Annexure 1 (To be filled by ITMU) Receipt No __________ Date ____/____/_____ Form No. APPLICATION FORM FOR ADMISSION TO MBA DEGREE (FULL TIME) ACADEMIC SESSION 2015 – 2016 Applicable for Resident Indian Students | All columns need to be filled with black ball point pen only 1. Name of the Applicant (IN CAPITAL LETTERS) __________________________________________________ (In Hindi) __________________________________________________ 2. Father’s Name _____________________________________________ PASTE FIRMLY YOUR RECENT COLOR PHOTOGRAPH OF GOOD QUALITY (SIZE 3.5 x 4.5 CMS) (In Hindi)_____________________________________________________ 3. Mother’s Name ____________________________________________ (In Hindi _____________________________________________________ 4. Address CORRESPONDENCE ADDRESS PERMANENT ADDRESS (Fill only if different from Correspondence Address) Address ……………………………………………………….………….. …………………………………………………………………………….. Town/City ………………………………………………………………… State ….................................................. Pin Code……………..……. Student Mobile No………………………………………………………. Parents Mobile No……………………………………………………… Parents Email ID………………………………………………………… Landline no. with STD Code…………………………………………. Address ……………………………………………….………..….. ……………………………………………………………………….. Town/City …………………………………………………………… State …................................ Pin Code…………………….……. Parents Mobile ……………………………………………….…… Parents Email ID ………………………………………………….. Landline no. with STD Code……………………………………… 5. Date of Birth _________________ _____ 6. Gender : Male 7. Nationality ________________________ 8. Domicile Details (Applicable for Haryana, Resident students only, tick one only) Haryana General Female Transgender Haryana SC 9. Annual Family Income (In INR) ________________________________ 10. Stream/specialization at Under Graduation Level (Please Specify) ______________________________ 1 11. Educational Qualification (Starting from 10th) Name of Examination 10th Name of the Board/University Year of Marks Obtained / Completion Out of Total Marks Overall Result 12th Graduation 12. Qualifying Entrance Examination Details: CAT 2014/CMAT 2015/MAT (September2014‐May2015) / IMET 2015 (If you have appeared for more than one exam give details of all exams) Examination Roll No. Composite Score Percentile From To 13. Professional Qualifications (such as CA, ICWA, etc): Professional Institution Course Title Month Year Month Year 14. Details of Work Experience: Organization/Company name Job Title From Month To Year Month Year 2 15. Have you ever been convicted for any Criminal Offence? Yes No 16. Is there any case pending against you before a Court/Police/ School/ University? Yes No (If yes, provide full details on a separate sheet of paper) 17. How did you get information about ITM University, Gurgaon? Newspaper ITM Website Current Student of ITM Counselor Internet Friends/ Relatives Alumni Others (Please Specify)………………………………. 18. PERSONAL STATEMENT A. How would MBA help you? (200 words only) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3 B. Why do you want to pursue MBA from ITM University? (100 words only) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 19. List of Enclosures (Self Attested) S.No. Documents Yes/No 1 Class X mark sheet(as proof of date of birth) 2 Graduation (or equivalent) Degree and Mark‐sheet or last set of result declared 3 CAT 2014/CMAT 2015/MAT(September2014‐May2015) scorecard. 4 Haryana Resident Certificate (only if applying for seats reserved for Haryana General–(Form‐1) 5 Haryana SC certificate (only if applying for seats reserved for Haryana SC–(Form‐2) 6 Experience Certificates from the Employers. 20. IMPORTANT DATES : S.No 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Actions Uploading of Admission Policy and Selection Procedure on ITMU, Gurgaon website www.itmindia.edu Applications Available Online/Downloaded forms on the ITM University, Gurgaon website www.itmindia.edu Application Forms available at the ITMU, Gurgaon Campus (Offline Mode) Last date for submission of Application Forms with Processing Fee and required documents by any mode, online, offline or by post Display of first shortlist for GD and PI on the ITMUG website www.itmindia.edu and at the campus GD and PI as per date announced for each candidate in shortlist Display of first admission cum merit list on the ITMUG website and at the campus Last date for payment of first semester fees for students offered admission in first list Last date for withdrawal of admission with refund 11. Last date for submission of marks sheets and result of graduation with minimum 50% marks by candidates offered provisional admissions Admission against vacant or dropout seats, if any, based on merit 12. 13. Commencement of Academic Session 2015‐16 Last date of admission for any unfilled seats Date (Day) 23‐01‐2015 (Fri) 23‐01‐2015 (Fri) 23‐01‐2015 (Fri) 25‐03‐2015 (Wed) 30‐03‐2015 (Mon) 09‐04‐2015 (Thu) & 10‐04‐2015 (Fri) 15‐04‐2015 (Wed) 30‐04‐2015 (Thu) 16‐06‐2015 (Tue) 15‐07‐2015 (Wed) 17‐06‐2015 (Wed) to 28‐08‐2015 (Fri) 03‐08‐2015 (Mon) 28‐08‐2015 (Fri) 4 DECLARATION BY THE CANDIDATE I, hereby declare that all the particulars stated in this Application Form are true to the best of my knowledge and belief. I also affirm that I have read in detail the Admission Policy & Selection Procedure 2015 of ITM University including its fee structure and refund & cancellation policy before submitting this application and agree to unconditionally abide by the same. I understand that the decision of the University is final with regard to my admission. I promise to abide by the rules and regulations of the University as existing and as would be amended from time to time. If it is proved that I was admitted on false particular and / or documents provided by me or my antecedents prove that my continuance in this University is not desirable, the University shall have the right to expel me from the University, besides being liable for legal action against me, at my cost. I agree that all disputes are subject to the jurisdiction of the court at Gurgaon only. I also understand that a student from a University / Board not recognized by CBSE/AICTE/UGC/AIU/MHRD or any other statutory body of Government of India shall not be eligible for admission. Date:________________ Place:______________ Signature of the Applicant _______________________ 5