-
8/8/2019 Fpm App Form 2010
1/12
1
APPLICATION FORM
Fellow Programme in Management - Communicat ions (FPM-C)
2010-13
Please read the instructions on page 10-12 before filling up the
form
s
1. Name (in BLOCK letters)Last Name First Name Middle Name
2. Fathers / Guardians Name (in BLOCK letters)3. Mothers Name
(in BLOCK letters)4. Correspondence Address (in BLOCK letters)
City
State Country
Pin/ Zip
5. Telephone 6. Mobile
7. Email8. Date of Birth 9. Gender Male Female10. Nationality
11. Marital Status Single Married
Married with child/ children
Please affix your
recent colour
passport size
photograph (not
more than three
months old)
Application fee details:
Demand Draft No Date .
Bank. Branch ..
Please write your name and contact details on the back of demand
draft.
DD MM YYYY
Rs. 1000 (Non-Refundable)
-
8/8/2019 Fpm App Form 2010
2/12
2
12. Academic Record from High School onwardsName of theDegree/
Certificate/Diploma
University/Institution/Board
Period Subjects taken(Major & Minor)
PercentageONLY*
From To
10th
10+2
Graduation
...
Post Graduation
...
Any other (please
specify)
...
* ALL LETTER OR NUMBER GRADESSHOULD BE CONVERTED AND EXPRESSED
ASPERCENTAGE ONLY.Candidates in the final year of post graduation
should indicate the percentage in first year examinations.
13. Have you completed M Phil? Yes NoIf yes, University
Department.......... Year............
Topic of Thesis/
Dissertation.........................................................................
14. Have you qualified NET/ JRF (UGC) in Mass Communication/
Management? Yes NoIf yes, Month and
Year...........................................................
(Please attach copy of the certificate.)
-
8/8/2019 Fpm App Form 2010
3/12
3
15. Work ExperienceS. No. Name & Address of the
Employer
Position Held Period
(Months)
Total Pay
(Rs./ Month)
Nature of Work
Attach extra sheet if required.
16. Research/ Academic PublicationsS. No. Titl Author(s) Name of
Publication Month and Year
(in chronologicalorder)
Attach extra sheet if required.
-
8/8/2019 Fpm App Form 2010
4/12
4
17. Honours, awards, or distinctions that you have earnedA.
--------------------------------------------------------------------------------------------------------------------------------------B.
--------------------------------------------------------------------------------------------------------------------------------------C.
--------------------------------------------------------------------------------------------------------------------------------------D.
--------------------------------------------------------------------------------------------------------------------------------------Attach
extra sheet if required.
18. The FPM offers four areas of specialisation. You are
required to choose any one area. Please tick your choice.A.
Integrated Marketing CommunicationsB. Communication for Social
ChangeC. Communications and Cultural StudiesD. New Media and
Communications
19. Statement of Purpose (SOP): see details in instructions.
Attach a separate sheet.
20. Please give below any other information you would like to
provide--------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------Attach
extra sheet if required.
21. List the documents enclosed with this application1. 2.3.
4.5. 6.7. 8.9. 10.11. 12.13. 14.
-
8/8/2019 Fpm App Form 2010
5/12
5
22. The FPM application requires two letters of recommendation
in sealed envelopes signed by the referee across theseal. Blank
forms for referees are enclosed. Both the referees should be
persons who are in a position to commenton your candidature. At
least one referee should preferably be a faculty member of a
University, College orInstitution of higher studies and research.
The application will be treated as incomplete without
theserecommendation letters. I nstructions for submitting these
letters are given in the enclosedrecommendation letter forms.
Name and address of the referees
Name: Name:
Address: Address:
23. DeclarationI agree to abide by the decisions of the
Institute regarding my selection to the programme.I certify that
the information furnished in this application form is correct to
the best of my knowledge and belief.
Place Date Signature of the Applicant
The completed application form with enclosures should reach the
following address.
FPM Office, MICOREMudra Institute of Communications, Ahmedabad
(MICA)
Shela, Ahmedabad 380058Phone: +91 2717 308250, +91 937 525 1347
(direct line),
Email: [email protected]
-
8/8/2019 Fpm App Form 2010
6/12
6
LETTER OF RECOMMENDATI ON I
(Applicant may please complete the top section of this form
before giving it to the Referee)
Name of Applicant:
____________________________________________________________________Last
First Middle
Area of specialisation applied for (P lease tick only one)A.
