Institute of Business Administration, University of Dhaka

Executive MBA Program

INSTITUTE OF BUSINESS ADMINISTRATION

UNIVERSITY OF DHAKA Photo

Application for Admission

(Semester Fall 2014)

Instructions

1. This application form comprises 3 (three) separate pages.

2. After filling in the form, put your signature on the 4 (four) designated places.

3. Attach 2 (two) recent colored Passport Size photos with the application.

4. Do not write anything in the shaded areas designated “For Office Use Only”.

5. Make a Pay Order / Bank Draft for Tk.1500, payable to “Executive MBA, IBA”.

6. Submit the filled-in form & the Pay Order /Bank Draft to the EMBA Program Office by Wednesday, October 22, 2014.

7. After submitting this form, collect your Admit Card from EMBA Program Office on the assigned delivery date.

Personal Data

Fill applicant’s name in BLOCK letters. If currently unemployed, provide only one contact address.

Name:

Last/Family First Middle

Mother’s Name:

Father's Name:

Date of Birth: / /

dd mm yy

Nationality: National ID No / Passport No:

Gender: Male Female

Currently Employed? Yes No

Address 1:

(Home)

Address 2:

(Work)

Telephone #

Work Home Cell phone

Email:

Work Experiences

Give details of all full-time employment, starting from the most recent.

Position / Organization / Major Responsibilities / Duration
(From - To)

Total duration of full-time employment: Years Months

Academic Qualifications

Please list all degrees earned, starting from the most recent.

Degree / Institution / Year Awarded / Area / Major / Class/CGPA

GMAT Information (if applicable)

Verbal / Quantitative / Total
Raw Score:
Percentile:
Last Test Scores: / Test Date:
/ /
dd mm yy

Achievements, Memberships & Activities

Please list all noteworthy achievements / distinctions / awards, professional / association memberships & voluntary / community activities (in order of perceived importance).

Achievement/Membership/Activity / Organization/Field / Year

Declaration

“The information provided in this application form is true and correct. I accept that IBA reserves the right to restrict my admission or cancel my registration at any time if any item of information given by me on this form is found to be false or incorrect.”

Date: / /

Signature of Applicant dd mm yy

Application Fees Payment Information

Pay Order/Bank Draft # Payable to “Executive MBA, IBA”

Bank: Dated: / /

dd mm yy

Name of Applicant (in BLOCK letters) Signature of Applicant

Executive MBA Program

Institute of Business Administration

University of Dhaka

(Semester Fall 2014)

Admit # Photo

Receipt No. Signature of IBA Official

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