Form No. www.iilmgsm.ac.

in

Institute for Integrated Learning in Management

IILM Graduate School of Management

Application Form for Admission

XIXth Batch (2011-13)

Name of the Student

2 year full time programmes

Approved by All India Council for Technical Education(AICTE).

Applying for:
(Please indicate your choice of Programmes in order of preference)

Post Graduate Diploma in Management: PGDM (Only through CAT)

Post Graduate Diploma in Management (Financial Services): PGDM(FS)
Post Graduate Diploma in Management (Retail Management): PGDM(RM)
Post Graduate Diploma in Management (International Business): PGDM(IB)

Admissions to PGDM (RM), PGDM (FS) and PGDM (IB) is through CAT, MAT, XAT, GMAT and subsequent GDPI.

FOR OFFICE USE ONLY (Not to be filled by Applicant)

Date Venue Test Taken GD Score PI Score Faculty Signature
Faculty 1 Faculty 2
Instructions
1. Read the application form carefully before filling in.
2. Enclose only Demand Draft/Banker's Cheque/Pay Order of 1200 in favour of “IGSM Fee
Collection Account”, payable at New Delhi, no cash/cheque will be accepted.
3. Do not attach any copies/photocopies of the certificates.
4. Application from should be filled in by the student in their own handwriting.
Photo
5. Incomplete forms will be rejected. (Stamp Size)
6. In case of paucity of space, you can attach additional sheet of paper mentioning the item
number responded.

Part A Personal Information (To be filled in block letters)

1. Full Name (Ms./Mrs./Mr.)

2. Date of Birth DD MM YYYY

3. Correspondence Address

City Pin State

Tel Mob

Email

4. Permanent Address

City

City State Pin

5. Nationality

6. Father's Name

Father's Profession Business Pvt. Service, Govt. Employee Others

Organization's Name

7. Mother's Name

Mother's Profession Business Pvt. Service Govt. Employee Housewife Others

8. Annual Family Income Gross

Part B : Academic Qualification

9. Marks stated here must tally with those in the original mark sheets. Percentages should be computed by including
all subjects/papers that you took in your exams.

Particulars Name of School/ Board/University Stream Year of %

Institution Passing

Std. X NA

Std XII Arts/Commerce/Sci

Graduation NA

Post Graduation NA

Professional Course NA

Others NA

Note: If you are awarded grade points please convert them into percentage of marks.

Part C: Professional Information

10. Work Experience:

Organization Designation No. of Months

Part D : Others

11. Awards/Scholarships/Achievements

S No. Achievement (Academics & Extra Curricular) Event/Activity/Area

12. List two of your strengths & weakness:

Strength :

Weakness:
13. List and explain your hobbies and interest.

14. Statement of Purpose:

Please write why do you desire to pursue the chosen programme and what are your career goals.

Part D

15. How did you get the information about IILM? (Please specify names)

ii. Newspaper: iii. Websites:

TOI pagalguy.com

Dainik Jagran facebook.com

Economic Times totalgadha.com

Others institute's own

others

ii. Magazines: NAVVIN HARJWANI (pune)

iv. Counselor : ............................................

Business Magazine (Specify Name) Centre Name

IMS/CL/TIME/PT City

Others

16. Do you require hostel accomodation?

Yes No

Acknowldgement Form No.

PGDM/ PGDM(International Business)/ PGDM(Retail Management)/ PGDM(Financial Services)

Form Received from Date

Address:

Mobile/ Phone No with STD Code: E-Mail

17. Entrance Test Information (Please mention details for all Entrance Exams Taken):

S No Admission Test Taken CAT MAT XAT GMAT

1 Registration No
2 Month & Year of Test
3 Composite Score
4 Percentile

18. Choice of Centers for Group Discussion & Interview

Assam A.P. Bihar Chattisgarh

Guwahati Hyderabad Patna Raipur

Chandigarh Delhi Gujrat Haryana

Ahmedabad Hisar

Jharkhand M.P. Maharashtra Orissa

Jamshedpur Bhopal Pune Bhubaneswar
Ranchi Gwalior

Indore

Punjab Rajasthan Uttar Pradesh West Bengal

Amritsar Jaipur Agra Durgapur

Kota Allahabad Kolkata
Gorakhpur
Kanpur
Lucknow
Meerut
Varanasi

(IILM Graduate School of Management reserves the right to add or cancel any center without specifying any reason)

Declaration by the Applicant

I declare that the particulars given above are correct to the best of my knowledge and belief. If at any stage it is
found that any of the information provided is incorrect, I will withdraw from the programme. I will adhere to the
rules and discipline of IILM Graduate School of Management. I hold myself responsible for my dues and payment
of fees.

Name & Signature Date

 Personal Interview Evaluation Sheet
S.No. Criteria Parameter Marks Break-up Marks Obtained

Faculty I Faculty II

1 English Language and

Communication Skills LF 3  
VTP 3  
CAL 3
  C 3  
OI 3    
15  

2 Subject Knowledge RK 2  
DK 2  
AK 2  
CT 2  
OI 2      
10  
3 General Awareness RA 3  
OI 2      
5  
4 Personality Disposition PD 2  
SM 1  
OI 2      
5  
5 Employability/
Placement Potential SM 3  
IE 3
CI 3  
EL 3  
WE 3      
15  
Total Marks Total =50 /50 /50
Grand Total (Faculty I + Faculty I) /100
Average (Grand Total/2)  

Filled forms should be sent to

Institute for Integrated Learning in Management

IILM Graduate School of Management
16, Knowledge Park-II, Gautam Budh Nagar
Greater Noida – 201 306, Uttar Pradesh

Tel: 0120 - 3374 456/ 318, 93129 40388

Email: admissions@iilmgsm.ac.in Website: www.iilmgsm.ac.in