Institute of Journalism

Press Club, Thiruvananthapuram

P.B. No. 103, Press Club Road, Thiruvananthapuram – 695 001, Kerala

Tel: 0471 – 3012024, 2331642, 2338950, Fax: 0471 – 2325701

Email: pressclubtvm@asianetindia.com

Application for Admission

to THE condensed DIPLOMA course in Journalism

Affix your recent passport size photo here

1. Name in full: Mr./Ms.

(In block letters)

2. Age & Date of Birth:

3. Sex: Male / Female Marital Status: Married / Single

4. Name of Father / Guardian and occupation:

5. Nationality:

6 (a). Residential address & Telephone No.

6 (b). Email address:

7. Academic qualifications

		Year	Subject	Class	Board / University
a.	Matriculation / Higher Secondary
b.	Pre-degree / Plus -2
c.	Degree
d.	Post Graduation

8. Present occupation and official address (if any) :

9. Any other qualification:

10. Distinction, prizes or special recognition received, if any:

11. Experience in Journalism (if any).

12. Hobbies:

13. Any other information relevant for your admission to the course:

(Use extra sheets if necessary)

14. Why have you chosen to join this course?

Declaration

I hereby agree to abide by the rules and regulations of the Press Club and the Institute and I undertake that as long as I am a student of the Institute, I will do nothing either inside or outside the Institute that will interfere with its orderly administration and discipline.

Place:
Date: Applicant’s signature

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REMARKS

Director