2017-2018

TATA INSTITUTE OF SOCIAL SCIENCES

(A Deemed University)
V.N. Purav Marg, Deonar, Mumbai-400 088
Paste one recent
PASSPORT SIZE
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Detailed Application Form: with your
signature on it for
identification
 All entries in the Application Form should be written in CAPITAL LETTERS.
Incomplete application forms will not be accepted. Please use additional sheets,
wherever required.

1. Full Name: Dr./Mr./Ms.__________________________________________________________________

(Candidate’s Name) (Last Name)
2. Registration Number : ___________________

3. Name of the Programme selected: ___________________________________________________________

4. Date of Birth: Marital Status:

Single Married

5.1 Age as on June 01, 2017._____________Years.

6. Residential Address_______________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

___________________________________________________________________________________________________________
(Pin Code) (State)

___________________________________________________________________________________________________________
(Telephone No. with STD Code) (Cell No.) (E-mail)

7. State of Original Domicile: ________________________________________________________________

7. State particulars of your education beginning with S.S.C. or equivalent examination.

Name of Duration of Board/Uni Name of Attended Year of Major Total Marks Obtained in
Examination Study (in versity Institution Passing Subjects all Subjects including
Years) (Put Attended Studied Languages/Major
Tick Mark (Main)/Subsidiary
in the Subject, etc.
Relevant
Box)
From (Month and To (Month and
Year) Year)
S. S. C or its 10 years ( )
equivalent
Higher Secondary, 1 year ( )
Pre-University or 2 years ( )
Intermediate
Graduation 1 st year
(Specify
degree.......................

................................)
2 nd year

3 rd year
4 th year
Post - Graduation 1 st year
(Specify
degree.......................

................................)
2 nd year

3 rd year
4 th year
Other
Degrees/Diplomas
(Specify.................

…...........................)

7.1 Explain any unaccounted period from the date of passing school (S.S.C. or equivalent examination) to the date
of this application
Period unaccounted How was this time spent?
From To
8. (a) Have you appeared for any examination conducted by any other University/Institute? Yes / No
(b) If yes, please specify the details.__________________________________________________________

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9. Family Background: (Members who are alive only father and mother, brother / sister, if dependant on him).
( as per given in the Summary sheet )

Sr. Name of Family Member Relationship, Educational Occupation Monthly Additional

No. i.e, Father / Qualification Income Information
Mother, etc. (In Rupees) If any
i.

ii.

iii.

11. Why are you interested in pursuing this course? Please add pages, if necessary.

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12. Write your Biographical Sketch (not exceeding 250 words). The sketch is important as it enables the
Interview Panel to assess your interests. Please use separate sheet, if necessary.

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13. Mention any work done by you relevant to the field of study selected by you.
________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

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14. Which languages do you know? Please mention your proficiency as Good or Fair or Poor.

Language Speak Read Write

1. English
2.
3.
4.

15. Please indicate how you will meet your expenses during the period of study.

Source of Funds Amount Expected, Period for which it

Per Month is Assured

Name Relationship

(i)
(ii)
(iii)
(iv)

16. Are you employed? If yes, please give the following details of your past and present job(s).

Name of Employer and Place of Work Designation and Nature of Work Years of Gross/Consolidated/
Service Monthly Salary
Drawn
(i)

(ii)

(iii)

(iv)
17. If you are employed, how will you ensure attending classes and also field work (Please tick any one of the
followings).

• Your employer will grant you study leave/duty leave for these periods.

• You will use your personal leave/vacation slots to attend classes in these period.

• You will have to lose pay for these periods.

• It will pose difficulty and you have not yet worked out how to manage this.

18. Declaration by the Applicant

I hereby certify that the information provided in the Application and Detailed Application Form is complete and
accurate. I have not been disqualified by any university or other institution from appearing for any examination
or from seeking admission for any programme of study.

I will be appearing for final year examination of my Bachelor’s Degree under

________________________________________________________________________________________
(If it is applicable) (specify the pattern of study)
(10+2+3 OR 10+2+2+1)

I agree that the Institute has the right to cancel my admission and/or withdraw the Degree awarded to me if the
Institute finds that the information in this application is incorrect and/or misleading at any point of time. I also
agree that on being admitted, I shall abide by the rules of attendance requirements, discipline, conduct, hostel,
etc., of the Institute and any modification to the rules, as may be made from time to time, after my admission.

_______________ _________________ ______________________________

(Place) (Date) (Signature of applicant)