SUHAM 

INSTITUTE OF RESEARCH & DEVELOPMENT ON HUMAN BEHAVIOUR 
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SUHAM INSTITUTE  OF RESEARCH  AND DEVELOPMENT

ON HUMAN BEHAVIOUR 

(Duly fill and to be sent with Rs.100/- M.O (or) D.D payable to S.G.IMMANUEL,Vellore  

No. 5, Suham House,  5th West Cross Road, Gandhi Nagar, Vellore : 632 004

    EMAIL : suhamay@gmail.com   abcdmj@yahoo.com

 

Application No:                                                        Include Three Passport size Photo    

 

Name: ………………………………………………………………………………………………………………….

 

Name  of Parent/ Spouse ………………………………………………………………………………………

 

Postal Address…………………………………………………………………………………………………………

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Telephone    ………………  Fax contact: ………………………  Email: ……………………………….…

 

Date of Birth       Day/ Month Year  ………………………………

Nationality       ………………………………………………………..

Gender       Male/ Female                                                Married / Single

Present occupation   ……………………………………………………………………………………………

Mother Tongue ………………………………………….

Languages                      literate                       spoken

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Medium of Higher education

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Name and Address of your affiliation of Church

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Your ministry in the church

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Identify your involvement in   /community/ school/society/prison/other-specify……………………….

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Specify your role  as counselor/ teacher/ social worker/ warden/ lawyer/ other--specify

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Do you have an ordination of a church Give details  

Who ordained ………………………………………………………………………………..

When……………………………………………………………………………………………………

Which order specify your Church affiliation……………………………………..

 

 

 

Educational qualification

 

 Name & place                                 Degree/Diploma           Date of                       Division /  Grade      

 Board / University                           Received                     completion                  obtained        

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Attach attested Copies of all documents and transcripts  mentioned

 

Those who do not have previous degree, If you want to earn work experience credit   (ask for format to acquire credit)

 

List your publications if any

Date      Title of the book      subject         Number pages        Publisher               ISBN No.

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Give names and Addresses of two Christian Leaders who can certify you for this course

( One may be  your Pastor, and the second one an academician) ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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Declaration and pledge:

 

I  ____________________________________________ hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I have provided necessary information in this regard. In the event of any information being incorrect or misleading my candidature shall be liable to cancellation by your institute at any time and I shall not be entitled to receive refund of any fee paid by me to the institute. I shall maintain a high academic standard to the best of my ability. I shall pay all the required fees as stipulated by the administration. I shall be obedient to the rules and regulations and requirements determined by the institute from time to time.

 

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Signature of the candidate                    Date                    Place:

 

OFFICE USE ONLY

The Applicant _______________________________________  has provisionally admitted for

 

_____________________________________  Degree/ diploma/ certificate programme.

 

Date of Admission   ___________________ 

Comments:  __________________________________________________________________

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Registrar                                           Dean of Admission                               Director