THE INSTITUTE OF CONSTITUTIONAL AND PARLIAMENTARY STUDIES

18-21 Vithalbhai Patel House,Rafi Marg, New  Delhi -110001

Tel Nos. 011-23716038, 23717339, Telefax: 011-23716038 Director 23710405,

Website:icpsindia.org; E-mail: info@icpsindia.org

Diploma Form
Application Form for(Tick appropriate box/es):
	1.  Parliamentary Fellowship Programme
	2.  Diploma in:
	(i)   Consitutional Law
	(ii)   Parliamentary Institutions & Procedures

APPLICATION FORM

	Serial No.:
	1. Name:                     Mr. Ms. Mrs.
	2. Add.(a) Permanent:
	(b) Present:
	(c)  Ph. No.s           Off:	Res:     Mob:
	(d)  E-mail:
	3.  Father/Husband'sName:
	4.  Nationality:
	5.  Date of Birth:	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31     Month January February March April May June July August September October November December    Year 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030             Place of Birth:
	6.  Marital Status:	SingleMarried

	8.  Whether Employed:			YesNo
	If yes,Destination & Add:
	Reporting to Whom:					Phone No.:
	9.  Professional/Research Experience
	(a)  Professional:
	(b) Research:
	10.  Publications,if any:
	11.  How do you think you will be benefited by pursuing this course?
	12. Are you/have ever been a Member of this Institute?				YesNo
	If yes, Membership No:			Year:
	13.  Whether associated with any professional/research organization?						YesNo
	14.  Details of Fees:         Cheque/ Institute's Cash Receipt No.:
	Amount:		Dated:				Show Calender

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