2015-2017

TATA INSTITUTE OF SOCIAL SCIENCES

(A Deemed University)

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

Paste one recent
PASSPORT SIZE
photograph here
with your
signature on it for
identification

Detailed Application Form

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.

1. Full Name: Dr./Mr./Ms.__________________________________________________________________

(Candidates Name)
(Last Name)
2. Date of Birth:

Marital Status:

Single

Married

2.1 Age as on June 01, 2015._____________Years.

3. Residential Address_______________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
___________________________________________________________________________________________________________

(Pin Code)

(State)

___________________________________________________________________________________________________________

(Telephone No. with STD Code)

(Cell No.)

(E-mail)

4. State of Original Domicile: ________________________________________________________________

5. Have you taken part in NSS activities? Yes / No

6. State particulars of your education beginning with S.S.C. or equivalent examination.

Name of
Examination

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

Name of
Institution
Attended

Attended

From (Month
and Year)
S. S. C or its
equivalent

10 years ( )

Higher Secondary,
Pre-University or
Intermediate

1 year ( )
2 years ( )

Graduation
1 st year
(Specify
degree.......................
................................)
2 nd year
3 rd year
4 th year
Post - Graduation
1 st year
(Specify
degree.......................
................................)
2 nd year
3 rd year
4 th year
Other
Degrees/Diplomas
(Specify.................
...........................)

To (Month and
Year)

Year of Passing Major Subjects

Studied

Total Marks
Obtained in all
Subjects
including
Languages/Maj
or
(Main)/Subsidi
ary Subject, etc.

Out of
Maximum
Marks

Overall
Percentage of
Marks OR
Average Grade
Point Obvtained

6.1 Explain any unaccounted period from the date of passing school (S.S.C. or equivalent examination) to the date of this application

Period unaccounted
From

How was this time spent?

To

7. (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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8. Family Background: (Members who are alive only father and mother, brother / sister, if dependant on him).
( as per given in the Summary sheet )
Sr. Name of Family Member
No.

Relationship, Educational Occupation

i.e, Father / Qualification
Mother, etc.

Monthly
Income
(In Rupees)

Additional
Information
If any

i.
ii.
iii.
9. If you have applied for more than one programme, have you qualified for PIT/PI of any other Master's
Degree programme(s) at this Institute, in 2015-17?
Yes / No
If yes, specify the name of the programme(s) and Admit Card Nos.
(a) ______________________________________________________________________________________
(b) ______________________________________________________________________________________
10. Why are you interested in pursuing this course? Please add pages, if necessary.
_______________________________________________________________________________________
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_________________________________________________________________________________________

11. Write your Biographical Sketch (not exceeding 250 words). The sketch is important as it enables the
Interview Panel to assess your interests. Please use separate sheet, if necessary.
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12. Mention any work done by you relevant to the field of study selected by you.
________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
13. Which languages do you know? Please mention your proficiency as Good or Fair or Poor.
Language

Speak

Read

Write

1. English
2.
3.
4.
14. Please indicate how you will meet your expenses during the period of study.
Source of Funds

Name

Amount Expected,

Period for which it

Per Month

is Assured

Relationship

(i)
(ii)
(iii)
(iv)
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

(i)
(ii)
(iii)
(iv)

Designation and Nature of Work

Years of
Service

Gross/Consolidated/
Monthly Salary
Drawn

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. 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)