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COLLEGE OF SOCIAL WORK
(Affiliated to the University of Mumbai)
Nirmala Niketan
38, New Marine Lines
Mumbai 400 020
Telephone: 22002615 / 22067345
Fax: 22014880 E-mail: [email protected]
www.cswnn.edu.in
(3 Photographs)
Write your name
on the back of
photograph for
Identification
(Application for the year 2015-16)
Name of the course applied for:________________________________________________
Full Name (Block Letters):
__________________________________________________________________________
(Surname)
(First)
(Middle)
Contact Details:
Address: (i) Present__________________________________________________________
___________________________________________________________________________
Contact No. 1) __________________ 2)_________________ 3) C/o ___________________
E-mail ID:._________________________________________________________________
(ii)Permanent_______________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Personal Details:
Age: __________ Gender: __________ Marital Status: ______________________________
(Kindly attach marriage certificate and change of name)
Date of Birth: _________________ Place of Birth: _________________________________
Religion: _____________Mother Tongue: ___________ Nationality:___________________
Caste: SC
ST
NT
OBC
Minority
General
Disability Specify_________
Occupation:-________________________________________________________________
Currently are you pursuing any other course/training elsewhere? Yes
No
If Yes, Give Details___________________________________________________________
Name of the Guardian (For applicants outside Mumbai):
___________________________________________________________________________
Relationship to Applicant:______________________________________________________
Address:____________________________________________________________________
___________________________________________________________________________
Contact No (In Mumbai)____________________ E-mail ID:__________________________
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Educational Details:
Name and
place of
Educational
Institution
Name of the
university/
Exam Board
Stream
(Arts,
Commerce,
Science
Social Work)
Principal
Subjects
Marks
obtained out
of
Percentage of
marks / grade /
Credits Earned
HSC
Bachelor’s
Degree
( Part I )
( Part II )
( Part III )
Master’s
Degree
( Part I )
( Part II )
Any other
Degree/
Diploma/
Certificate
Work Experience:
Name of
Organisation
Designation
Period
Your Responsibilities
2
Year Of Passing
Give particulars of any award and/or scholarship obtained in earlier academic carrier.
State whether in school or college. Yes
No
If Yes Specify_______________________________________________________________
Are you deputed by your organization? Yes
No
Name of deputing organization: _________________________________________________
Financial Resources for training:
How will you meet your educational expenses?
(i) From the family income.
(ii) Scholarships from any other organization.
(iii) Any other______________________________________________________________
Attach a biographical statement of 300 words on a separate sheet. This should include
your interest in Social Work, your reasons for choosing this course as a career, persons
who have influenced your choice, experience in social work if any, and your plans after
training.
Application must be accompanied by the following certificates
(Please tick documents attached)
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Caste Certificate & Validity where applicable
Minority Status Certificate where applicable
Marksheet of H.S.C or equivalent/ Graduation/ Post Graduation
Any other Degrees Obtained
Work experience Certificate/s
Three copies of Photographs 2 ½ x 1 ½ for the Identity Card
Biographical statement (300 Words)
Marriage certificate/ gazette certificate For change of name for married candidates
Scan Copy Of Demand Draft
Kindly Note:1. Admission will be confirmed only when you will submit all applicable documents.
2. Kindly fill all relevant information before submitting form
Date_______________
Signature of the applicant_____________________
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