CENTRE FOR RESEARCH STUDIES

APPLICATION FORM FOR ADMISSION TO FELLOW PROGRAMME IN MANAGEMENT (FPM)/

EXECUTIVE FELLOW PROGRAMME IN MANAGEMENT (EFPM) (Incomplete forms will not be considered)

Form No: __________

Registration No. (for office use only) __________________________________________________ Date of Admission (for office use only)_________________________________________________

------------------------------------------------------------------------------------------------------------------ Full Name: ____________________________________________________________________________________________

Fathers Name: _________________________________________________________________________________________

Mothers Name: ________________________________________________________________________________________ Date of Birth: ______ /____/__________ Married/ Unmarried: ___________________ Nationality: ________________________

Correspondence Address: ________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Phone No.: (off.) _________________________ (Res./Mobile) ______________________Fax No.: _______________________ E-mail: _______________________________________________________________________________________________ A. Academic Record (Attach attested photocopies)

Examination Name of the Institution

Board/University Year of Passing

Marks (%)/

CGPA

Subject(s)/ Specialization

Secondary(X)

Senior Secondary(XII)

Graduate Degree

Post Graduate Degree

Professional Degree

Any Other

B. Academic/Professional Awards/ Medals/ Prizes/ Scholarships/ Certificates/ Honors etc.

___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

Recent

Coloured

Passport Size

Photograph

C. Employed/ Unemployed (Please Tick)

(If employed, attach details of Institution(s)/Organization(s) served and No objection certificate from the employer)

In Case of Teachers: Teaching Experience of UG_________________________PG___________________________________

D. Research Papers/Articles published

1. ________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________

E. Research Conferences /Seminar Attended

1. ________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________ F. Area of Research Interest

1. ____________________________________________________________________________________________________ 2. ________________________________________________________________________________________________________ G. Please write a brief note on the proposed area of research that you would like to take-up for in-depth study and reasons for your choice H. Describe briefly how do you consider this programme to help you in achieving your career plans?

I. Give 3 reasons that you consider should weigh in your favour for admission J. Declaration

a) I declare that all the information given by me in this application form is correct to the best of my knowledge and belief and I

understand that false or incomplete information would cause invalidation of the application.

b) I shall abide by the decision of BIMTECH in all matters pertaining to admission and administration of the program. The Institutes decision shall be final and binding on me.

c) I shall abide by the rules and regulations of BIMTECH, if selected.

d) For all legal actions, suits and proceedings, the jurisdiction of a court of law shall be deemed to lie exclusively at the place at

which the institution is situated and at no other court or place.

e) I understand the contents of this form and particularly this declaration being made here. Place: Date:

Signature of the Applicant

* Attach separate sheet where needed