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    IPGP Application Form

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    mohitashish
    This document provides instructions and an application for the Five Year Integrated Post-Graduate Programme in Management (IPGP) commencing in October 2011 at the Indian Institute of Management Indore. Applicants must submit their completed application along with supporting documents by September 6, 2011. The application requests personal details, academic qualifications, SAT scores, scholastic achievements, career plans, medical history, and a declaration agreeing to the program requirements. Incomplete or false applications may result in disqualification from the selection process.

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    IPGP Application Form

    Uploaded by

    mohitashish
    36 views4 pages
    This document provides instructions and an application for the Five Year Integrated Post-Graduate Programme in Management (IPGP) commencing in October 2011 at the Indian Institute of Management Indore. Applicants must submit their completed application along with supporting documents by September 6, 2011. The application requests personal details, academic qualifications, SAT scores, scholastic achievements, career plans, medical history, and a declaration agreeing to the program requirements. Incomplete or false applications may result in disqualification from the selection process.

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    This document provides instructions and an application for the Five Year Integrated Post-Graduate Programme in Management (IPGP) commencing in October 2011 at the Indian Institute of Management Indore. Applicants must submit their completed application along with supporting documents by September 6, 2011. The application requests personal details, academic qualifications, SAT scores, scholastic achievements, career plans, medical history, and a declaration agreeing to the program requirements. Incomplete or false applications may result in disqualification from the selection process.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    36 views4 pages

    IPGP Application Form

    Uploaded by

    mohitashish
    This document provides instructions and an application for the Five Year Integrated Post-Graduate Programme in Management (IPGP) commencing in October 2011 at the Indian Institute of Management Indore. Applicants must submit their completed application along with supporting documents by September 6, 2011. The application requests personal details, academic qualifications, SAT scores, scholastic achievements, career plans, medical history, and a declaration agreeing to the program requirements. Incomplete or false applications may result in disqualification from the selection process.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    INDIAN INSTITUTE OF MANAGEMENT INDORE FIVE YEAR INTEGRATED POST-GRADUATE PROGRAMME IN MANAGEMENT (IPGP) COMMENCING IN OCTOBER 2011

    Last date for receipt of application at IIM Indore: September 6, 2011 1. 2. 3. 4. 5. 6. INSTRUCTIONS This application form is a key part of admission process and important for your selection. Complete and accurate information are 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. In all matters relating to admission to the five integrated programme, the decision of the Institute's authorities will be final and binding on the applicant. No correspondence will be entertained from the applicant regarding his/ her non-selection. Please submit your application so as to reach IIM Indore on or before September 6, 2011 along with attested copies of relevant certificates. The application fee of Rs. 1000 (Rupees one thousand only) shall be paid by DD in drawn in favour of Indian Institute of Management Indore, payable at Indore or transfer by RTGS/NEFT as per the details given below Name of the beneficiary: Indian Institute of Management Indore, Account Number: 53018623445 Swift Code: SBININBB00700, Bank Name: State Bank of India, Branch: IIM Indore Remittance Details; Remitter Name

    Remitting bank

    Branch location

    Date of Remittance

    Remittance advice No

    Amount Remitted

    (Please produce evidence of fee payment at the time of interview) (I) PERSONAL DATA Name of the Candidate (As given in the certificates) Date of Birth M Y Age as on June 30, 2011 Y Y Y

    Affix your recent passport size colour photograph


    PWD/ DA

    Gender and Category (Tick appropriate one) Male Female General

    NC-OBC

    SC

    ST

    (Candidates belonging to NC-OBC/SC/ ST/PWD/DA need to submit valid certificate copy with the application) Name of the Parents/ Guardian: Contact number Email

    Mailing address:

    City Phone: Fax:

    State Email:

    PIN

    Five year Integrated PGP at IIM Indore -Application

    A. B.

    (II) ACADEMIC QUALIFICATIONS Provide complete and accurate information on examination marks in all columns. Wherever you have received letter grades or grade points instead of marks, provide equivalent marks and attach a certificate from competent authority 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.

