Indian Institute of Management Rohtak Application Form For Doctoral Programme

Transcription

1 Indian Institute of Management Rohtak Application Form For Doctoral Programme (Fellow Programme in Management ) Application Form No. FPM Bulletin No. (For Official use) Instructions for filling the Application Form 1. Fill in the Application Form in capital letters. 2. Please enclose copies of all certificates and testimonials.. Please enclose two copies of passport size photograph. 4. All certificates (originals) should be produced at the time of interview. 5. The form should be complete in all respects. Incomplete forms will not be considered. 6. Strike out whichever is not applicable. Affix your recent photograph (5cmx4cm) 1. Personal Data 1.1 Name: 1.2 Date of Birth D D M M Y Y 1. Sex M F 1.4 Marital Status M S 2. Qualifying Examination: C AT/ G A TE/ GM AT / G R E/JRF / P GDM/ O t h e r (Please tick the right one and enclose the copy of mark sheet / scorecard or Grade sheet) 2.1 Have you appeared for CAT-2015? If yes, give your CAT Reg. No. 2.2 If not, give details of others: (Reg.No./Date of Appearance) Year CAT GMAT GRE (Gen/ Advanced) JRF of UGC/ CSIR GATE 2. Test Score* (if available) Score Percentile Overall Section 1 Section 2 Section Section 4 *Attach score card/certificates 2.4 Nationality (If not Indian Resident or NRI, mention country name) Indian NRI PIO Other Foreign 2.5 Addresses: (a) Mailing: (b) Permanent: Pin Pin (c) Landline No. with code: Mobile No. (d) ID

2 . Family Details Father s Name/ Spouse s Name (if married): Occupation: Phone No. : Mobile No: 4. Academic Performance 4.1 Education Stage SSE (10 th ) Title of Qualificati -on Name of the Board/ Univ. /Institute Month & Year of Exam Month Year M M Y Y Subjects/ Specialization Max. Marks/ CGPA for the Exam. % of Marks/ CGPA Obtained Class/Div. Obtained (if any) HSSE (10+2) Bachelor s Degree Master s Degree Professinal Degree (MBA/LLB/ CA/ICWA etc.) Any other 4.2 Please account for break in your academic career, if any: 4.. Awards/Medals/Prizes/Scholarships/Certificates/Honors, etc. (Mention only top three and those related to Academic/ Professional Activities) No. Name of the Award Awarding Institution Year Total work experience in full-time jobs: Years Months. 2

3 5.1 Work Experience: From most recent to backward (Please mention full-time jobs only)* Designation No. Name of organization Reporting to (Designation) Nature of Duties Period From To Total Exp. in months Monthly Salary in Rs. 1 2 *(Add sheets if required) 6. Extra-Curricular Activities/Hobbies* (Please mention only top three) Activity Your Role Year Awards/Prizes/Honors, No. if any From To Total Remarks 1 2 *(Add sheets if required) 7. Why are you interested in the Fellow Programme in Management? (Please write in 150 words only)

4 8. Previous Research Experience: (Explain any research project/experiment/field work completed as part of your Master s degree or afterwards. If not applicable, present your views on an important issue in your area of interest. Please write in 150 words only). Note: If you have any published research work, a copy or, if its size is large, its abstract may be enclosed. 9. Proposed research work: (Please write about your possible idea that could be taken up for the doctoral research by you. Please write in 150 words only). 4

5 10. Area of Specialization (Select only two and give your order of preference (I or II)) S. No. Area Preference 1 Business Environment 2 Financial Management Human Resources Management 4 Information Technology Systems 5 Marketing 6 Operations 7 Strategic Management Referees: (Two are compulsory) 1.Name: Address: Pin: Phone: 2. Name: Address: Pin: Phone: Note: Confidential referee recommendations need to be enclosed with the application in the given format. 12. Details of Demand Draft: Name of issuing bank Place DD No. Amount Date of issue 1. Details of enclosures sent with the application: Declaration All the details provided by me in this application form are true to the best of my knowledge and belief. I will produce the original certificates on demand at any stage of the programme. Place: Date: Signature of the applicant Last date for receiving the completed application forms at IIM Rohtak is January 0, 2016 Please mail the filled in application form to In-charge, FPM Office Indian Institute of Management Rohtak MDU Campus, Rohtak, Haryana FOR OFFICE USE ONLY Areas Applied Area Code Qualifying Test : 5

