SUMMER SCHOOL PROGRAM 2016

APPLICATION FORM

Course Period / July 04th – 24th, 2016
Last date to receive nominations / 31st January 2016

1. HOME INSTITUTION

Name of the Institution: ……………………………………………………………………………..

Address: ……………………………………………………………………………………….

……………………………………………………………………………………….

Name, Phone, Fax, E-mail of Exchange

Program Coordinator and/or Contact Person: …………………………………………………

……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..

I confirm that this proposed program study for ……………………………………………….

is approved.(full name of the student]

Exchange Coordinator’s SignatureDate:

Checklist:

Before sending your application form, please check that you have included the following:

  • Application form with all sections completed
  • CV/Resume in English
  • MBA First Year/Graduate Transcripts (i.e. you must have a completed Bachelor’s Degree or 15 years of education, {starting from Grade I} to enter the program]. These documents should be sent compulsorily.
  • Permission letter from parent University
  • Copy of latest valid passport
  • 4 Nos. of your recent passport size front faced photograph with your name written on the backside
  • Specimen signature on a separate sheet (for preparation of ID Card)

2. STUDENT PERSONAL DATA

Last Name (Family Name) / First Name
Date of Birth / Place of Birth
Sex / Marital Status / Nationality
Passport Number / Expiry Date
Father’s Name (Last name) / First Name
Current Address
Zip Code / City / Country
Current address is valid until:
Permanent Address (if different)
Zip Code / City / Country
Phone / Email

3. PAST AND PRESENT ACADEMIC RECORD:

Title of the Diploma or Degree that
you are Current pursuing
Year(s) of higher education study completed prior to departure abroad
to attend IIMA
Are you a Graduate / Yes [ ] / Title of Graduation
Period of Study: / From / To / No.of Months

4. ACCOMMODATION:

(Please note that the accommodation in IIMA campus will be made available to the student only 2 days prior to the registration day of the study period, and not earlier than that, and the accommodation will be available to the student only till the term end date)

YES [ ] / From / To

5. LANGUAGE COMPETENCE

Level of Competence

English / Language-1: / Language-2:
Basic [ ]
Intermediate [ ]
Very Good [ ] / Basic [ ]
Intermediate [ ]
Very Good [ ] / Basic [ ]
Intermediate [ ]
Very Good [ ]

Date: …………………….signature______available to the student only till the term end date.ent only 2 days prior to the registration d

Candidate’s signature

Please mail this duly filled in form with all needed attachments to the following address only:

To
Mr. Jatin Nagori
Manager (PGP)
Student Exchange Programme Office
Indian Institute of Management
Vastrapur, Ahmedabad – 380 015
INDIA
Phone: 91-79-6632 4656/4654
Fax: 91-79-6632 6896
Email: / Please enclose:
  • 4 nos. of your recent passport size front-faced photograph with your name written on the backside of the photo and also a specimen signature of the student concerned on a separate sheet (for preparation of ID card)
  • Your CV/Resume written in English
  • MBA First Year/Graduate Transcripts should be sent compulsorily
  • A copy of your latest passport page
  • Permission letter from parent University