Application Form: ipolicy for Young Leaders: Certificate Course in Public Policy, IIT Mumbai | 20-21 January 2018
Please fill out all sections of this form (unless marked as an optional question).
Plagiarism will not be tolerated.

Eligibility: The course is open to all students, recent graduates as well as post graduates. Participants will be selected based on the merit of their application.

Please Note: Selected participants are required to attend all the sessions held during the course upon which they will receive a certificate of participation.

Venue: IIT Mumbai
Dates: 20-21 January 2018

• The ipolicy fee is Rs 3000*, which shall cover food and course materials for the entire duration of the program.
• The program is NON-RESIDENTIAL and participants are to make their own travel and accomodation arrangements.
• The fee is payable upon selection, and can be made online, details of which will be communicated later.
• Application deadline: 7 January 2017
• Selected participants will be notified: 9 January 2018

*Limited number of merit based scholarships are available for current IIT Mumbai students

If you have any further queries, please contact Sampurna Khasnabis: | +91 98108 85917

Personal Details
Full Name *
Your answer
Date of Birth *
College/Organisation *
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Permanent Address *
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City/Town *
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State *
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Country *
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Postal Code *
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Mobile Number *
Please provide here, your number and not of any acquaintance or family member.
Your answer
E-mail Address (Official) *
We will communicate with you primarily via this e-mail address. Please ensure the e-mail address you have entered is correct.
Your answer
E-mail Address (Personal/Secondary)
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Emergency Contact Name *
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Emergency Contact Number *
Your answer
Educational Qualifications *
Your answer
Have you attended any CCS program in the past? (LSS, ISPP, ipolicy, Freedom Caravan, Colloquium, internship, etc.) *
Your answer
How did you hear about ipolicy? *
Name of Referee
Your answer
ESSAY: In 300-500 words present your thoughts on any ONE of the following issues *
a. Urban areas are rich because population causes prosperity. Do you agree? b. Should there be reservation in the education sector? c. Should there be any censorship on Google/Facebook? d. What do you think should be the government’s role in the economy? e. Should there be any laws regarding sex among consenting adults?
Your answer
Why do you want to attend the course? *
(Not more than 150 words):
Your answer
List up to two people or books that have influenced your philosophical or ideological thinking and a single sentence stating how each has influenced you. *
(Not more than 100 words, please do not include your family members or pets)
Your answer
Please ensure that the information you have provided is accurate, and that you will be able to attend the entire course. Failure to do so will result in non-issuance of the certificate. *
The course will start on 20 January at 9 am and conclude on 21 January at 6 pm.
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