Application Form International Applicants
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INDIAN INSTITUTE OF MANAGEMENT INDORE POST-GRADUATE PROGRAMME IN MANAGEMENT PGP (INDORE & MUMBAI campus) 2018-20 Batch Application Form for International Applicants ………………………………………………………………………………………………………………………………………………………………………………………………….. INSTRUCTIONS 1.
Please refer to the admissions procedure available on the institute’s website and ensure that you are fulfilling the eligibility criteria to apply as an international applicant for PGP 2018-20 batch of IIM Indore. 2. This application form is a key part of admission process and important for your selection. Complete and accurate information are, therefore, extremely important. Incomplete or false information will adversely affect your chances of selection. Admission granted on the basis of false and / or misleading information will be ipso facto null and void. 3. In all matters relating to admission to the programme, the decision of the Institute will be final and binding on the applicant. No correspondence will be entertained from the applicant regarding his/ her non-selection. ………………………………………………………………………………………………………………………………………………………………………………………………….. SECTION: 1- PERSONAL DATA NAME: ……………………………………………………………………………………………………………................ (CAPITAL Letters) DATE OF BIRTH:
DD
MM
AGE AS ON 30TH JUNE, 2018: SEX:
FEMALE
MARITAL STATUS:
MALE SINGLE
YYYY
AFFIX YOUR RECENT PASSPORT SIZE PHOTOGRAPH HERE
Years Transgender
MARRIED
Complete mailing address (valid till July, 2018) in CAPITAL letters for intimating the final result. ADDRESS: ………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………………. PHONE NO.: ……………………………………..CITY CODE: ……………………………………COUNTRY CODE: ……………………………………… EMAIL ID: ………………………………………………………………………………………………………………………………………………………………………. Passport Details: Country and Place of Issuance: ……………………………………………………………………………………………………………………………………. Date of Issuance: ………………………………………………… Valid up to: …………………………………………………………………………………… Country of Residence: …………………………………………Date From: ………………………………..To:……………………………………………. Nationality: ……………………………………………………………………..Passport No.: ……………………………………………………………………. Gross Annual Family Income: ……………………………………………………………………………………………………………………………………….
PGP 2018-20 Batch Application Form for International Applicants
Page 1 of 5
SECTION: 2- ACADEMIC QUALIFICATION A. The percentage of marks obtained in Class X and Class XII would be the aggregate marks of all subjects that appear in the marks sheet or grade sheet, irrespective of whether the Board considers them for calculation of percentage. B. Provide complete information on examination marks in all columns. Marks stated in these columns MUST MATCH those in the original mark sheets. C. Wherever you have received letter grades or grade points instead of marks, provide equivalent marks and attach a certificate from Registrar/ Principal/ Head of the Department explaining the method of conversion. Where such conversions are not possible, please provide an explanatory note in the additional space provided at the end of this page. The Admission Committee's decision in such cases would be final. (A): SCHOOLING: Standard
Board/University
Year of Passing
Class/ Division
% of Marks Obtained
10th or Equivalent 12th of Equivalent
………………………………………………………………………………………………………………………………………………………………………………………. (B): GRADUATION: Duration of your graduation degree course: 3 Years (………) 4 Years (…………) 5 Years (……..) Discipline (Arts/Science/Commerce/ Engineering Etc.): …………………………………………………………………………………......... Subject Specialization: ……………………………………………………………………………………………………………………………………………….. Name of the college: ……………………………………………………………………………………………………………………………………………………. Name of the University: ……………………………………………………………………………………………………………………………………….…….. Mode of Study (Full Time/ Part Time/ Distance Education Etc.): ……………………………………………………………………………… Total Number of Years of Education in English Medium: …………………………………………………………………………………………… Did You Have Mathematics or Statistics as a Formal Subject at Graduation Level: Yes (………..) / No (……………) Year 1st Year
Year of Examination
Maximum Marks/ GPA
Obtained Marks/ GPA
% of Marks Obtained
2nd Year 3rd Year 4th Year 5th Year OVERALL % OF MARKS (TOTAL)
...........................................................................................................................................
