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ASSAM INSTITUTE OF MANAGEMENT

(A Government of Assam Society)

ADMISSION TO TWO-YEAR POST GRADUATE DIPLOMA IN MANAGEMENT (PGDM) 2018-2020

APPLICATION FORM

• National Level Written test appeared (Please tick the one you have appeared)

CAT ATMA MAT CMAT XAT held on …….……………….………... (Attach photocopy of the scorecard)

FILL IN CAPITAL LETTERS ONLY (No block should be left blank)

01. Name (in capital letter): / Affix a recent (Coloured) Passport size photograph
02. Date of Birth: / 03. Place of Birth :
04. Phone Nos.: / 05. Whether ST/SC/OBC/People with disability:
06. E-mail:

07. Name of the qualifying degree (e.g. BA/ B.Sc./B. Com./B. Tech./MBBS or others.):…………………………………………………

08.EDUCATIONAL QUALIFICATIONS (HSLC/SSC ONWARDS): Attach a separate sheet giving complete information of marks scored in all Board/University examinations. Applicants whose Final results have not been declared should give details of marks upto last examination. Attach attested copies of marks-sheet from Matriculation onwards.

Exam. or name of the equivalent exam. / Full Name of School/College / Board/Council/University / Year of passing / Class / Div. / % of marks
HSLC/SSC
Higher Secondary
Degree
1st Year
Degree
2nd Year
Degree
3rd Year
Degree
4th Year or others *

* In case of engineering and other courses as applicable

09. Distinction/Award/Special Achievements/Extra Curricular Activities/Work Experience (Candidates will have to submit copies of documentary evidence in support):

10. Father’s Name :
11. Father’s Occupation, Designation & Address:
12. Mother’s Name :
13. Mother’s Occupation & Address (if any) :
14. Guardian’s Name :
15. Relationship of Guardian to applicant:
16. Guardian's occupation, designation address:

(In case the guardian is one of the parents of the applicant, the name of the parent should be mentioned. In case guardian is other than parent, full details of guardian should be given.)

17. Address of Correspondence:
Pin: District: / 18. Permanent address of applicant:
Pin: District:

19. Why do you want to pursue a career in management?

20. Anything else you will like to mention which you feel may be relevant.

Enclosed Demand Draft for Rs. 1000.00 (Rupees One Thousand) onlydrawn in favour of "Assam Institute of Management" payable at Guwahati.D/D No………….……………………….……….. Dated ………………………………

Drawn on…….……………………………………………………………………..

DECLARATION

I certify that the particulars given above are correct and true to the best of my knowledge. If at any time the above information is found to be false, the Institute will have the liberty to take action as deemed appropriate. I agree to abide by the Rules & Regulations of the Institute. I fully understand that the decision of the Institute about my admission will be final.

Date: Signature:

Place: Name in Full:

INSTRUCTIONS:

While filling up the AIM Application Form, applicants are requested to note the following:

  1. This application is a key part of the admission process. Fill each and every part of the Form carefully and completely. In case any clause in the form is not applicable in your case, please write “Not Applicable” in the space provided. Incomplete applications will be rejected. Admission granted on the basis of false information will ipsofacto be null and void.
  2. In all matters relating to admission to the course, the decision of the institute Authorities will be final and binding on the applicant. No correspondence will be entertained form the applicant regarding his/her non-selection.
  3. Please enclose attested copies of marks-sheet of all Board/University examinations you have appeared in.
  4. Please provide a list of enclosures.
  5. Applicants, whose graduation results are not available at the time of application, should clearly indicate their marks for every yearupto the pre-graduation level and enclose all marks-sheets.
  6. The LAST DATE of submission should be strictly adhered to.
  7. Students desirous of availing admission under tuition fee waiver scheme should make an application to the Director of the Institute separately.

LAST DATE OF SUBMISSION: 16thFebruary 2018

Address to: Admission Coordinator

Assam Institute of Management

Bigyan Path, (Opposite IASST), Paschim Boragaon, Guwahati – 781035.

Phone: 0361-2131992; E-mail: ; website:

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