Integrated Marketing CommunicationsB. Communication and Social
ChangeC. Communications and Cultural StudiesD. New Media and
CommunicationsDate: Signature of Applicant
To the Referee
. (N ame of the candidate)has applied for the Fellow Programme
in Management - Communications (FPM-C) at Mudra Institute
ofCommunications, Ahmedabad (MICA). You are requested to seal the
envelope containing this letter and signacross the seal and hand
over the sealed envelope to the applicant.
1. I have known the applicant for .. years.2. He/ she has been
(please tick an appropriate option):
A student in my course(s) My adviseeA personal friend or
acquaintance Other . (Please specify)
3. Compared with a typical group of students I have encountered
at this institution or otherwise I wouldrank him/ her as indicated
below (please tick as appropriate):CATEGORY EXCELLENT
Top 5%V. GOODNext 10%
GOODNext 20%
FAIRNext 25%
POORBottom 40%
NO BASIS FORJUDGEMENT
AcademicStrengthMotivation
TeachingPotential
ResearchPotentialSpeakingAbilityWritingAbilityOVERALLRATING
-
8/8/2019 Fpm App Form 2010
7/12
7
4. Strength of the candidate:
5. Weakness of the candidate:
6. Comments on the suitability of the candidate to a doctoral
programme (please use separate sheet(s), ifdesired):
Date: Signature of the referee
Name of the Referee:
_________________________________Designation:
_______________________
Organisation
_________________________________________________________________________
Address:
____________________________________________________________________________________
____________________________________________________________________________________
Phone Number(s) _____________________________________ Mobile
No_______________________
Email
______________________________________________________________________________
-
8/8/2019 Fpm App Form 2010
8/12
8
LETTER OF RECOMMENDATI ON I I
(Applicant may please complete the top section of this form
before giving it to the Referee)
Name of Applicant:
____________________________________________________________________Last
First Middle
Area of specialisation applied for (P lease tick only one)A.
Integrated Marketing CommunicationsB. Communication and Social
ChangeC. Communications and Cultural StudiesD. New Media and
CommunicationsDate: Signature of Applicant
To the Referee
. (N ame of the candidate)has applied for the Fellow Programme
in Management - Communications (FPM-C) at Mudra Institute
ofCommunications, Ahmedabad (MICA). You are requested to seal the
envelope containing this letter and signacross the seal and hand
over the sealed envelope to the applicant.
1. I have known the applicant for .. years.2. He/ she has been
(please tick an appropriate option):
A student in my course(s) My adviseeA personal friend or
acquaintance Other . (Please specify)
3. Compared with a typical group of students I have encountered
at this institution or otherwise I wouldrank him/ her as indicated
below (please tick as appropriate):CATEGORY EXCELLENT
Top 5%V. GOODNext 10%
GOODNext 20%
FAIRNext 25%
POORBottom 40%
NO BASIS FORJUDGEMENT
AcademicStrengthMotivation
TeachingPotential
ResearchPotentialSpeakingAbilityWritingAbilityOVERALLRATING
-
8/8/2019 Fpm App Form 2010
9/12
9
4. Strength of the candidate:
5. Weakness of the candidate:
6. Comments on the suitability of the candidate to a doctoral
programme (please use separate sheet(s), ifdesired):
Date: Signature of the referee
Name of the Referee:
_________________________________Designation:
_______________________
Organisation
_________________________________________________________________________
Address:
____________________________________________________________________________________
____________________________________________________________________________________
Phone Number(s) _____________________________________ Mobile
No_______________________
Email
______________________________________________________________________________
-
8/8/2019 Fpm App Form 2010
10/12
10
INSTRUCTI ONS AND INFORMATI ON ON TH E APPLICATI ON
PROCEDURE
Instructions
1. This application form is an integral part of the admission
process. Please provide correct information.Admission granted on
the basis of incorrect information will be ipso factonull and
void.