PGP 2018-20 Batch Application Form for International Applicants
Page 2 of 5
(C): POST GRADUATION Degree Name: ………………………………………………………………………………………………………………………………………………..……………. Discipline (Arts/Science/Commerce/ Engineering Etc.): ………………………………………………………………………………………….. Subject Specialization: ……………………………………………………………………………………………………………………………………………….. Name of the college: ……………………………………………………………………………………………………………………………………………………. Name of the University: ………………………………………………………………………………………………………………………….………………….. Year
Year of Examination
1st Year
Maximum Marks/ GPA
Obtained Marks/ GPA
% of Marks Obtained
2nd Year 3rd Year OVERALL % OF MARKS (TOTAL) ………………………………………………………………………………………………………………………………………………………………………………………. (D): PROFESSIONAL EXAMINATION (CA, ICWA, CS, etc.) Degree Name: …………………………………………………………………………………………………………………………………………………. Subject Specialization: …………………………………………………………………………………………………………………………………….. Name of the college: ………………………………………………………………………………………………………………………………………. Name of the University: ………………………………………………………………………………………………………………………………….. Year 1st Year
Year of Examination
Maximum Marks/ GPA
Obtained Marks/ GPA
% of Marks Obtained
2nd Year OVERALL % OF MARKS (TOTAL) ………………………………………………………………………………………………………………………………………………………………………………………. SECTION: 3- ACHIEVMENTS a)
Scholastic Achievements: Please list scholastic awards or scholarships conferred on you.
………………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………………………………….
b)
Please describe your strengths and weaknesses that you have identified in yourself as a student.
………………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………………………………….
PGP 2018-20 Batch Application Form for International Applicants
Page 3 of 5
SECTION: 4- EMPLOYMENT RECORD Ø Mention ONLY full-time, paid work experience after Graduation. Ø Do not include training/ project work done as an integral part of any curricular requirement. Organization & Location
Designation
Joining
Leaving
Monthly
date
date
Remuneration (US$)
Total Work Experience as on July 31, 2017
Reasons for leaving
Months
………………………………………………………………………………………………………………………………………………………………………………….…… SECTION: 5. DISCONTINUITY IN CAREER If work experience and academic/ professional qualifications do not account for the entire period from the time you completed the 10th standard till date, please specify the time gaps, with full explanation. ……………………………………………………………………………………………………………………………………………………………….…..……………… …………………………………………………………………………………………………………………………………………………………………………..………. ……………………………………………………………………………………………………………………………………………………………………..……..……. SECTION: 6 - EXTRA-CURRICULAR ACTIVITIES Indicate your extracurricular interests. ……………………………………………………………………………………………………………………………………………………………………………………… Please give details about your accomplishments, awards received and position held (a) in sports, games, and hobbies, (b) in associations and voluntary organizations. (Please show original certificates during the time of registration, if selected.) …………………………………………………………………………………………………………………………………………………………………..…………………. ………………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………….…… SECTION:7 - CAREER PLAN Why do you wish to go in for a management career? …………………………………………………………………………………………………………………………………………………………………………..………. ……………………………………………………………………………………………………………………………………………………………………………………. Besides management education, which area/ field would interest you most for a career and/ or for further education? …………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………….
PGP 2018-20 Batch Application Form for International Applicants
Page 4 of 5
SECTION: 8 - GMAT SCORE REPORT GMAT Registration details: …………………………………………………………………………. Test Date
Verbal
Quantitative
Analytical Writing
Total
Integrated Reasoning
……………………………………………………………………………………………………………………………………………………………………………..………
SECTION: 9 - STAY OUTSIDE INDIA From
To
Total Number of Months
Purpose of Stay
…………………………………………………………………………………………………………………………………………………………………….………………… SECTION: 10 - ENCLOSERS
Self-Attested copy of the valid GMAT scores card [] Self-Attested copy of the latest TOEFL score, if the medium of instruction has not been English [] Demand Draft of US$ 100 (One hundred only) drawn in favor of Indian Institute of Management Indore, payable at Indore towards non-refundable application fee [] Three letters of recommendation from your Teachers/ Employer(s), [] Statement of purpose. [] Self-attested Photocopy of passport (all pages) Certificate from the Indian Embassy/High Commission/Consulate of the country where the candidate stayed during December 1, 2016 to January 31, 2018 clearly stating the duration of stay. []
………………………………………………………………………………………………………………………………………….…………………………………………… SECTION: 11 - DECLARATION I certify that the information I have provided here is true and correct to the best of my knowledge. I agree to abide by the decision of the IIM Indore on all matters (including the outcome of the selection process) relating to my application for admission to the Post Graduate Programme in Management (2018-20 batch).
