APPLICATION FORM

Fellow Programme in Management - Communications (FPM-C) 2010-13

Please read the instructions on page 10-12 before filling up the form

Application fee details: Rs. 1000 (Non-Refundable) Please affix your

recent colour
s
Demand Draft No………………………………… Date …………………. passport size
photograph (not
Bank………………………………………….…… Branch ………………..
more than three
Please write your name and contact details on the back of demand draft. months old)

1. Name (in BLOCK letters)

Last Name First Name Middle Name

2. Father’s / Guardian’s Name (in BLOCK letters)

3. Mother’s Name (in BLOCK letters)

4. Correspondence Address (in BLOCK letters)

City
State Country
Pin/Zip

5. Telephone 6. Mobile

7. Email

8. Date of Birth DD MM YYYY 9. Gender Male Female

10. Nationality 11. Marital Status Single Married

Married with child/children

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12. Academic Record from High School onwards

Name of the University/ Period Subjects taken Percentage

Degree/ Certificate/ Institution/ (Major & Minor) ONLY*
Diploma Board
From To
10th

10+2

Graduation

……………………...

Post Graduation

……………………...

Any other (please

specify)

……………………...

* ALL LETTER OR NUMBER GRADES SHOULD BE CONVERTED AND EXPRESSED AS PERCENTAGE ONLY.
Candidates in the final year of post graduation should indicate the percentage in first year examinations.

13. Have you completed M Phil? Yes No

If yes, University……………………………… Department……………………..……........… Year….........…...

Topic of Thesis/Dissertation…………......................................................................………………………………...

14. Have you qualified NET/JRF (UGC) in Mass Communication/Management? Yes No

If yes, Month and Year…........................................................…... (Please attach copy of the certificate.)

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15. Work Experience

S. No. Name & Address of the Position Held Period Total Pay Nature of Work
Employer (Months) (Rs./Month)

Attach extra sheet if required.

16. Research/Academic Publications

S. No. Title Author(s) Name of Publication Month and Year

(in chronological
order)

Attach extra sheet if required.

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17. Honours, awards, or distinctions that you have earned

A. --------------------------------------------------------------------------------------------------------------------------------------

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 Communications

B. Communication for Social Change
C. Communications and Cultural Studies
D. 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 application

1. 2.

3. 4.

5. 6.

7. 8.

9. 10.

11. 12.

13. 14.

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22. The FPM application requires two letters of recommendation in sealed envelopes signed by the referee across the
seal. Blank forms for referees are enclosed. Both the referees should be persons who are in a position to comment
on your candidature. At least one referee should preferably be a faculty member of a University, College or
Institution of higher studies and research. The application will be treated as incomplete without these
recommendation letters. Instructions for submitting these letters are given in the enclosed
recommendation letter forms.

Name and address of the referees

Name: Name:

Address: Address:

23. Declaration

I 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, MICORE
Mudra Institute of Communications, Ahmedabad (MICA)
Shela, Ahmedabad 380058
Phone: +91 2717 308250, +91 937 525 1347 (direct line),
Email: fpm.micore@micamail.in

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 LETTER OF RECOMMENDATION – 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 (Please tick only one)

A. Integrated Marketing Communications
B. Communication and Social Change
C. Communications and Cultural Studies
D. New Media and Communications

Date: Signature of Applicant

To the Referee
………………………………………………………………………….…… (Name of the candidate)
has applied for the Fellow Programme in Management - Communications (FPM-C) at Mudra Institute of
Communications, Ahmedabad (MICA). You are requested to seal the envelope containing this letter and sign
across 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 advisee

A personal friend or acquaintance Other …………………. (Please specify)

3. Compared with a typical group of students I have encountered at this institution or otherwise I would
rank him/her as indicated below (please tick as appropriate):
CATEGORY EXCELLENT V. GOOD GOOD FAIR POOR NO BASIS FOR
Top 5% Next 10% Next 20% Next 25% Bottom 40% JUDGEMENT

