Please read the instructions given on last page before you fill the application APPLICATION NO: For Office use only INSTITUTE OF MANAGEMENT EDUCATION & CONSULTANCY Approved by A.I.C.T.E, Ministry of HRD, Govt. of India 89/1, Bindukhera, Rudrapur, US Nagar, Uttarakhand 263153 Tel : +91-9811749947; +91-999998851 E-mail: admission@imeceducation.in: website: www.imeceducation.in APPLICATION FORM PGDM (2017-19) 1. Name (in BLOCK letters as in Degree Certificate /Mark Sheet) Date of birth Age as on 1/7/2015 DD MM YY Gender Marital status Married Unmarried Candidates to affix passport size photograph Category (check box) SC ST BC OBC Others Nationality NRI Yes No Details of Parents Name Father Mother Occupation / Job Position & Organization 2. (a) Entrance Exam (Tick) CAT MAT CMAT OTHERS (b) Registration No. (2016-17) (c) Exam date (DD-MM-YY) (d) Score (2016-17) (e) Score in percentile (2016-17) 3. Preferred GD/Interview Centre (Tick) Rudrapur Dehradun Haldwani Kiccha Bareilly Nainital Delhi
4. Permanent Address with PIN Mailing Address with PIN 5. Academic Record Qualification Year From - To Name of School, Board, College University & Place Major Subjects Total Marks obtained Max. Marks % Marks (Aggregate) Class-X Class- XII Degree (specify below) P.G. Degree (specify below) Other Recognized Course ** Applicants are required to have a bachelor s degree from a recognized university with a minimum aggregate of 50% for all subjects taken together (45% for SC/ST & Differently Abled candidates) 6. Awards, Scholarships, and Significant Achievements (Be specific) School Level Level Academics Sports Others College Level University / State /National Level
7. List Work Experiences Organization Designation From Date To Annual Salary Reasons for Leaving Describe the nature of work and responsibilities in your most recent job 8. What makes you to choose IMEC for PGDM program? (please explain) 9. How did you come to hear about IMEC? (Please tick) IMEC website Newspaper Coaching Centre Other sources (specify) Internet (Mention sites visited)
10. Do you have any existing medical conditions or concerns? Yes No If yes, give details below Do you have any allergies? Yes No If Yes, give details below Mention any other Health Issues or Medical Concern you have Declaration I hereby declare that the particulars given in this application are true and correct to the best of my knowledge and belief. I have carefully read the contents in the prospectus / website and agree to all the conditions mentioned therein. If admitted, I agree to abide by the rules and regulations of IMEC as may be enforce from time to time. I understand that any information furnished falsely and / or a misrepresentation is a sufficient ground for summarily canceling my admission and / or expulsion from the school. Place... Date... Signature of the applicant
INSTRUCTION FOR FILLING PGDM APPLICATION FORM List of the documents to be submitted for processing of the application: (DO NOT SEND ORIGNALS; submit the ATTESTED photocopies only) 1. Signed & Completed Application form 2. Copies of marks sheet for class-x/xii, Graduation and others (if any) 3. Copy of Score Card (CAT/MAT/CMAT or others (if any) 4. Copies of work experience (if any) 5. Copies of certificates pertaining to awards, scholarships, and achievements in academics or nonacademics (like sports etc.) Applicants are advised to send the PGDM Application Package through registered post or courier (with tracking number) to ensure the safe & timely delivery. If you have downloaded the application form from our website, please do not fill the application number. (OFFICIAL USE ONLY). Submit the duly filled-in & signed application form with the listed documentations at the Institute s address along with the processing fees of Rs. 1100/- (non-refundable). The processing fees of Rs. 1100/- can be paid in the form of DD/PO in favor of IMEC, payable at Rudrapur. Please write clearly your name, contact number and e-mail address on the back side of DD / PO. Cash payment towards processing fees is also accepted at Institute s office. Application Forms can also be obtained in-person from the Institute s Office from Monday through Saturday: 10.00 am to 5.00pm (except Holidays) Serial numbers refer to the numbers in the application form Serial # 2: Score card information Enter details about the test in which you had the best result from among the 3 tests shown. In case you want to give results of more than one admission test, attach additional sheet. Only the results in the admission tests conducted during 2016-17 will be considered. Serial # 4: Mailing address information To avoid any delays in the processing of your application form, please write clearly your mailing address (with pin code), telephone number (with area code followed by the number) & email address. Serial # 5: Academic record information Please provide name & location of the institution and affiliated Board or University. Candidates appearing for the final year bachelor s degree/equivalent qualifying exams and those who have completed degree requirement and are awaiting results are eligible to apply. In case you are appearing in final examination, cumulative marks of all previous semesters/ years must be estimated and entered. Such candidates must produce a certificate from the Principal/ Registrar/Director of the university/institution certifying that the candidate is currently in the final year/is awaiting final results and has obtained at least 50% marks or equivalent (45% in case of candidates belonging to SC/ST/DA category) based on latest available grades/marks. Serial # 6: Awards, scholarships and achievements information Please enter the data which is support by certification (attested copy need to be submitted, please refer to the list of documents to be submitted)