Date: …………………………………. Place: ………………………………..
PGP 2018-20 Batch Application Form for International Applicants
Signature: …………………………………………………
Page 5 of 5
Please refer to the admissions procedure available on the institute’s website and ensure that you are fulfilling the eligibility criteria to apply as an international applicant for PGP 2018-20 batch of IIM Indore. 2. This application form is a key part of admission process and important for your selection. Complete and accurate information are, therefore, extremely important. Incomplete or false information will adversely affect your chances of selection. Admission granted on the basis of false and / or misleading information will be ipso facto null and void. 3. In all matters relating to admission to the programme, the decision of the Institute will be final and binding on the applicant. No correspondence will be entertained from the applicant regarding his/ her non-selection. ………………………………………………………………………………………………………………………………………………………………………………………………….. SECTION: 1- PERSONAL DATA NAME: ……………………………………………………………………………………………………………................ (CAPITAL Letters) DATE OF BIRTH:
DD
MM
AGE AS ON 30TH JUNE, 2018: SEX:
FEMALE
MARITAL STATUS:
MALE SINGLE
YYYY
AFFIX YOUR RECENT PASSPORT SIZE PHOTOGRAPH HERE
Years Transgender
MARRIED
Complete mailing address (valid till July, 2018) in CAPITAL letters for intimating the final result. ADDRESS: ………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………………. PHONE NO.: ……………………………………..CITY CODE: ……………………………………COUNTRY CODE: ……………………………………… EMAIL ID: ………………………………………………………………………………………………………………………………………………………………………. Passport Details: Country and Place of Issuance: ……………………………………………………………………………………………………………………………………. Date of Issuance: ………………………………………………… Valid up to: …………………………………………………………………………………… Country of Residence: …………………………………………Date From: ………………………………..To:……………………………………………. Nationality: ……………………………………………………………………..Passport No.: ……………………………………………………………………. Gross Annual Family Income: ……………………………………………………………………………………………………………………………………….
PGP 2018-20 Batch Application Form for International Applicants
Page 1 of 5
SECTION: 2- ACADEMIC QUALIFICATION A. The percentage of marks obtained in Class X and Class XII would be the aggregate marks of all subjects that appear in the marks sheet or grade sheet, irrespective of whether the Board considers them for calculation of percentage. B. Provide complete information on examination marks in all columns. Marks stated in these columns MUST MATCH those in the original mark sheets. C. Wherever you have received letter grades or grade points instead of marks, provide equivalent marks and attach a certificate from Registrar/ Principal/ Head of the Department explaining the method of conversion. Where such conversions are not possible, please provide an explanatory note in the additional space provided at the end of this page. The Admission Committee's decision in such cases would be final. (A): SCHOOLING: Standard
Board/University
Year of Passing
Class/ Division
% of Marks Obtained
10th or Equivalent 12th of Equivalent
………………………………………………………………………………………………………………………………………………………………………………………. (B): GRADUATION: Duration of your graduation degree course: 3 Years (………) 4 Years (…………) 5 Years (……..) Discipline (Arts/Science/Commerce/ Engineering Etc.): …………………………………………………………………………………......... Subject Specialization: ……………………………………………………………………………………………………………………………………………….. Name of the college: ……………………………………………………………………………………………………………………………………………………. Name of the University: ……………………………………………………………………………………………………………………………………….…….. Mode of Study (Full Time/ Part Time/ Distance Education Etc.): ……………………………………………………………………………… Total Number of Years of Education in English Medium: …………………………………………………………………………………………… Did You Have Mathematics or Statistics as a Formal Subject at Graduation Level: Yes (………..) / No (……………) Year 1st Year
Year of Examination
Maximum Marks/ GPA
Obtained Marks/ GPA
% of Marks Obtained
2nd Year 3rd Year 4th Year 5th Year OVERALL % OF MARKS (TOTAL)
...........................................................................................................................................