Academic
Strength
Motivation

Teaching
Potential
Research
Potential
Speaking
Ability
Writing
Ability
OVERALL
RATING

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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), if
desired):

………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

Date: Signature of the referee

Name of the Referee: _________________________________Designation: _______________________

Organisation _________________________________________________________________________

Address:
____________________________________________________________________________________

____________________________________________________________________________________

Phone Number(s) _____________________________________ Mobile No_______________________

Email ______________________________________________________________________________

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 LETTER OF RECOMMENDATION – II

(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 (Please tick only one)

A. Integrated Marketing Communications
B. Communication and Social Change
C. Communications and Cultural Studies
D. New Media and Communications

Date: Signature of Applicant

To the Referee
………………………………………………………………………….…… (Name of the candidate)
has applied for the Fellow Programme in Management - Communications (FPM-C) at Mudra Institute of
Communications, Ahmedabad (MICA). You are requested to seal the envelope containing this letter and sign
across 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 advisee

A personal friend or acquaintance Other …………………. (Please specify)

3. Compared with a typical group of students I have encountered at this institution or otherwise I would
rank him/her as indicated below (please tick as appropriate):
CATEGORY EXCELLENT V. GOOD GOOD FAIR POOR NO BASIS FOR
Top 5% Next 10% Next 20% Next 25% Bottom 40% JUDGEMENT

Academic
Strength
Motivation

Teaching
Potential
Research
Potential
Speaking
Ability
Writing
Ability
OVERALL
RATING

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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), if
desired):

………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

Date: Signature of the referee

Name of the Referee: _________________________________Designation: _______________________

Organisation _________________________________________________________________________

Address:
____________________________________________________________________________________

____________________________________________________________________________________

Phone Number(s) _____________________________________ Mobile No_______________________

Email ______________________________________________________________________________

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 INSTRUCTIONS AND INFORMATION ON THE APPLICATION 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 facto null and void.

2. In all matters regarding admission to the programme, the decision of the institute will be final and
binding. 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 “Mudra
Institute 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 to
you). 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 of
the 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 under
Supporting Documents.

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10. The completed application form with enclosures should reach the following address.
FPM Office, MICORE
Mudra Institute of Communications, Ahmedabad (MICA)
Shela, Ahmedabad 380058
Phone: +91 2717 308250, +91 937 525 1347 (direct line),
Email: fpm.micore@micamail.in

Contact Person: Mr. Himanshu Dandotiya, Programme Officer, FPM

Supporting Documents

A. Academic Documents

Please provide copies of transcripts of academic records/Mark sheets. The key to the letter grade system
should be included wherever necessary.

B. Writing & Research

Please enclose with this application any published or unpublished research work which you might have
completed. 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 will
comprise of the following:

i. Written Test (WT)

Written Test will examine candidate’s (communication) theoretical understanding, ability to investigate a
communication 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 it
in a systematic and scientific manner.

iii. Personal Interview (PI)

Personal Interview will be an extension of OP where the candidate’s personality and passion for research
will be assessed.

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Eligibility

Applicants must have a Masters Degree/equivalent qualification with at least 55% marks or equivalent grade
in any discipline of the Humanities /Social Sciences / Business Management having
Communication/Journalism/Advertising/PR/Marketing as a core subject. The candidate also should have
completed a three-year Bachelor’s 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 any
discipline of the Humanities /Social Sciences / Business Management having
Communication/Journalism/Advertising/PR/Marketing as a core subject, obtained after completing higher
secondary (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 qualifications
listed above are also eligible to apply for the programme.

Candidates with M. Phil. or NET/JRF (UGC) qualification in Mass Communication and

Journalism/Management and relevant work experience in a recognised communication/media institution will
be preferred.

Final year students appearing for the Master’s degree or equivalent examination can also apply. Such
candidates, if selected, will be provisionally admitted provided they complete all requirements for obtaining
the degree before December 2010. The admission of these candidates will remain provisional until they
produce mark sheets proving that they satisfy the eligibility criteria. The deadline for submitting the final year
degree mark sheets is December 31, 2010.

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