PGDM PGDCM Application Form

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INDIAN INSTITUTE OF MANAGEMENT CALCUTTAPOST GRADUATE DIPLOMA IN MANAGEMENT (PGDM)

ANDPOST GRADUATE DIPLOMA IN COMPUTER AIDED MANAGEMENT (PGDCM)

APPLICATION FORM FOR THE SESSION 2010-2012

PGDM PGDCM

Please write (1) in the appropriate box, if you have applied for only one programme. If you have applied forboth the programmes, please write (1) for the programme of your first choice and (2) for the programme ofyour second choice.

Name: ___________________________________________________________________________________(IN CAPITAL LETTERS, as recorded in your school leaving certificate)

General NC-OBC SC ST DA+

________________________________________________S R

CAT Registration No. Category (Tick)If NC-OBC, SC, ST or DA, attach necessary certificate(s)

Single Married Indian Others_________________________ ________________________ Date Month Year_

Martial Status (Tick) Nationality (Tick) Date of Birth

Mailing Address:

Pin code:

Landline No.: Mobile No.:

E-mail ID:

Interview City (Tick): BANGALORE KOLKATA MUMBAI NEW DELHI

Fathers Name:________________________________ Mothers Name:_______________________________

Education Occupation Designation Annual Income (Rs.)

Father

Mother

Annual Income of family including the Applicant*(Rs.): _________________ Financial Year: _______________

Family Size: ____________________ Annual Income of the Applicant (Rs.): ___________________________

Guardians Name: _______________________________________________ Relationship: ________________

Mailing Address:

Pin code:

Landline No.: Mobile No.:

E-mail ID:

_________________________________________________________________________________________+ Differently Abled

*Please ensure the validity of self and family income statements as they may be subject to verification for internal administration.


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ACADEMIC RECORD

1. Pre-Bachelor Degree Examination:Stream during classes 11 12: _______________________________________________________________

Class Name of the School / Board& University

Year ofPassing

Total MaximumMarks

MarksObtained

Percentage Division

10th

12th

2. Bachelors Degree Examination:A. Discipline (Tick): Arts Commerce Engineering Science Others

If Others, please specify: _____________________________________________________________________

Specialization in Bachelors Degree: _____________________________________________________________

B. Bachelors Degree Examination (if completed):Attach an attested copy of the final mark-sheet.

YearDegree Name of College /Institute & University From To

Total MaximumMarks / CGPA

Total Marks/ CGPAObtained

Percentage Class

C. Bachelors Degree Examination (if not yet completed):i. Attach attested copies of all mark-sheets received so far.

ii. A certificate from the college/institution certifying that you have obtained at least 50%marks or equivalent (45% in case of candidates belonging to SC, ST and DA category) basedon the latest available grade/marks. The proforma of the certificate is enclosed.

Degree sought: ___________________________ Institute / University: ________________________________

Expected date of completion of final examination including practical / viva / assignments / projects:

Month: __________________________________ Year: ____________________________________________

Years of Attendance (Bachelors Degree Examination, if not yet completed):

Year From To Total MaximumMarks / CGPA

Marks / CGPAObtained

Percentage

1st

2nd

3rd

4th

5th

Total

3. Masters Degree Examination (if completed):YearDegree Name of College /

Institute & University From To

Total MaximumMarks / CGPA

Total Marks/ CGPAObtained

Percentage Class

4. Other Professional Degree / Diploma (if completed): _________________________________ACADEMIC RECORD GIVEN ABOVE ATTESTED BY(MANDATORY Please see Point No. 10 under Instructions)

______________________ _______________________ _____________________

Name Designation & Office Seal Signature


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REASONSFORLEAVING

TOTALSALARY

(PERMONTH)

DURATION

(MONTHS)

JO

BPROFILE

DESIGNATION

WorkExperience:(UptoJanuary31,

2010inchronologicalorder.

Pleaseattachaseparatesheetif

required)

Donotincludetraining/project

work/workdoneasanintegralpa

rtofcurricularrequirement.StateworkexperienceafterGraduationonly.

Attachcopiesof

experiencecertificatesorfirst&

lastpayslips.Incaseyouareself

-employedoremployedinafamily

businessorinacompanynotlistedinNSEorBSE,attach

anotedetailingthebusiness(includingturnoverandprofit)andth

enatureofyourexperience.

ORGANISATION


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Extra Curricular Activities in College / University:

Nature of Activity Honours / Award & Prizes, if any

Extra Curricular Activities at District / State / National Level:

Nature of Activity Level* Honours / Award & Prizes, if any

* Mention District / State / National Level

List out your hobbies (not more than two) with brief description:


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Career Goals: (Do not write more than 60 words):

Academic Distinctions / Prizes / Awards / any other useful information:

DECLARATION:

I declare that the information given by me in this application form is true and complete in allrespects to the best of my knowledge. I understand that suppression of facts or falseinformation may lead to rejection of my application at any stage of the selection process. I alsounderstand that the decision of the Admissions Office of IIM Calcutta in any matter related tothe selection process is final and binding on me.

_______________________ ______________________ ________________________Place Date Signature of Applicant


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I N S T R U C T I O N SI N S T R U C T I O N S

1. This Application Form should be completely filled in and must be handed over to the interviewpanel during the interview.

2. The CAT 2009 Admit Card must be presented to the interview panel forverification. You also need to bring at least one acceptable form of photo-identification. Acceptable forms of photo identification are Drivers license,Passport, PAN Card, Voter ID, College ID, Employee identification card, or anotarized Affidavit with Photo, Signature, Date of Birth and Residential Address.

3. NC-OBC / SC / ST candidates are required to submit a certificate (proforma enclosed) dulysigned by the appropriate authority along with the application form. Candidates are alsorequired to bring the original certificate for verification at the time of interview. Onlycertificates from appropriate authorities designated by the appropriateGovernment will be considered.

4. Differently Abled (DA) candidates are required to submit a certificate (proforma enclosed)

duly signed by the appropriate authority as per the Persons with Disability (PWD) Act 1995along with the application form. Candidates are also required to bring the original certificatefor verification at the time of interview.

5. Please ensure the correctness of the self and family income statements as they may besubject to verification for internal administration.

6. The original academic certificates/mark-sheets must be produced at the time of interview forverification. Please bring the attested copies of all mark-sheets and certificates.

7. Necessary evidence in support of work experience must be attached along with theapplication form and also produced at the time of interview (Certified record of experience orfirst and last pay slips). If evidence of work experience is not produced during theinterview, the work experience will be taken as NIL.

8. Necessary evidence must be produced in support of extra curricular activities at the time ofinterview.

9. Wherever letter / point grades are used, their percentage equivalents should be specified. Acertificate from the relevant University / Institute must be enclosed indicating the conversionformula. If such a conversion is not possible, mention it below the marks columns and enclose

a certificate from the relevant University / Institute to this effect.

10. Academic records in the Application Form can be attested by the Registrar, Principal, Head ofthe Department or a Gazetted Officer (Central or State Govt.). In the case of letter or pointgrades or if applicants are in their final year, the attestation has to be done by the Registrar,Principal, Director or Head of the Department. Attestation of academic records in the

Application Form is mandatory.

11. The Application Form and proformas of certificates can also be downloaded from the Instituteswebsite(www.iimcal.ac.in).

PGDM PGDCM Application Form

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Transcript of PGDM PGDCM Application Form