1

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)

2

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

3

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

4

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.

5

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

6

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: _____________________ _____________________

7

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