Affix a Photograph of Size 35mm X 35mm Founded in 1962 (An Autonomous Institution affiliated to Madurai Kamaraj University) Pamban Swamy Nagar, Thirupparankundram, Madurai, Tamil Nadu- 625 005. Tel: 0452-2484099, 2485014/ Mobile: 9655500925,9585957366, 9585957388 E-mail: admission@tsm.ac.in URL: www.tsm.ac.in Post Graduate Diploma in Management (PGDM) / Master of Business Administration (MBA) 2016-2018 Batch (TSM PGDM is a 2-year programme approved by AICTE, accredited by NBA & recognized by AIU. TSM MBA is approved by AICTE & accredited by NBA) APPLICATION FORM Application Number (To be filled by TSM Admissions Office) Instructions: Please read the admission brochure and application form and follow the instructions therein. Candidates may apply for either PGDM or MBA or for both by indicating their preference in the space provided in the application form. It is clarified that there is no additional processing fee required even if candidates apply for both PGDM and MBA programmes. Fill the application in block capital letters except item 17, using black ballpoint pen. Tick appropriate boxes and write not applicable (NA) wherever necessary. Do not attach originals; attach only copies of all mark statements and certificates. Attach copy of the marks obtained in admission test. Applicants may submit the application form without waiting for the admission test score. On publication of admission test results, a copy of admission test score sheet with TSM application number will have to be forwarded to TSM. 1A. Programme Incomplete applied applications for: are liable to be rejected. PGDM MBA Both PGDM & MBA 1B. Please indicate your preferred choice of venue for the Group Discussion & Personal Interview. Venues : Chennai, Bangalore, Kolkata, Delhi, Mumbai, Kochi, Guwahati, Vizag & Madurai. First Preference: Second Preference: Third Preference: 2. Name of the Candidate (as in the Mark Sheet of Class X) 3. Date of Birth (dd/mm/yyyy): 4. Gender Male Female 5. a. Name of Parent or Guardian: b. If Guardian, relationship with Guardian: c. Occupation of Parent/ Guardian: d. Annual Income of Parent/ Guardian: 6. Contact Details a. Address: b. City: c. Pincode: d. Telephone Number with STD Code: e. Mobile Number: f. Email id: g. Contact Number of Parent/Guardian: Page 1 of 5
X Standard XII Standard Bachelor s Degree Master s Degree PG Diploma Other Academic Qualifications Name of Degree or Board/ University, Major and Ancillary Subjects * Name of Institution (School or College) Month and Year of Passing Medium of Instruction Overall percentage of Marks Did you Pass all subjects in the first attempt? If no, specify subjects and number of attempts. Academic awards, if any 7. Academic Record * If B.tech/B.E, please mention the Branch such as mechanical, ECE etc. Page 2 of 5
7 A. Total number of history of arrears (cumulative) in your under graduation: 7 B. Number of standing arrears in your under graduation at the time of applying: 8. Scholarships/ grants received (if any): 9. Extracurricular Activities & Hobbies: 10. Extracurricular Achievements & Awards: 11. Have you held any position of responsibility in school or college? If yes, please specify: 12. Work Experience (starting with most recent assignment): # Period From To 1. Name of the organisation Designation & Nature of Responsibility Place of Posting Salary Last Drawn (Rs. / month) 2. 3. Page 3 of 5
13. Please identify the source(s) that helped you to apply to TSM (Tick the source(s) applicable to you) A. Newspaper advertisement (Name and date) B. Internet (Mention the name of the website) C. Present Student of TSM D. Alumni of TSM E. Friends F. Relatives G. TSM Website H. Coaching centre (please specify) I. Any other source (please specify) 14. Admission Test Results Candidates who have taken more than one test are requested to furnish ALL their test scores. The best test score after moderation will be considered for evaluation. Registration Name of Test Date of Test Overall Score Overall Percentile Number CAT 2015 MAT May 2015 MAT September 2015 MAT December 2015 MAT February 2016 CMAT September 2015 CMAT February 2016 XAT 2015 15. Community Details (Tick appropriate column) Open Category / General (OC) Backward Class (BC) Most Backward Class (MBC) Scheduled Caste (SC) Scheduled Tribes (ST) Page 4 of 5
16. Please write in not less than 100 words why you wish to pursue your management studies in TSM: 17. Application Fee Details: Application fee of Rs. 500/ - to be paid in the form of demand draft drawn in favour of Thiagarajar School of Management payable at Madurai. Attach DD to the filled -in-application form. Demand draft Name of the Bank Branch DD date Amount number Rs. 500/- I hereby declare that all the information given above are correct to the best of my knowledge. I have not misrepresented any facts or particulars furnished in this application form. I am aware that such a misrepresentation may result in rejection of my candidature and if admitted, may also result in cancellation of my enrolment. I further undertake that I will abide by the rules and code of conduct of Thiagarajar School of Management, as amended from time to time. I am also aware that any contravention could result in disciplinary action including discharge from the programme. Date: Signature of the applicant The downloaded application form duly filled-in along with the demand draft is to be sent by courier/registered post to the following address: The Admissions Office, Thiagarajar School of Management, Pamban Swamy Nagar, Thirupparankundram, MADURAI, TAMIL NADU -625005. The last date for receipt of MBA / PGDM form, duly filled is 9 March 2016. Page 5 of 5