    Schooling: Standard Name of Board/ University Year Total Max. Marks/ Grade Total Marks/Grade Obtained % Marks / Grade Obtained Class/ Division/ Rank*

    X Std / Secondary/ Equivalent XI Std / Higher Secondary/ Equivalent XII Std / Higher Secondary / Equivalent *Please produce certificates/ evidence if a rank is mentioned.

    Standard

    From (Yr)

    To (Yr)

    Core subjects

    Marks/ Grade obtained

    Other subjects

    Marks/ Grade obtained

    No of attempts

    X Std Secondary Equivalent

    / /

    XI Std / Higher Secondary/ Equivalent

    XII Std / Higher Secondary/ Equivalent

    Space for explanation of letter grades / grade points/ any other relevant information relating to academic qualification

    Five year Integrated PGP at IIM Indore -Application

    (III) SAT-1 Score details SAT-1 Score Card (SAT- 1 scores obtained during January 1, 2010- August 30, 2011 are only valid) Writing Section Critical Reading Section Mathematics Section Overall

    Choice of Center for Aptitude Test and Personal Interview: Interview Centre Preference (Bangalore/ Chennai/ Delhi/ Hyderabad/ Indore/ Kolkata/ Mumbai) 1 2 3

    (IV) SCHOLASTIC ACHIEVEMENTS Scholastic Achievements: Please list scholastic awards or scholarships conferred on you during your School education at SSC and HSC or equivalent level in curricular, co-curricular and extra curricular activities at district, state, and national level. You need to produce certificates in support of your claim.

    (V) CAREER PLANS Why do you wish to go in for a management education through five integrated programme? (Limit your response to 100 words)

    Five year Integrated PGP at IIM Indore -Application

    (VI) MEDICAL HISTORY Please state whether you have any existing physical disability or any chronic illness, including mental illness, which could affect your studies at the Institute.

    If you have suffered from any chronic illness, including mental illness, in the past, please provide details below: Nature of illness 1. 2. 3. It is mandatory for all applicants to ensure that they are medically fit for joining the programme and they shall get the medical fitness certificate from authorised doctor/ hospital preferably from Government Hospitals. When suffered Date of completion of treatment Remarks, if any

    (VII) DECLARATION I clearly understand that if I am selected, I will be allowed to join the programme only if I satisfy all requirements of the programme including the submission of a certificate at the time of registration from Principal of my school that except for declaration of results, I have completed all requirements for obtaining XII/ Higher Secondary/equivalent qualification and that I would have to produce evidence (mark sheet/ certificate) of having passed the XII/Higher Secondary/equivalent examination on or before December 31, 2011. Non-fulfilment of these requirements will automatically result in the cancellation of the provisional admissions offer and no refund of fee will be made. I certify that the particulars given by me in this application are true to the best of my knowledge and belief. I understand that admission granted on the basis of false and/ or misleading information will be ipso facto null and void. I agree to abide by the decision of the institute authorities regarding my selection/ non-selection for the programme. I also understand that commitment fee which I may pay are non refundable and no claim will be made by me or on my behalf for the same. I undertake to produce the following documents at the time of personal interview, if called for: Original and attested copies of all academic certificates / marksheets / certificates from School authorities evidencing proof of all claims made in this application. A duly signed copy of this application

    Place: ______________________

    Date:______________________

    _________________________ Signature of the applicant

    PLEASE READ THIS FORM ONCE AGAIN AND MAKE SURE THAT YOU HAVE COMPLETED ALL THE DETAILS RELEVANT FOR YOU AND HAVE COMPLIED WITH ALL REQUIREMENTS. INCOMPLETE APPLICATION ARE LIABLE TO BE REJECTED

    Five year Integrated PGP at IIM Indore -Application

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