Admission Form

Please tick the following, as relevant: Campus applied for: Bhubaneswar Campus

Program applied for: PGDM

A. Personal Data (in CAPITAL letters)


CAT / XAT Registration No………………………

B. History of Educational Career: (Please start with the most recent, including High School)

Course/ Degree / Name of School / College / Year of
Passing / Percentage / CGPA / Academic Strea m/
specialization

Academic scholarships, distinctions, prizes, etc.

Extra Curricular Activities (where positions held or distinctions achieved.)

_

C. CAT / XAT / GM AT Score

CAT / XAT Score ……….. Sectional percentile: 1. Quantitative Ability Data Interpretation………..…

2. Verbal Ability Logical Reasoning …………...

GMAT registration No: …………… Month Year……………… GMAT Score……………….

( prior to Dec 31, 2013)

D. Academic Performance: (DO NOT attach any copies, Originals will be verified at the time of admission)

CLASS X Name of Board :
Year of passing : / Name of School :
Subjects (list all main subjects) / Marks obtained / Max. M arks
English
Mathematics
TOTAL / %
CLASS XII Name of Board :
Year of passing : / Name of School :
Subjects (list all main subjects) / Marks obtained / Max. M arks
English
Mathematics
TOTAL / %
GRADUATION : Name of University Course:
Year of passing : / Name of College:
List all Years or Semesters / Marks / CGPA obtained* / Max. M arks / CGPA
TOTAL ( up to most recent result) / %

*Where CGPA is cited, please provide the Institutional conversion norms adopted

**Those who have done Post Graduation may provide similar information on a separate sheet

Explain break / gaps, if any, in educational career:

E. State briefly what you consider your strengths and limitations:

STRENGTHS / LIMITATIONS

F. Identify one personality trait, that you think makes you suitable for a managerial career and justify the same in not more than 100 words. (If space is insufficient attach a separate sheet)

G. Work Experience as on December 31, 2013: (Where applicable; start with the most recent)

Briefly describe the nature of your responsibilities in your present/most recent job.

H. Tell us about your media consumption habits:

a) Did you visit any on-line sites for information about IMI, if yes, name the same ______

b) Do you visit PaGalGuy.com ? Yes / No c) Do you visit MBA Universe? Yes/No

d) How did you come to know about IMI? ______

e) Did you see any of our admission advertisements in newspapers /magazines? Yes/ No.

If yes, please name the publication(s) ______

I. Please give na mes and contact details of two persons from whom we may request a reference, if needed:

(Such persons may be your professors or immediate superiors but not a relative, please do not enclose testimonials.)

1. Na me Designation_

Na me of organization/institution_

Email: Mobile:

How do you know the individual

2. Na me Designation_

Na me of organization/institution_

Email: Mobile:

How do you know the individual

J. Please give any other information which you feel would be relevant for consideration of the Admission

Committee.

_

_

K. DD Number ………………………. Date …………………………….. Amount ……………………………

………………………………….

L. Interview Choice (1st)…………………………………………………………… Interview Choice (2nd) …………………………………………………………..

M. Declaration

I certify that the information given above is true and I have not concealed anything which may render me ineligible for being considered for admission to the Post Graduate programs at IMI. I am aware that if at a later date anything is found to be incorrect or misrepresented, I may be disqualified from the institute.

Place: Date: (Signature of Applicant)

Kindly mail this filled in application form to /

PLEASE ENSURE YOU ANSWER ALL SECTIONS CORRECTLY.