Tiss Detail A

7/29/2019 Tiss Detail A

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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:

3.1 Age as on June 15, 2010. ________________Years.

4. Marital Status: Single Married

5. Residential Address ________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

(Pin Code) State)

___________________________________________________________________________________________________

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

6. State of Original Domicile: __________________________________________________________________________

TTTTTAAAAATTTTTA INSTITUTE OF SOCIAL SCIENCESA INSTITUTE OF SOCIAL SCIENCESA INSTITUTE OF SOCIAL SCIENCESA INSTITUTE OF SOCIAL SCIENCESA INSTITUTE OF SOCIAL SCIENCES(A Deemed University)

VVVVV.N. Purav Marg, Deonar.N. Purav Marg, Deonar.N. Purav Marg, Deonar.N. Purav Marg, Deonar.N. Purav Marg, Deonar, Mumbai-400 088, Mumbai-400 088, Mumbai-400 088, Mumbai-400 088, Mumbai-400 088

PLEASE USE SEPPLEASE USE SEPPLEASE USE SEPPLEASE USE SEPPLEASE USE SEPARAARAARAARAARATE D.A.FTE D.A.FTE D.A.FTE D.A.FTE D.A.F. FOR EACH PROGRAMME. FOR EACH PROGRAMME. FOR EACH PROGRAMME. FOR EACH PROGRAMME. FOR EACH PROGRAMME

Detailed Application Form forDetailed Application Form forDetailed Application Form forDetailed Application Form forDetailed Application Form for

D SD SD SD SD S C LC LC LC LC L W SW SW SW SW S H RH RH RH RH R G LG LG LG LG L S ES ES ES ES E S WS WS WS WS W DAD ADAD ADA

H EH EH EH EH E H OH OH OH OH O P H H PP H H PP H H PP H H PP H H P P H S EPH SEP H S EPH SEPH SE D MD MD MD MD M M CM CM CM CM C

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

All entries in the Applicat ion Form should be written in CAPITAL LETTERS. Incomplete application forms wi ll not

be accepted. Please use additional sheets, wherever required.

2010201220102012201020122010201220102012

Date Month Year

Paste one recent

PASSPORT SIZE

photograph here

with your

signature on it for

identification

Registration No. Date of GD / PI

0 30 30 30 30 3 1 01 01 01 01 0


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7.

State

particularsofyoureducationbeginningwithS.S.C.orequiva

lentexamination.Attachphoto

copiesofallthemarksheets.

Duration

Attended

TotalMarks

Overall

ofStudy

Obtainedinall

O

utof

Percentage

Nameof

(inYears)

Board/University

NameofInstitutionAttended

From

To

Yearof

Mediumo

f

Subjectsincluding

Maximum

ofMarks

Examination

(PutTick

(Month

(Month

Passing

Instruction

Languages/Major

Marks

OR

Markinthe

and

and

Main/Subsidiary

AverageGrade

Relevant

Year)

Year)

Subjects,etc.

PointObtained

Box)

S.S.C.orits

equivalent

10years(

)

HigherSecon

dary,

1year(

)

Pre-Universityor

Intermediate

2years(

)

1styear

2ndyear

3rdyear

1styear

2ndyear

3rdyear

4thyear

M.A.

M.Sc.

M.Com.

OtherMastersDegree

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

DiplomainPGDHR

Otherdegree

s/diplomas

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

7.1

Explainanyunaccountedperiod

unaccountedperiod

unaccountedperiod

unaccountedperiod

unaccountedperiod

fromt

hedateofpassingsch

ool(S.S.C.orequivalentexam

ination)tothedateofthisapplication

Period

unaccounted

From

To

Howwasth

istimespent?

B.E./

B.Tech.

B.

Architect

M.B.B.S.

B.D.S.

B.H.M.S.

B.A.M.S.

B.A.

B.Sc.

B.Com.

B.M.S.

B.B.S.

2


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8. Have you taken part in NSS activities? Yes No

9 Fami ly Background: (Members who are al ive only )

Name of Family Relationship, i.e., Educational Monthly Any

Member Father/Mother, etc. Qualification Occupation Income Additional

Rs. Information

( i)

(ii)

(iii)

10. Have you qualified for GD/PI of any other Masters Degree programme(s) at this Institute, in 201012? Yes No

10.1 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) Yes No

Hostel accommodation is based on Institute criteria.

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

Language Speak Read Write

1. English

2.

3.


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

Source of Funds Amount Expected, Period for which

Name RelationshipPer Month 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 Gross/Consolidated/

Service 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. ___________________________________________________________________


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19.19.19.19.19. Declaration by the ApplicantDeclaration by the ApplicantDeclaration by the ApplicantDeclaration by the ApplicantDeclaration by the Applicant

I hereby certify that the information provided in the Application and Detailed Application Form is complete and accu-

rate. 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)Biographical Sketch (not exceeding 250 words)Biographical Sketch (not exceeding 250 words)Biographical Sketch (not exceeding 250 words)Biographical Sketch (not exceeding 250 words). The sketch is important as it enables the

Interview Panel to assess your interests. Please use separate sheet.

IMPORIMPORIMPORIMPORIMPORTTTTTANTANTANTANTANT

(i) A set of photocopies of all the relevant marksheets and certificates as mentioned on page 12page 12page 12page 12page 12 of the Information

Brochure must be attached with this Form, if you have not sent with earlier form.

(ii) 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.April 22 to May 07, 2010.April 22 to May 07, 2010.April 22 to May 07, 2010.April 22 to May 07, 2010.

(iii) Admission will be confirmed subject to the verification of original certificates, marksheets and eligibility fulfilment

of the selected candidates.


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List of Enclosures:

1. 10th Std. Marksheet Yes No

2. 12th Std. Marksheet Yes No

3. First Year Degree Marksheet Yes No

4. Second Year Degree Marksheet Yes No

5. Third Year Degree Marksheet (If graduate completed) Yes No NA

6. Fourth Year Degree Marksheet (If it is four years degree) Yes No NA

7. Caste Certificate (for SC/ST/OBC candidates only) Yes No NA

8. Non-creamy Layer Certificate (for OBC Candidates only)***** Yes No NA

9. Income Certificate, 20082009 (for SC/ST/OBC Candidates only) Yes No NA

10. Work Experience Certificate, if any Yes No NA

11. Profile written in a plain paper (compulsory) Yes No

12. Any other certificates relevant to the course, like PG Degree/Diploma Yes No NA

13. Internship completion certificate (For medical graduates) Yes No NA

14. Post-graduate statement of marks Yes No NA

This application along with enclosures, should be sent through Speed Post / Registered Post only, superscribing on the

envelope DAF for ___________________ Course, Date of GD/PI __________________, by February 28, 2010 to:

Section Officer (Admission)Section Officer (Admission)Section Officer (Admission)Section Officer (Admission)Section Officer (Admission)

TTTTTata Institute of Social Sciencesata Institute of Social Sciencesata Institute of Social Sciencesata Institute of Social Sciencesata Institute of Social Sciences

Sion-TSion-TSion-TSion-TSion-Trombay Road, Deonarrombay Road, Deonarrombay Road, Deonarrombay Road, Deonarrombay Road, DeonarMumbai 400 088Mumbai 400 088Mumbai 400 088Mumbai 400 088Mumbai 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.

February 22, 2010

Documents

Tiss Detail A