INDIAN INSTITUTE OF MANAGEMENT INDORE FIVE YEAR INTEGRATED PROGRAMME IN MANAGEMENT (IPM) 2019-24 Batch, Commencing in August 2019 Last date for receipt of application at IIM Indore: May 20, 2019 INSTRUCTIONS 1. Please go through the admissions procedure available on the institute s website and ensure that you are fulfilling the eligibility criteria before applying for IPM 2019-24 batch. 2. 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. (All information should be filled in block letters only by using a ball point pen) 3. Admission granted on the basis of false and / or misleading information will be ipso facto null and void. 4. In all matters relating to admission to the Five-Year Integrated Programme in Management (IPM), the decision of the Institute's authorities will be final and binding on the applicant. 5. No correspondence will be entertained from the applicant regarding his/ her non-selection. 6. Please submit your application so as to reach IIM Indore on or before May 20, 2019 along with self-attested copies of academic mark sheets/certificates, SAT score card, Passport documents along with Demand Draft. 7. The application fee of US $118 (US Dollar One hundred and eighteen only) shall be paid (non-refundable) by Demand Draft (DD) drawn in favour of Indian Institute of Management Indore, payable at Indore 8. The complete application packet is to be sent by Post/Courier only. IIM Indore will not be responsible for any postal delay. Application Fee Details; Drawee Bank Branch Location Amount (In US $ Only) : DD/BC No DD/ BC Date Name of the Candidate (As given in the Std.X /SSC/Equivalent Marksheet) Date of Birth D D M M Y Y Y Y (I) PERSONAL DATA Candidate should have been born on or after August 01, 1999 Affix your recent passport size colour photograph here Gender (Tick appropriate one) Male Female Transgender Correspondence Address: Address Line 1: Address Line 2: Address Line 3: City: State:. Pin code:. Email Id (Candidate s):. Mobile No. (Candidate s):. Email Id (Guardian s):.. Mobile No. (Guardian s):. Family Income (Total): Five year Integrated Programme in Management (IPM ) at IIM Indore Application Form 1
(II) ACADEMIC QUALIFICATIONS A. Provide complete and accurate information on marks in all columns. B. The percentage of marks obtained by the candidate in X and XII Standard would be calculated based on the aggregate marks of all subjects that appear in the mark sheet/grade sheet, irrespective of the Board s regulation. In case the candidates are awarded letter grades or grades points instead of marks, the conversion of grades to percentage of marks would be based on the procedure certified by the Board/ Competent Authority explaining the method of conversion from where they have obtained the certificate. 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. Standard Name of Board/ University Year of Passing Total Max. Total Obtained % of Marks / Obtained Class/ Division/ Rank* Standard X /SSC Standard XII /HSC/Diploma # *Please produce certificates/ evidence if grade is mentioned. * Students who are studying in XII Std. are required to produce certificate as per the format given in Page: 5. # Candidate should have passed Standard XII/HSC/Diploma in 2017, 2018 or appearing in 2019. Standard From (Yr) To (Yr) Core subjects obtained Other subjects obtained No of attem pts Standard X /SSC Standard XII /HSC/Diploma Space for explanation of letter grades / grade points/ any other relevant information relating to academic qualification (III) SAT Score details SAT Score Card (SAT scores obtained during November 01, 2017 to May 15, 2019 are only valid) Evidence-Based Reading and Writing Math Overall Section Section (.. out of 1600) Five year Integrated Programme in Management (IPM ) at IIM Indore Application Form 2
(IV) IPM Interview Centre Choice of Center for Written Ability Test (WAT) & Personal Interview (PI), which will be held (tentatively) in June, 2019, if shortlisted: PI Centre Preference (Bangalore/Chennai/Delhi/Guwahati/ Hyderabad/Indore/Kolkata/Mumbai) 1 2 3 (V) SCHOLASTIC ACHIEVEMENTS Scholastic Achievements: Please list scholastic awards or scholarships conferred on you during your School education at Secondary and Higher Secondary 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... (VI) CAREER PLANS Why do you wish to go in for a management education through Five Year Integrated Programme in Management (IPM)? (Limit your response to 100 words) (VII) 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: 1. 2. Nature of illness When suffered Date of completion of treatment Remarks, if any 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 (at the time of registration to the programme). Five year Integrated Programme in Management (IPM ) at IIM Indore Application Form 3
(VIII) 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 Std / Higher Secondary/Equivalent qualification and that I would have to produce evidence (mark sheet/ certificate) of having passed the XII Std/Higher Secondary/Equivalent on or before the date of admission. 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 application fee which I may pay is non-refundable and no claim will be made by me or on my behalf for the same. I hereby certify that I am fulfilling the eligibility conditions like Age, Percentage of marks and Reservation Category (If applicable) as per Govt. of India norms. I undertake to produce the following documents at the time of Written Ability Test (WAT) & personal interview (PI), if called for: Original and self-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 AS MENTIONED IN THE ADMISSIONS PROCEDURE. INCOMPLETE APPLICATION ARE LIABLE TO BE REJECTED Send in your completed application form so as to reach this office latest by May 20, 2019 along with DD and photocopy of the following: Proof of Date of Birth, 10 th Mark sheet, 12 th Mark sheet (or provisional Certificate), SAT score card copy, Passport copy (all pages). To, The Admissions Office Indian Institute of Management Indore, Prabandh Shikhar, Rau-Pithampur Road, Indore 453556, Madhya Pradesh, India Note:- No other documents to be attached with the application form except the above mentioned certificates. Five year Integrated Programme in Management (IPM ) at IIM Indore Application Form 4
The below certificate is applicable only for candidates appearing in Standard XII/ HSC/Diploma/ Equivalent Examination only (in session 2018-19) This is to certify that Mr./Ms. is currently studying in the standard XII/ is awaiting the results, during the academic year 2018-2019 in this School/Institution. This certificate has been issued to enable the candidate to apply for IPM 2019-24 Batch of IIM Indore. Signature of the Authority: Designation: Seal: Date: Note: Ensure to obtain this certificate on School/Institution s letter head Five year Integrated Programme in Management (IPM ) at IIM Indore Application Form 5