardian’s occupation

 

Father/Guardian’s Mobile No.

 

Father/Guardian’s Email ID

 

 

Name of Mother

 

 

Mother’s occupation

 

 

Mother’s Mobile No.

 

 

Mother’s Email ID

 

 

Annual Family Income

 

 

Educational Qualifications* 

Name of Degree Course attended

 

Board/University Exams

10th

11th

12th

Bachelor’s Degree

Any other

Percentage

 

 

 

 

 

Year of Pass

 

 

 

 

 

Name of University along with name of college

 

 

 

Work Experience (if any)*

Organization

Designation

Period

 

 

 

 

 

 

Course Details for which the candidate is applying for

Name of Course applied for

 

Centre for Entrance Examination.

 

Fee Details

Rs 1000

Rs.750

Name of Bank:

Transaction ID:

Date of Transaction:

 

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.

 

 

 

 

Date

 

 

 

 

Signature of the Candidate

                                     

*Photocopies of Educational qualifications/proof of work experience to be provided along with application form and the original to be shown at the time of interview/admission.