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Admission Form

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Form No. I __ __ __ __ __
Downloaded from Website

INDIAN INSTITUTE OF SOCIAL WELFARE AND BUSINESS MANAGEMENT
MANAGEMENT HOUSE, COLLEGE SQUARE WEST, CALCUTTA – 700 073

Application for the admission in: ________________________________________________

(For PSM Programme only please indicate your course priority number (1 or 2 or 3 etc.) in the first blank box in sequence, against the course you would like to be considered for.)

Environment (Day)   Energy (Day)  
Transportation & Logistics (Day)   Health Care & Hospital Management (Day)  
    
1. Name :MR./MISS/MRS. _________________ _________________ _________________
    (IN CAPITAL LETTER) FIRST NAME MIDDLE NAME SURNAME

   
2. Father’s/Husband’s Name : _________________________________________________________

3. Father’s/Husband’s Occupation :_____________________________________________________

4. Date of Birth:
    (ddmmyy)
5. Sex
Male Female

6. Do you belong to Scheduled Caste/Scheduled Tribe/OBC (Tick in the appropriate box)

   SC
 ST
 OBC
 N/A
Affix a recent
Passport size
coloured
Photograph

7. Permanent Address:_______________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

8. Present Address:__________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

9. Telephone: Residence:____________________________Office:____________________________

10. University Registration No.__________________________________

11. Name Code : (First ten Letters of Name)

                   

12.(For MBA(D) /MBA(E) / MHRM / PSM / PGDBM  Courses only as applicable)

a. CAT/MAT Registration No.
   
  b. CAT/MAT Centre Code
   

13. Academic Qualifications (Secondary Onwards)

Exam Board/
University		 Year Main Subjects Specify
Specialisation		 % of
Marks		 Class
Div.		 Max.
Marks		 Total
Marks
                       
                       
                       
                       
                       

14. Any other Qualification/Extra-Curricular Activities: _______________________________________
____________________________________________________________________________________
____________________________________________________________________________________

15. Work Experience : Yes
   
No
   

16. Work Experience Details (if any):

Organisation
Name & Address		 Designation Department Salary per
Month		 Period of
Service		 Short Description
of the Job
                       
                       
                       
                       

17. Person reporting to (in current organisation): __________________________________

18. (For MBA (Even) / PGDBM  / PGDTTIM Programmes)

     Signature of the Sponsor:____________________________________________

  

     Office Seal & Date : ________________________________________________

19. Signature of the Applicant: ___________________________________________

20. Email of the Applicant (mandatory): ____________________________________

21. Date of Application: ________________________________

22. Demand Draft No.___________      Amount___________    Bank___________
     (No form will be entertained if not accompanied with a demand draft)