6 INSTRUCTIONS AND INFORMATION TO APPLICANTS ON THE APPLICATION PROCEDURE 1. Applications for the Fellow Programme should be sent only in the prescribed Application form, which can be obtained from the FPM Office of the Institute by sending a request by e- mail/post/fax along with a DD of Rs. 500/- as non-refundable application fee. The DD should be drawn in favour of Indian Institute of Management Rohtak payable at Rohtak. Alternatively, you can download the form from the IIM Rohtak Website and send the application fee of Rs.500 as DD along with the Application. Applications without the application fee will not be accepted. 2. You may choose to apply to a maximum of two areas from the eight choices. For each area selected, you must submit a separate copy of application form (complete in all respects). However, there is no need to pay a second fee.. For each area applied for, two letters of recommendation in prescribed format are required. Blank format for recommendation letters and the instructions to send these are enclosed. So, a candidate applying in one area should send two and one applying in two areas should send four letters of recommendations. 4. Ensure that you respond to all items in the application form (Use N/A for items which do not apply to you). 5. Please submit the documents in support of the application according to the instructions given below under Supporting Document. 6. The completed application form with enclosures must reach the following address latest by January 0, The In-Charge Fellow Programme in Management Indian Institute of Management Rohtak MDU Campus, Rohtak fpm.incharge@iimrohtak.ac.in Phone: , Fax: While contacting Fellow Programme Office, please quote your application Number and/or FPM Bulletin number and the area of specialization as opted for in this application. SUPPORTING DOCUMENT A. Official Transcript: Please provide official transcripts of records and/or mark sheets (or attested copies of the same) in support of your academic qualifications. Attestation may be done by a College or University authorities, regular faculty of any IIM, or any Gazetted Officer whose designation should be given. The key to the letter grade system should be included wherever necessary. B. Copy of the Score Card/Certificate of CAT, GMAT, GRE (General/Advanced), UGC/CSIR JRF or GATE. C. Writing & Research: Please enclose with this application any published or unpublished research work which you might have completed. You may give abstracts or summaries if the entire document cannot be sent. 6

7 Letter of Recommendation For an applicant to the Doctoral Programme at IIM Rohtak (The candidate has applied for the Fellowship Programme (equivalent to a PhD Programme) at IIM Rohtak. You are requested to seal the envelope containing this letter and sign across the seal. You may either hand over the sealed envelope to the applicant or mail it directly to Officer-in-charge, Fellow Programme in Management, Indian Institute of Management Rohtak, MDU Campus, Rohtak , India so as to reach the office by January 0, 2016.) Indian Institute of Management Rohtak Doctoral Programme (Fellow Programme in Management) Name of the applicant: (Use upper case) FIRST MIDDLE LAST Area Applied for: 1. I have known the applicant for years and months. 2. He/she has been (please check most appropriate answer): A student in my course(s) A personal friend or acquaintance My advisee Other (please specify). Compared with a typical group of students/persons I have encountered at my institution/in my contact, I would rank him/her as indicated below (please tick as appropriate): CATEGORY Academic Strength Motivation Teaching Potential Research Potential Communication Ability Writing Ability Overall Rating EXCELLENT Top 5% VERY GOOD Next 10% GOOD Next 20% FAIR Next 25% POOR Bottom 40% NO BASIS FOR JUDGEMENT 4. Please write briefly about the strengths of the candidate: 5. Please write briefly about the weaknesses of the candidate: 6. Comments on the suitability of the candidate to a doctoral Programme (please use separate sheet, if desired): Your name: Designation: Address: Signature: Institute affiliation: Pin Phone: 7

8 Letter of Recommendation For an applicant to the Doctoral Programme at IIM Rohtak (The candidate has applied for the Fellowship Programme (equivalent to a PhD Programme) at IIM Rohtak. You are requested to seal the envelope containing this letter and sign across the seal. You may either hand over the sealed envelope to the applicant or mail it directly to Officer-in-charge, Fellow Programme in Management, Indian Institute of Management Rohtak, MDU Campus, Rohtak , India so as to reach the office by January 0, 2016.) Indian Institute of Management Rohtak Doctoral Programme (Fellow Programme in Management) Name of the applicant: (Use upper case) FIRST MIDDLE LAST Area Applied for: 1. I have known the applicant for years and months. 2. He/she has been (please check most appropriate answer): A student in my course(s) A personal friend or acquaintance My advisee Other (please specify). Compared with a typical group of students/persons I have encountered at my institution/in my contact, I would rank him/her as indicated below (please tick as appropriate): CATEGORY Academic Strength Motivation Teaching Potential Research Potential Communication Ability Writing Ability Overall Rating EXCELLENT Top 5% VERY GOOD Next 10% GOOD Next 20% FAIR Next 25% POOR Bottom 40% NO BASIS FOR JUDGEMENT 4. Please write briefly about the strengths of the candidate: 5. Please write briefly about the weaknesses of the candidate: 6. Comments on the suitability of the candidate to a doctoral Programme (please use separate sheet, if desired): Your name: Designation: Address: Signature: Institute affiliation: Pin Phone: 8