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ACADEMY OF INTEGRATED CHRISTIAN STUDIES Shekina Hill, Tanhril, MZU Road, Post Box No: 80
Aizawl –796 001, Mizoram (India) (Affiliated to the Senate of Serampore College/University)
Affix
Recent Passport
Size Photograph
APPLICATION FORM 2020—2021 [₹ 200/- AS APPLICATION FORM FEE TO BE PAID ON THE FIRST DAY OF ENTRANCE TEST]
1. Applicant Name : _________________________________________
2. Father’s Name :_________________________________________
3. Mother’s Name :_________________________________________
4. Date of Birth :________________________
5. Gender (Male/Female) : ________________________
6. Mother Tongue :________________________
7. Nationality :________________________
8. Married or Unmarried :________________________
9. Permanent Address :_______________________________________________
_______________________________________________
10. Mobile No. :_________________________________________
11. Email Address :_________________________________________
* B.D = Bachelor of Divinity, M.Div.= Master of Divinity, DipMS= Diploma in Mission Studies. The
minimum required qualification to apply for B.D or M.Div. is B.A., B.Th. or an equivalent degree from a
recognized university.
Last Date of Submission:
30th March 2020
Tentative Entrance Exam
& Interview Date:
28—30 April 2020
Course:
*B.D/M.Div./DipMS
(Tick against the course for which
admission is sought)
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12. Academic Qualifications:
13. What was/is your past and present responsibility/employment?
(a) In the
Church:________________________________________________________
_______________________________________________________________
(b) In other Sectors: _________________________________________________
_______________________________________________________________
14. Church (Denomination) in which you are a member
_________________________________________________________
15. Name of your local Church
_________________________________________________________
16. Name and Address of your Pastor/Presbyter: (A Letter of your Pastor/Presbyter stating your status and activity in the Church should be
enclosed) __________________________________________________________
17. Are you ordained? Yes/ No (for BD & M.Div. candidates) (If ordained, date of Ordination)
__________________________________________________________
18. Are you a sponsored Candidate of your Church/Institution/Organization?
(If so, give the name of the Church/Institution/Organization responsible for the
sponsorship. Enclose a letter from the authority sponsoring your candidature).
________________________________________________________________
Examination Passed
Name of University/ Board/School
College/School Attended
Year of Passing
Reg.No. Class/ Grade
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19. Are you an Independent Candidate?
(If so, give the name of the person responsible for your financial support during
your study.
Enclose a letter from the person who will be responsible for your financial support)
________________________________________________________ 20. Complete the following (for independent candidates only):
i) Occupation of your parents or guardian responsible for your sponsorship.
___________________________________________________
ii) Annual income of your parents or guardian who is responsible for your sponsorship.
Rs. ____________(Rupees_____________________________________) 21. What motivated you to pursue theological training? ________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
22. Why did you apply to AICS?
__________________________________________________________________
________________________________________________________________________
23. What is your aim after you complete your study?
_________________________________________________________ 24. If you are admitted, do you promise to live according to the discipline laid down in
the rules and regulations? Yes/No
______________________ _________________
Full Name of the candidate Date
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ACADEMY OF INTEGRATED CHRISTIAN STUDIES Shekina Hill, Aizawl
Health History to be completed by the candidate before Medical Examination Candidate’s Name: _________________________________________ FAMILY HISTORY: ANY ILLNESS IF DEATH (deceased) CAUSE OF DEATH 1. Father: 2. Mother: 3. Sister/Brother: 4. Wife/Husband: MEDICAL HISTORY (Indicate dates of any of the following conditions you have had). 1. Typhoid 20. Asthma
2. Malaria 21. Diabetes
3. Jaundice 22. Appendicitis
4. Dysentery 23. Stomach trouble
5. Diphtheria 24. Skin Disease
6. Chicken Pox 25. Eye Problem
7. Mumps 26. Discharging Ears
8. Filariasis 27. Backache
9. Joint Pains 28. Deafness
10. Rheumatic Fever 29. Nervous Breakdown
11. Recent loss/gain in weight 30. Depression
12. Pleurisy 31. Sleeplessness
13. T.B. 32. Lack of Confidence
14. Tonsillitis 33. Fainting Spells
15. Easy Fatigue 34. Dizziness
16. Piles 35. Fits
17. Shortness of Breath 36. Inability to concentrate
18. Heart Trouble
19. High B.P.
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FOR WOMEN ONLY: a) Menstrual Irregularities
b) Pregnancies
c) Present or Past Treatment for Female Disorder
Any operation or injuries:
Any deformities:
Medication being taken and date and dosage:
I certify that I have answered the above questions fully and honestly. So far as my
knowledge is concerned there are no other significant health issues known to me.
Date:_____________ Signature: _________________________
(TO BE DONE BY A PHYSICIAN ONLY) Eye Visual Acuity Distant Vision Near Vision Pupils Eyelids Hearing Nose &Throat Glands Cervical Skin Rash Axillary Inguinal CIRCULATORY SYSTEM B.P: Peripheral Pulses Pulse Varicose Veins ORTHOPAEDIC: Posture Gait Spine Hands & Feet RESPIRATORY INSPECTION: Lungs Abdomen Liver Teeth & gums Spleen Hernia NERVOUS SYSTEM: Higher Function Speech Motor
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Reflexes other Abnormality
EMOTIONAL STABILITY: Evidence of Psychiatric disorders LABORATORY EXAMINATION: Stool Urine H.B. % WMC …..T…..P….L…..M…..E…..B….. Blood Group:__________________
Chest X-Ray
Summary of current findings:
FITNESS FOR STUDY: I consider that the candidate is physically fit /unfit (tick either one) to
undertake theological training/any professional course of study.
Date: _____________ Physician’s Signature: ___________________ Physician’s Name: _____________________ Designation: _____________________ Address: _____________________ _____________________
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IMPORTANT IMFORMATION
I. FOOD AND LODGING During the entrance examination, arrangement will be made for “food and lodging” —on payment— for few students, especially for those coming from outside of the state of Mizoram. If food and lodging are needed, then kindly fill up the following: i) Name :
ii) Male/Female :
iii) Expected date & time of arrival :
iv) Expected date & time of departure :
II. Check List: Before sending please check and tick the following (i—vi are compulsory):
i) Duly filled-in Application Form
ii) Attested copies of academic documents — Mark sheets and Certificates from HSLC &
Above
iii) Self attested recent passport size photograph
iv) A letter from your church/organization which testifies to your membership and your
involvement in the church/ministry
v) Birth Certificate or other acceptable evidence for date of birth
vi) Duly filled-in Medical examination report form
vii) (If selected) Migration/Transfer Certificate should be submitted at the time of
admission (for BD candidates only)
Kindly send the duly filled-in Application Form and other necessary documents, including Check List to the address given below:
The Academic Dean
Academy of Integrated Christian Studies
Shekina Hill, Tanhril, MZU Road
Post Box – 80, Aizawl – 796 001
Mizoram: India
NB: *The applicant has to write two subjects in the Entrance Test: i) English (100%)
and, ii) General Knowledge (50%) & Scripture (50%)
*Original copies of all academic documents to be produced at the time of personal interview *Incomplete documents shall be liable to rejection of the application
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