International Institute for Population Sciences

International Institute for Population Sciences

(DEEMED UNIVERSITY)

APPLICATION FOR ADMISSION TO

MASTER OF POPULATION STUDIES (MPS)COURSE

(Distance Learning)

Application processing fee

1.Name in full : Dr./Mr./Ms./Mrs. ______

(IN BLOCK LETTERS)

2.Sex:______3. Nationality:______4. Marital Status:______

5.(a)Address for correspondence:______

______

______

(b)Permanent Address:______

(if different from the above)______

(c)E-mail :______

(d)Phone Number:Off.______Resi. ______Mobile______

6.Date of Birth:______Completed age ______

7.Whether belong to SC/ST/OBCNo/Yes (Specify) ______

(If applicable, Please attach certificate)

8.Academic Record

Give particulars of all the examinations and degrees obtained

Note: Only Master Degree/equivalent Mark sheets Certificate is required for MPS Admission.

9.Give reasons in brief as to what do you expect to gain from this programme

(Attach additional page if required)

10. Source of admission information (write Yes/No)

Thorough Google search______

Through Text Advertisement on Google ______

Through IIPS Website ______

Through Newspaper Advertisement______

Through Reference ______

Others, if any (please specify)______

11.Employment Record (if any)

Total experience year = ______Year ______Month (Please attach the certificate).

DECLARATION BY THE APPLICANT

I hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief.

Place & Date: ______

Signature of the Applicant

CERTIFICATE BY THE EMPLOYER (If applicable)

This is certified that Dr./Mr./Ms./Mrs. ______holds a post of ______in this Dept./Office/Institution and all the statements made by him/her in this application are correct to the best of my knowledge and belief. I recommend his/her admission to the MPS programme of the Institute.

Place & Date: ______Signature: ______

Designation : ______

Dept./Institution/Organisation: ______

(Office Seal)

Note :-

1.Applications should be sent by registered post/courier to the Head, Department of Extra Mural Studies, International Institute for Population Sciences, (IIPS), Govandi Station Road, Deonar, Mumbai - 400 088, India, so as to reach on or beforeAugust 01, 2011.

2.Completed application form and copies of transcripts attested by a Gazetted Officer or public notary should be submitted along with a processing fee of Rs.400/- (For foreign student $ 25) through a demand draft payable to “The Director, International Institute for Population Sciences, Mumbai”.

3.Applicants who are selected for admission to the course will be informed by Registered post/E-mail.

4.SC/ST candidates are exempted from paying the processing fee.

5.INCOMPLETE FORM WILL BE SUMMARILY REJECTED.