JMI-WADF-2015

Form No

JAMIA MILLIA ISLAMIA

Centre for Distance and Open Learning
Arjun Singh Block, Maulana Mohammed Ali Jauhar Marg, New Delhi 25

Affix your recent

self attested coloured
photograph
(Size 2.0 x 1.5)
It should be pasted
with gum and covered
with
transparent tape

Application Form for Admission

Post Graduate Programmes

(DISTANCE MODE) 2015 2016

Roll No.
(To be filled in by the office)

(To be filled in capital letters using Blue /Black Ball pen only. See Instructions and necessary codes overleaf)

1.

Name of the Programme applied for

2.

Name of the Study Centre

3.

Category Code

6.

Candidates Mobile No.

Programme Code
Study Centre Code
4. Disability Code

%age of Disability

7. Enrollment No. for Jamia Students

(If earlier allotted by the Jamia Millia Islamia)

For SMS Alert Service

8.

Candidates Full Name

9.

Fathers Name

10.

Mothers Name

11.

Date of Birth : (based on Matriculation/Sec. School Certificate)

Date

5. Medium Code

out whichever is not applicable)

Month

Year

14.

State of Domicile

15. Territory Code

17.

Address (i) For Correspondence

12. Sex

13. Marital Status Code

16. Nationality
(ii) Permanent

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

...

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

...

....

....

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

...

State......

State......

PinTelephone No

PinTelephone No...

18. MA Education Optional Course Codes for Specialized area (Select one optional Group )
19.

Educational Qualifications
S.
Exam. Passed
No.
1.

2.

3.

4.
20.

21.

Board/
University

Year

Division

%age

Subjects

X / Sec. School Certificate

XII / Sr. Sec. School

Certificate
Graduation

Others

Appointment so far held (if Applicable)

Name & Address of
Period of Service
S.
Employer /
From
To
Total Period
No
Recognized School

Post
held

Nature of
Appointment

Duration
of Service

Total Work
Experience

To be filled in case of downloaded form DD/Pay Order No.. DateDrawn on Bank .

(Note : The Demand Draft for Rs. 300/- should be in favour of Jamia Millia Islamia, payable at New Delhi)
Date ...

-------------------------Signature of Applicant

DECLARATION BY APPLICANT
I SOLEMNLY UNDERTAKE to accept and abide by the rules of the Jamia Millia Islamia and all the decisions of the admission
committee and other appropriate university bodies in regard to my admission.
I SOLEMNLY AFFIRM that I have never been convicted by a court of law nor rusticated/expelled from any educational institution /nor
disqualified/debarred from any examination.
I will accept the cancellation/ forfeiture of my candidature in case any information supplied by me in this form is found to be incorrect at
the time of admission or thereafter.

---------------------------------------Signature of Father/Guardian

------------------------------Signature of Applicant

Date:

For Office Use Only

Document Verification

Bank Draft / Pay Order No...Date..Drawn on Bank..

Enrollment No:..

Roll No:.

Signature of the Verification Officer

Dated.

INSTRUCTIONS
1.

PROGRAMME CODE AND NAME

M.A. English MEG
M.A. Sociology MAS
M.A. HRM
MHRM
M.A Education MAE
M.Com.
MCM

M.A. Hindi
M.A. History
M.A - Political Science
M.A.-Public Administration

2.

STUDY CENTRE CODE

For Study Centre Code details please refer to Prospectus on Page No. 35.

3.

CATEGORY CODE
General
Muslim Women
Muslim Scheduled Tribe
Kashmiri Migrants

G
MW
MST
K

MHD
MAH
MAPS
MAPA

Muslim General
Muslim OBC
Persons with Disability

MG
MO
PD

No change of category is permissible, once the choice has been made

4.

Disability Code (if applicable)

Blindness/Low Vision
Hearing Impairment
Locomotors disability or cerebral palsy
Others

L
H
C
O

5.

Please do not prefix Mr/Mrs/Ms. at Sl.No. 6, 7 & 8 of the application form.

6.

SEX CODE

Male M

7.

MARITAL STATUS CODE

Married

8.

TERRITORY CODE

Urban 01

Rural - 02

9.

Medium Code for Study Material

English E

Hindi H

10.

Category Code should be given carefully. Candidates falling under more than one category should choose any one category for
consideration and mention the same in the form. Incorrect proclamation of the category shall lead to immediate cancellation of
form/admission.

11.

In case of downloaded Application Form a Bank Draft should be made in favour of Jamia Millia Islamia, payable at New Delhi. Candidate
must write his/her name and number of his/her application form on the back of the bank draft on top left corner.

Female F
01 Unmarried 02 Divorced

03 Widowed 04

Tribal 03 Kashmiri Migrant 04