MINGLEBOX MBA COUNSELING

1. PERSONAL INFORMATION

First Name . …... . . . . . . . . . . . . . . Middle Name . . . . . . . . . . . Last Name . . …….. . . . . . . . . . . . .

Birth date (mm/ dd / yyyy) . . ………... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. INTENDED COURSE OF STUDY

Degree you want to pursue : MBA

Area of Interest/ Desired Concentration: Finance/HR/Marketing/Operations

Entry Month (Please check one or more) : Jan – March 2011 April to June 2011
July to October 2011

City Preference 1 –
City Preference 2 –
City Preference 3 -

3. Please mention any particular Institute that you are interested in along with their city

1
2
3
4
5

4. Have you already applied to any B School? We will no be including these in the final suggested list
of college(s)

If yes, list name(s)

1.
2.
3.

5. Please provide any other information that should be taken into consideration while preparing
your university list.

Budget –
Accommodation –
Any other
 6. CONTACT INFORMATION

Email ID : XXXXXXXXXXXX@gmail.com

Street:

City: State/Province

Postal Code Country INDIA

Tel. No.(Residence/Business) . . . 91-XXXX-XXXXXXX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(Country Code/ City Code/Number)
Mobile No. 91-XXXXXXXXX

7. EDUCATIONAL BACKGROUND

School (Class IX, X, XI and XII) Information

Class School Board Year Percentage Stream

IX 0 0 0 0 NA
X 0 0 0 0 NA
XI 0 0 0 0 XX
XII 0 0 0 0 XX

Achievements/Extra Curricular Activities at School

Sl No Activity Year Achievement
1 0 0 0

Undergraduate College or University

Name of College :
Name of University :
Location (City, State/Province, Country) :
Degree/Diploma (eg., BE, BTech, BA, etc.) : B.E.
Major (Eg., Computer Science, History, etc.): Electronics & Communication
Dates Attended [From / To (mm/dd/yyyy)] : 09/21/2002 – 06/15/2006
Aggregate Grades/Percentage : 73.69%

Postgraduate College or University (If applicable)

Name of College :
Name of University :
Location (City, State/Province, Country) :
Degree/Diploma (eg., MTech, MA, etc.) :
Major (Eg., Computer Science, History, etc.):
Dates Attended [From / To (mm/dd/yyyy)] :
Aggregate Grades/Percentage :

Other Educational Qualification (Certifications/Vocational Courses)

Name of College/Institute
Name of University (If applicable)
 Location (City, State/Province, Country)
Degree/Diploma (CA foundation, CCNA , etc.)
Dates Attended [From / To (mm/dd/yyyy)]:
Aggregate Grades/Percentage (If applicable)

8. TEST INFORMATION

Test Section Section Section

Date A B C Total Percentile
CAT
MAT
XAT
Any
other

If you have taken the test more than once then please write the test scores (along with sectional
scores) for each of your previous attempts.

Test Section Section Section

Date A B C Total Percentile
CAT
MAT
XAT
Any
other

9. CURRENT EMPLOYMENT (If Working)

Total number of months of work experience . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current Employer . ……….

Job Title . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Job Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Please list all part-time, summer training and internship experiences.

Sl No Project Year Title

0 0 0 0 0

11. Please provide the following details of your family

Salaried/Business Monthly Income/Annual income
Father 0 0
Mother 0 0

No of siblings