Institute of Journalism

Press Club, Thiruvananthapuram

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

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

Email: pressclubtvm@asianetindia.com

Application for Admission

to the post graduate diploma course in Electronic Journalism

Affix your recent passport size photo here

1. Name in full Mr./Ms.

(In block letters)

2. Date of Birth: Age:

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

4. Nationality:

5. Residential address & Telephone No.

6. Email address:

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

8. Name of Father / Guardian and occupation:

9. Academic qualifications

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

10. Any other qualification:

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

12. Experience in Electronic Journalism (Radio / TV etc). Give details

13. Hobbies:

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

(Use extra sheets if necessary)

15. Why have you chosen a course in Electronic Journalism?

16. Are you doing any other course simultaneously? If so give details:

Course Class hours

Institution

Declaration

I hereby agree to conform to 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