PGP 2018-20 Batch Application Form for International Applicants
Page 2 of 5
(C): POST GRADUATION Degree Name: ………………………………………………………………………………………………………………………………………………..……………. Discipline (Arts/Science/Commerce/ Engineering Etc.): ………………………………………………………………………………………….. Subject Specialization: ……………………………………………………………………………………………………………………………………………….. Name of the college: ……………………………………………………………………………………………………………………………………………………. Name of the University: ………………………………………………………………………………………………………………………….………………….. Year
Year of Examination
1st Year
Maximum Marks/ GPA
Obtained Marks/ GPA
% of Marks Obtained
2nd Year 3rd Year OVERALL % OF MARKS (TOTAL) ………………………………………………………………………………………………………………………………………………………………………………………. (D): PROFESSIONAL EXAMINATION (CA, ICWA, CS, etc.) Degree Name: …………………………………………………………………………………………………………………………………………………. Subject Specialization: …………………………………………………………………………………………………………………………………….. Name of the college: ………………………………………………………………………………………………………………………………………. Name of the University: ………………………………………………………………………………………………………………………………….. Year 1st Year
Year of Examination
Maximum Marks/ GPA
Obtained Marks/ GPA
% of Marks Obtained
2nd Year OVERALL % OF MARKS (TOTAL) ………………………………………………………………………………………………………………………………………………………………………………………. SECTION: 3- ACHIEVMENTS a)
Scholastic Achievements: Please list scholastic awards or scholarships conferred on you.
………………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………………………………….
b)
Please describe your strengths and weaknesses that you have identified in yourself as a student.
………………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………………………………….
PGP 2018-20 Batch Application Form for International Applicants
Page 3 of 5
SECTION: 4- EMPLOYMENT RECORD Ø Mention ONLY full-time, paid work experience after Graduation. Ø Do not include training/ project work done as an integral part of any curricular requirement. Organization & Location
Designation
Joining
Leaving
Monthly
date
date
Remuneration (US$)
Total Work Experience as on July 31, 2017
Reasons for leaving
Months
………………………………………………………………………………………………………………………………………………………………………………….…… SECTION: 5. DISCONTINUITY IN CAREER If work experience and academic/ professional qualifications do not account for the entire period from the time you completed the 10th standard till date, please specify the time gaps, with full explanation. ……………………………………………………………………………………………………………………………………………………………….…..……………… …………………………………………………………………………………………………………………………………………………………………………..………. ……………………………………………………………………………………………………………………………………………………………………..……..……. SECTION: 6 - EXTRA-CURRICULAR ACTIVITIES Indicate your extracurricular interests. ……………………………………………………………………………………………………………………………………………………………………………………… Please give details about your accomplishments, awards received and position held (a) in sports, games, and hobbies, (b) in associations and voluntary organizations. (Please show original certificates during the time of registration, if selected.) …………………………………………………………………………………………………………………………………………………………………..…………………. ………………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………….…… SECTION:7 - CAREER PLAN Why do you wish to go in for a management career? …………………………………………………………………………………………………………………………………………………………………………..………. ……………………………………………………………………………………………………………………………………………………………………………………. Besides management education, which area/ field would interest you most for a career and/ or for further education? …………………………………………………………………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………………………………………….
PGP 2018-20 Batch Application Form for International Applicants
Page 4 of 5
SECTION: 8 - GMAT SCORE REPORT GMAT Registration details: …………………………………………………………………………. Test Date
Verbal
Quantitative
Analytical Writing
Total
Integrated Reasoning
……………………………………………………………………………………………………………………………………………………………………………..………
SECTION: 9 - STAY OUTSIDE INDIA From
To
Total Number of Months
Purpose of Stay
…………………………………………………………………………………………………………………………………………………………………….………………… SECTION: 10 - ENCLOSERS
Self-Attested copy of the valid GMAT scores card [] Self-Attested copy of the latest TOEFL score, if the medium of instruction has not been English [] Demand Draft of US$ 100 (One hundred only) drawn in favor of Indian Institute of Management Indore, payable at Indore towards non-refundable application fee [] Three letters of recommendation from your Teachers/ Employer(s), [] Statement of purpose. [] Self-attested Photocopy of passport (all pages) Certificate from the Indian Embassy/High Commission/Consulate of the country where the candidate stayed during December 1, 2016 to January 31, 2018 clearly stating the duration of stay. []
………………………………………………………………………………………………………………………………………….…………………………………………… SECTION: 11 - DECLARATION I certify that the information I have provided here is true and correct to the best of my knowledge. I agree to abide by the decision of the IIM Indore on all matters (including the outcome of the selection process) relating to my application for admission to the Post Graduate Programme in Management (2018-20 batch).
Date: …………………………………. Place: ………………………………..
PGP 2018-20 Batch Application Form for International Applicants
Signature: …………………………………………………
Page 5 of 5
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