SCHOOL OF MANAGEMENT
Form No. ..............................
401, Delta, Technology Avenue, Hiranandani Business Park, Powai, Mumbai - 400076
APPLICATION FOR ADMISSION
Two Year Full Time PGPM Course
Applicant’s Name
Date of Birth
Male/Female
Married/Unmarried
(dd/mm/yyyy)
Nationality
Blood Group
Passport (Y/N)
Passport No. (If yes)
Email ID
Tele No.
Mobile No.
Correspondence Address
Permanent Address
Father’s/Guardian’s Name
Father’s/Guardian’s Occupation
Company
Designation
Mother’s Name
Company
Designation
Mother’s Occupation
Are You Specially Abled
Do you have any Ailments / Special Needs
Educational Qualification (write “Appeared” if the result is not yet declared)
Academic Qualifications :
Examination/ Board / University
Institute / School / College
Year
Subject / Specialisation
Results
ATHENA
Paste photo
of the
applicant
(size 3.5 cm X
4.5 cm)
SCHOOL OF MANAGEMENT
Form No. ..............................
401, Delta, Technology Avenue, Hiranandani Business Park, Powai, Mumbai - 400076
ATHENA
Two Year Full Time PGPM Course
Paste photo
of the
applicant
(size 3.5 cm X
4.5 cm)
Applicant’s Name
Date of Birth
Male/Female
(dd/mm/yyyy)
Email ID
Correspondence Address
Tele No.
Mobile No.
(Signature)
ADMIT CARD
Mobile No.
Mobile No.
Work Experience :
Name of Company
Designation
From
To
Months
Salary Drawn
I want to apply for an additional :
(A) MBA Degree
From UGC Recognised Indian University
YES
NO
UNDERTAKING:
I hereby declare that :-
I have received the prospectus and seen the website, and have read and understood all the terms & conditions of
admissions, fees, refunds, examinations and discipline.
I will abide by the rules and regulations to pay fees within stipulated time.
If I do not maintain the mandatory 80% attendance in each subject at the end of each semester as per Institute /
University regulations, and / or if I do not abide by any rules and regulations of the Institute, the Director / Dean
reserves the right to detain me from proceeding to the end-semester examination conducted by the Institute /
University including termination of my studentship.
I am aware of the consequences of ragging activities. I will immediately report any attempts to subject me to
ragging to the concerned authorities.
I will submit original mark sheets and other documents at the time of admission and registration.
FOR OFFICE USE ONLY
Signature of the Applicant
B C D
Written Test
GD PI
Total
Participation No.
Date :
Time :
TO BE HANDED OVER TO COUNSELLOR ON COMPLETION OF WRITTEN TEST, GD AND PI
Attended
Attended
Attended
.......................
.......................
.......................
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Signature of Admissions In-Charge
Signature of Admissions In-Charge
Signature of Admissions In-Charge
Signature of Assistant Dean - Admissions
...........................................
A
Written
GD
PI
..............................................
All the information stated above are true to my knowledge. Suppression and / or omission of any information
may result in the rejection of the application or termination of studentship at any stage of the course.
and understand it is not refundable.
