Price : Rs.

500/-
JAMIA MILLIA ISLAMIA
Jamia Nagar, New Delhi-110025 Form No.
Application form for admission, 2011-2012
Roll No. A.J.K. MASS COMMUNICATION RESEARCH CENTRE Affix your recent
self attested coloured
Name of the Course .....................................................................................................
IMPORTANT photograph
1. Separate application should be submitted for each of the courses. (Size 2” x 1.5”)
2. Demand Draft of Rs. 500/- (in case of downloaded Admission Form only. Candidate should write his/ It should be pasted with
her name and address on the back of DD) . gum and covered with
3. Enclose a Self addressed stamped (Rs. 25/-) (Size 12” x 4”) Envelope in case the Hall Ticket transparent tape
required by Post.

A. PERSONAL DATA (Write in block letters in each box)

Write in order:- First name, and the last name, leave spaces after each name.
1. Name of Candidate

2. Sex (M/F) 3. Date of Birth:

Date of Birth in words :...........................................................................................................................
4. Father’s Name: ……………………………………….............................…………Occupation: ………...........…
5. Mother’s Name ………………………..............................................................Telephone No....……………..
6. Name of local Guardian (if any): ………………………………………………………Telephone No....……………..
7. Category (please refer codes given below)
General (G), Jamia Student (J), Scheduled Caste (S), Scheduled Tribe (T), Persons with Disabilities (P), Kashmiri Migrant (K)
(If you belong to anyone of the categories other than the General and Jamia, please attach a certificate signed by competent
authority in support of your statement)
8. Address (Present for correspondence) 9. Address (Permanent)

City City
State State
PIN PIN
Telephone Nos. ……………………………….. E-mail …………………………………………………

10. State to which Candidate belongs ………………………...…….........11. Nationality…...............................……………

12. In case of down loaded form from Jamia Website, enclose a demand draft of Rs. 500/- in favour of "Jamia Millia Islamia",
payable at New Delhi. DD No. ..................................... Date ..........................Issuing Bank........................................
B. Academic Qualifications

S. Exam Passed Board/ Year Aggregate % Division Subjects

No. University
1. Matric/SSC
2. Sr.Sec/Intermediate
3. Graduation
(If Third year result is
awaited give aggregate
of first & Second year)
4. Others (Please Specify)
 C. Interest in activities related to Mass Media

For a postgraduate programme in Mass Communication it is essential that you must have had some experience of working in media
related activities during your graduate years. This experience does not have to be of a professional nature. A list of such activities is
given. Some space is provided for any activity in which may have been involved but which is not mentioned in the list. Please tick the
appropriate boxes in the table given below to give and account of the activities in which you might have participated

Activities in which you !/x Activities in which you !/x

May have participated May have participated

TV/RADIO
FILM (FICTION) RADIO PRODUCTION
FILM (NON FICTION) SOCIAL SERVICE/VOLUNTARY WORK
FINE ARTS STILL PHOTOGRAPHY
GRAPHIC DESIGN THEATRE
JOURNALISM (Print/Radio/TV) VIDEO/T.V. PRODUCTION
LITERATURE/CREATIVE WRITING FILM PRODUCTION
MUSIC (VOCAL/INSTRUMENTAL) ……………………………....
POPULAR ARTICLES IN NATURAL SCIENCES/TECHNOLOGY ………………………………
POPULAR ARTICLES IN SOCIAL SCIENCE ………………………………
D. Language Proficiency
Please write one of the following code numbers in the box against the corresponding language.
Name of Language Proficiency Code Name of Language Proficiency Code
1. …………………………………… 2. ……………………………………….
3. …………………………………… 4. ……………………………………….
5. ……………………………………
Proficiency Code Proficiency Code
SPEAK ONLY 1 READ ONLY 2
SPEAK AND READ 3 SPEAK, READ AND WRITE 4
Applicant must submit at the time of Interview:
(a) A statement of his/her media related activities and reasons for joining this course in Duplicate.

E. Declaration

1. Whether the candidate has ever been involved in any disciplinary cases at the academic institution (s)
attended previously. (Yes/No)
if yes, give details.
2. Whether the candidate has ever been involved/prosecuted in a criminal case. If yes, give details. (Yes/No)
3. Whether any criminal case is pending against the candidate in any court of law at present. If yes, give details. (Yes/No)

(Signature of the Candidates)

F. I Solemnly undertake that
1. I have carefully read the prospectus
2. I shall accept the decision of the admission committee with regard to admission.
3. I shall abide by the rules as given in the prospectus and issued by the Jamia or AJK MCRC from time to time.
4. My candidature, admission or Diploma/Degree is liable to be forfeited in case any information supplied by me in this form is
later found to be incorrect any stage.
5. All production done by me as student exercise or, for practical experience at the centre will be the property of the Centre
including their copyrights and I will have no claim on them.
6. I will handle the centre's equipments with extreme care and all damage and losses caused by me will be made good by me.
7. I will follow the rules of discipline as prescribed by the authorities of the University from time to time.

(Signature of the Candidates)

 A.J.K. MASS COMMUNICATION RESEARCH CENTRE
JAMIA MILLIA ISLAMIA
Jamia Nagar, New Delhi-110025 Form No.
Roll No. Hall Ticket for Entrance Test 2011-2012
Affix your recent
self attested coloured
Name of the Course ......................................................................................................................
photograph
Name (In Block Letters) : ............................................................................................................... (Size 2” x 1.5”)
It should be pasted with
Father’s / Mother’s Name:.............................................................................................................. gum and covered with
Present Address:........................................................................................................................... transparent tape

...................................... ....................................... ....................................

Candidate’s Signature Signature of Invigilator Authorised Signatory
(in the Exam Hall)
Date...............................
! Cut Here !
A.J.K. MASS COMMUNICATION RESEARCH CENTRE
JAMIA MILLIA ISLAMIA
Jamia Nagar, New Delhi-110025
Roll No. Hall Ticket for Entrance Test 2011-2012 Form No.
Name of the Course ...................................................................................................................

Name (In Block Letters) : ................................................................................................................. Affix your recent

Father’s / Mother’s Name:........................................................................................................ self attested coloured
photograph
Present Address:...................................................................................................................... (Size 2” x 1.5”)
....................................... ....................................... It should be pasted with
Candidate’s Signature Authorised Signatory gum and covered with
transparent tape

Date...............................

! Cut Here !
2011-2012 Acknowledgement Slip Form No.
MA MASS COMUNICATION MA CONVERGENT JOURNALISM

PG DIP. IN DEVELOPEMENT COMMUNICATION PG DIP. IN BROADCAST SYSTEM MAINTENANCE

PG DIP. IN GRAPHICS ANIMATION PG DIP. IN STILL PHOTOGRAPHY & VISUAL COMMUNICATION