2. In all matters regarding admission to the programme, the
decision of the institute will be final andbinding. No
correspondence from the applicant with respect to his/ her
non-selection will be entertained.
3. The institute reserves the right to re-schedule or change/
cancel venue for the admission test (MICAT-FPM).
4. Application form should be accompanied by a Demand Draft of
Rs. 1000/ - drawn in favour of MudraInstitute of Communications,
Ahmedabad payable at Ahmedabad. Please write your name and
contact
details on the back of demand draft.
5. You can choose only one area of specialisation out of the
four the FPM offers.6. Two letters of recommendation in prescribed
format are required with the application form. Blank forms
for recommendation letters and the instructions to send the same
are enclosed.
7. Ensure that you respond to all items in the application form
(use N A for items which do not apply toyou). You may use
additional sheet(s) wherever required.
8. Please submit your Statement of Purpose (SOP) on a separate
sheet with the application. Address each ofthe following points,
using essay form and a maximum of three pages.
(See item no 20 in the application form)
Why do you want to pursue FPM?What are your career &
professional goals?Provide a self-assessment (describe strengths
and weaknesses relevant to your career and professional
goals).Describe the key skills, knowledge, and experiences to be
developed by FPM.What will be the nature of your contribution to
the advancement of the chosen area of
specialisation/ profession?
9. Please submit documents in support of the application
according to the instructions given underSupporting Documents.
-
8/8/2019 Fpm App Form 2010
11/12
11
10.The completed application form with enclosures should reach
the following address.FPM Office, MICOREMudra Institute of
Communications, Ahmedabad (MICA)Shela, Ahmedabad 380058Phone: +91
2717 308250, +91 937 525 1347 (direct line),
Email: [email protected]
Contact Person: Mr. Himanshu Dandotiya, Programme Officer,
FPM
Supporting Documents
A. Academic DocumentsPlease provide copies of transcripts of
academic records/ Mark sheets. The key to the letter grade
systemshould be included wherever necessary.
B. Writing & ResearchPlease enclose with this application
any published or unpublished research work which you might
havecompleted. You may give abstracts or summaries if the entire
document cannot be sent.
Admission Criteria
Applicants for the FPM-C will be required to take the MICA
Admission Test (MICAT-FPM). MICAT willcomprise of the
following:
i.Written Test (WT)Written Test will examine candidates
(communication) theoretical understanding, ability to investigate
acommunication phenomenon and ability to interpret data and draw
conclusion.
ii.Oral Presentation (OP)The candidate will be given a decision
problem and asked to describe a broad-level approach to address
itin a systematic and scientific manner.
iii.Personal Interview (PI)Personal Interview will be an
extension of OP where the candidates personality and passion for
researchwill be assessed.
-
8/8/2019 Fpm App Form 2010
12/12
12
Eligibility
Applicants must have a Masters Degree/ equivalent qualification
with at least 55% marks or equivalent gradein any discipline of the
Humanities / Social Sciences / Business Management
havingCommunication/ Journalism/ Advertising/ PR/ Marketing as a
core subject. The candidate also should havecompleted a three-year
Bachelors degree/ equivalent qualification after completing higher
secondary (10+2)or equivalent education.
Or
At least 55% marks or equivalent grade in Five year Integrated
Masters Degree programme from anydiscipline of the Humanities /
Social Sciences / Business Management havingCommunication/
Journalism/ Advertising/ PR/ Marketing as a core subject, obtained
after completing highersecondary (10+2) or equivalent.
Qualifications described above must be recognised by AICTE/
Universities/ Deemed Universities.
International students whose qualifications are considered
equivalent (by UGC/ AICTE) to the qualificationslisted above are
also eligible to apply for the programme.
Candidates with M. Phil. or NET/ JRF (UGC) qualification in Mass
Communication andJournalism/ Management and relevant work
experience in a recognised communication/ media institution willbe
preferred.
Final year students appearing for the Masters degree or
equivalent examination can also apply. Suchcandidates, if selected,
will be provisionally admitted provided they complete all
requirements for obtainingthe degree before December 2010. The
admission of these candidates will remain provisional until
theyproduce mark sheets proving that they satisfy the eligibility
criteria. The deadline for submitting the final year
degree mark sheets is December 31, 2010.
