MEDIA EXPERTS REGISTRATION FORM
 
Name of the Candidate *
Date of Birth *
Father / Husband's Name *
Gender *

Contact Details of the Applicant

Address Line 1 *
Address Line 2
City / Town *
PIN Code *
 Enter only numeric 6 digits
District *
State *
Email Address *
Mobile No. *
Aadhar Number
 (if Available)

Qualification and Experience

Qualification *

Specify
Languages known
Read
Write
Speak
Teaching Experience Details

Work Details

Category 
Working / Last worked Organisation Name
Organisation Address
Designation
Field of Specialisation
Already worked with / in NIMI ?
Yes No
If Yes, Specify your work details
Specify your period of association with NIMI
(Years/Months)

Media Experience

Instructional design
 Yes
No
Educational media production
 Yes
No
E-learning development
 Yes
No
Teaching or training
 Yes
No
Digital media or communications
 Yes
No
Attached self attested copies of Qualification experience

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