20102012

TATA INSTITUTE OF SOCIAL SCIENCES

(A Deemed University) V.N. Purav Marg, Deonar , Mumbai-400 088 Deonar, PLEASE USE SEP ARA TE D.A.F . FOR EACH PROGRAMME SEPARA ARATE D.A.F.
Paste one recent PASSPORT SIZE photograph here with your signature on it for identification

Detailed Application Form for

DS CL WS HR GL SE SW DA

HE

H O PHHP PHSE

DM MC

(Please Tick off the course that you have qualified for)

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.
Registration No. Date of GD / PI 03 10

1.

Full Name: Dr./Mr./Ms. _____________________________________________________________________________

(Students Name) (Last Name)

2.

Category you belong to:

SC

ST

OBC

KM

PWD

GN

Specify the Caste, if you belong to SC/ST/OBC: _____________________________________________________ 3. Date of Birth:

Date Month Year

3.1 4.

Age as on June 15, 2010. ________________Years. Marital Status: Single Married

5.

Residential Address ________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________

(Pin Code) State)

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

6.

State of Original Domicile: __________________________________________________________________________

7.
Attended Name of Institution Attended From (Month and Year) To (Month and Year) Year of Passing Medium of Instruction Out of Maximum Marks

State particulars of your education beginning with S.S.C. or equivalent examination. Attach photocopies of all the marksheets.

Name of Examination

Duration of Study (in Years) (Put Tick Mark in the Relevant Box)

Board/University

Total Marks Obtained in all Subjects including Languages/Major Main/Subsidiary Subjects, etc.

Overall Percentage of Marks OR Average Grade Point Obtained

S.S.C. or its equivalent

10 years (

Higher Secondary, 1 year ( ) Pre-University or Intermediate 2 years ( )

B.A.

1st year

B.Sc.

B.Com.

2nd year

B.M.S.

B.B.S.

3rd year

B.E./B.Tech.

1st year

B. Architect

M.B.B.S.

2nd year

B.D.S.

3rd year

B.H.M.S.

2
To

B.A.M.S.

4th year

M.A.

M.Sc.

M.Com.

Other Masters Degree

(Specify...................................)

Diploma in PGDHR

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
How was this time spent?

Period unaccounted

From

8.

Have you taken part in NSS activities?

Yes

No

Family Background: (Members who are alive only)

Name of Family Member

Relationship, i.e., Father/Mother, etc.

Educational Qualification

Occupation

Monthly Income Rs.

Any Additional Information

(i)

(ii)

(iii)

10. 10.1

Have you qualified for GD/PI of any other Masters Degree programme(s) at this Institute, in 201012?

Yes

No

If yes, specify the name of the programme(s): (a) ________________________________________________________ (b) _________________________________________________________________________________________________

11.

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

12.

Do you need hostel accommodation? (We have limited accommodation facilities in the campus) Hostel accommodation is based on Institute criteria.

Yes

No

13.

Which languages do you know? Please mention your proficiency as Good or Fair or Poor
Language Speak Read Write

1. English 2. 3. 3

14.

Please indicate how you will meet your expenses during the period of study.
Source of Funds Name Relationship

Amount Expected, Per Month

Period for which it is Assured

(i)

(ii)

(iii)

15.

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 Service

Gross/Consolidated/ Monthly Salary Drawn

(i)

(ii)

(iii)

16.

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.

17.

Mention any work done by you relevant to the field(s) of study selected by you. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________

18.

(a) Have you appeared for any examination conducted by any other University/Institute?

Yes No

(b) If yes, please specify the details. ___________________________________________________________________

19.

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 Bachelors 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)

20.

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

IMPORT TANT IMPOR (i) (ii) (iii) A set of photocopies of all the relevant marksheets and certificates as mentioned on page 12 of the Information Brochure must be attached with this Form, if you have not sent with earlier form. Verification of original marksheets/certificates, etc., will be done after the announcement of the admission results, i.e., between April 22 to May 07, 2010. Admission will be confirmed subject to the verification of original certificates, marksheets and eligibility fulfilment of the selected candidates. 5

List of Enclosures: 1. 10th Std. Marksheet 2. 12th Std. Marksheet 3. First Year Degree Marksheet 4. Second Year Degree Marksheet 5. Third Year Degree Marksheet (If graduate completed) 6. Fourth Year Degree Marksheet (If it is four years degree) 7. Caste Certificate (for SC/ST/OBC candidates only) 8. Non-creamy Layer Certificate (for OBC Candidates only)* 9. Income Certificate, 20082009 (for SC/ST/OBC Candidates only) 10. Work Experience Certificate, if any 11. Profile written in a plain paper (compulsory) 12. Any other certificates relevant to the course, like PG Degree/Diploma 13. Internship completion certificate (For medical graduates) 14. Post-graduate statement of marks Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No NA NA NA NA NA NA NA NA NA

This application along with enclosures, should be sent through Speed Post / Registered Post only, superscribing on the February 22, envelope DAF for ___________________ Course, Date of GD/PI __________________, by February 28,2010 2010 to:

Section Officer (Admission) Tata Institute of Social Sciences Sion-T rombay Road, Deonar Sion-Trombay Mumbai 400 088

* Candidates belonging to OBC category who do not possess the NON-CREAMY LAYER (STATUS) Certificate will be treated as General candidates and their final selection will be done along with other general candidates and no extension of period will be granted to get it from competent authorities.