JAMIA MILLIA ISLAMIA

Jamia Nagar, New Delhi-110025

JMI-WDAF-2012
Price : Rs. 300/Form No.

Application Form for Admission to

MCA /PGDCA/M.A. in Conflict Analysis & Peace Building / M.A. in Social Exclusion & Inclusive Policy/
M.A. in Media Governance / M.A. in Comparative Religions / M.A. in Early Childhood Development/
P.G. Diploma in Digital Cartography/P.G. Diploma in Remote Sensing and GIS Applications Courses 2012-2013

Roll No.

Affix your recent

(To be filled in by the office)

self attested coloured

Read the instructions given overleaf and in the prospectus carefully before filling up this form.
photograph
All the particulars must be filled in by the candidate in his/her own hand writing.
(Size 2.0 x 1.5)
Applicant must ensure minimum eligibility conditions before applying.
It should be pasted with
Submission of Application Form will be no basis for claiming admission.
Do not attach copies of mark sheets, certificates etc. with this form. Original document with attested gum and covered with
copies along with Admit Card for Entrance Test shall be required at the time of interview.
transparent tape
Incomplete application form will NOT be considered.
An applicant may apply for a group of courses listed on page 2, by filling a single Application Form.

1. Application Form for admission to. (See the Instruction 1 on page 2 before filling up the name of the course(s) in the above).
Order of Preference of the subjects
(i)

(ii)

(iii)

(iv)

(v)

2. Faculty.............................................................................................................Deptt.........................................
3. Category (See instruction no. 2 overleaf for category code).....................................................................................
4. Name :
(In block letters)
5. Fathers Name :
(In block letters)
6. Mothers Name :
(In block letters)
7. Fathers Occupation............................................................................................................
8. Address : (i) Present (for correspondence)
(ii) Permanent
..........................................................................................
.........................................................................................
State.................................................................................
PIN..............................Telephone No..............................
9. Date of birth : (Based on Matriculation/Sec.School Certificate)
Date :

Month :

Year :

........................................................................
........................................................................
State................................................................
PIN........................Telephone No.......................
Nearest Railway Station.....................................
Age :

(As on 1/10/2012)

10. Nationality :..............................................

11. Sex:

12. Educational Qualifications :

S.No

Exams. Passed

1.

Matric/ S.S.C

2.

Intermediate/Sr.School
Certificate

3.

B.A./B.Sc./B.Com

4.

M.A./M.Sc./M.Com/LL.M.

5.

Others

Board/
University

Year Division

Agg.%

Subject
Studied

% of required
Subject (s)

13. Post Graduate Courses : Choice of specialization, if any : .................................................................................

14. DD No...................................................... Date ........................................................
(Note: In case of downloaded Application Form the Demand Draft for Rs. 300/- should be made in favour of Jamia Millia
Islamia, payable at New Delhi)
Date...................

Signature of Applicant.....................................

DECLARATION
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 the Applicant

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

DECLARATION BY THE PARENT/GUARDIAN

I certify that the above particulars are correct. I agree that in the event of my son/daughter/ward.............................................................
being admitted to the Jamia Millia Islamia, New Delhi, I shall pay dues and all personal expenses until the completion of the
applicants studies. I also undertake full responsibility for the good behaviour and conduct of the applicant.

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

.........................................................................................
Signature in full of the Parents/Guardian
Relation with student.....................................................
Address..........................................................................
..........................................................................................
Telephone No................................................................
E-mail..............................................................................

INSTRUCTIONS
1.

There shall be Common Entrance Test for admission to each of the following groups of courses. The applicants may apply
for a group of courses by filling a single Application Form, specifying the order of preference in appropriate column(s) in the
Application Form:
Group - I
Group - II
Group - III

2.

MCA /PGDCA,
M.A. in Conflict Analysis & Peace Building / M.A. in Social Exclusion & Inclusive Policy/ M.A. in Media
Governance/ M.A. in Comparative Religions / M.A. in Early Childhood Development.
P.G. Diploma in Digital Cartography/P.G. Diploma in Remote Sensing and GIS Applications.

Code for Category:

G
MO
K

General
Muslim OBC
Kashmiri Migrant

M
MT

Muslim General
Muslim ST

MW
PD

Muslim Women
Persons with Disabilities

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

3.

In case of downloaded Application Form a Bank Draft/Pay order (of a bank having its branch in New Delhi) 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/pay order/cash receipt on top left conrner.

4.

Filled Application Form complete in all respect along with Bank Draft/ Pay order, should be submitted in the office of the
respective Faculty/ Department/ Centre by the last date indicated in the Prospectus.

JAMIA MILLIA ISLAMIA

Form No. ...................

Jamia Nagar, New Delhi-110025

Admit Card for Entrance Test 2012-2013

Roll No.
(To be filled by the office)

Course(s) applied for: (i)

(ii)

(iii)

(iv)

Affix your recent

self attested coloured
photograph

(v)

(Size 2.0 x 1.5)

FOR CENTRE

It should be pasted with

Name (In Block Letters):...........................................................................................................

gum and covered with

transparent tape

Fathers Name:..................................................................................................................
Mothers Name:.................................................................................................................
Address:............................................................................................................................
.......................................
Signature of Applicant

.......................................
Signature of Invigilator

Cut Here

JAMIA MILLIA ISLAMIA

Form No. ...............

Jamia Nagar, New Delhi-110025

Admit Card for Entrance Test 2012-2013

Roll No.
(To be filled by the office)

Course(s) applied for: (i)

(ii)

(iii)

(iv)

Affix your recent

self attested coloured
photograph

(v)
FOR CANDIDATE

(Size 2.0 x 1.5)

It should be pasted with

Name (In Block Letters) : ..........................................................................................................

gum and covered with

Fathers Name:..................................................................................................................
Mothers Name:.................................................................................................................
Address:............................................................................................................................

transparent tape

.......................................
Signature of Applicant
Note:

.......................................
Signature of Invigilator

(i) Contact the Concerned Dept /Faculty for venue of Entrance Test.
(ii) Retain this Admit Card with you. It will have to be produced at the time of Entrance Test and
Interview.
Cut Here

Form No. ...............

Acknowledgement Slip

Received an Application Form from (Candidates Name) ............................................................ for admission

to ................................................................................................course.
...........................................................
Date.................................

Signature of receiving official with Stamp