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Global Programme (PGPEx) PG Programme in Management Fellow Programme in Management Management Development Programme Centre for Development of North Eastern Region

Rajiv Gandhi Indian Institute of Management Shillong Online Admission Form A.  PERSONAL DATA * Fields are mandatory       Name * : Date of Birth * :   (dd/mm/yyyy) Gender * : select Male Female Marital status * : select Single Married Nationality * : Upload Recent Color Photograph * : Category * ** : select SC ST OBC General (Photo size should be less than or equal to 1MB and dimension be around 150px x 150px) and don't use '&','.','/ ' in photo name (**If you belong to SC, ST or OBC categories, please bring the original/certified copy of your Caste, Tribe or OBC certificate from a competent authority such as Deputy Commissioner/ District or Sub-Divisional Magistrate/ Tehsildar, who is authorised to issue such certificates. Please note that only the Schedules specified by the Government of India for each state and union territory will be recognized.) Select the relevant option if you suffer from any physical disability to the extent of not less than 40%. (as per the Persons with Disabilities Act, 1995) : select Blindness/ Low Vision Hearing Impairment Locomotor disability/ cerebral palsy Ensure that you bring with you during the interview a document by a competent medical board certifying the same Postal mailing Address * (500 characters allowed) : Telephone(at least one) * :  (Land line) (With city code)  (Mobile) Email * : Foreign Language Known : Mode of funding the study * : -Select- Self Finance Sponsor B.  ACADEMIC QUALIFICATIONS Name of University/ Institute from which graduated / graduating * : Title of Degree * : Discipline * : Duration of your Bachelor's Degree course * : select 3 Years 4 Years 5 Years Mode of Study * : select Regular(full time) Part-time External (distance education) Bachelor's Degree Completed * : select Yes No B.1 Bachelor's Degree Marks (fill this item only if you have completed the bachelor's degree) Month & Year of Final Year/semester Exam* Maximum Marks / GPA* Marks/ GPA Obtained* Marks/GPA Obtained (%)* Class/ Division (if mentioned)* B.1 Bachelor's Degree Marks (fill this item only if you have not completed the bachelor's degree) Semester Month & Year of Semester Exam* Maximum Marks / GPA* Marks/ CGPA Obtained* Marks/CGPA Obtained (%)* Class/ Division (if mentioned)* I II III IV V VI VII C.  MASTER DEGREE Completed at least the part 1/ first year * YesNo Name of University/ Institute * : Title of Degree* : Discipline* : Year Dates(dd/mm/yyyy) From* To* Mention subjects taken in each year * Maximum Marks/ GPA* Marks/ GPA Obtained* Marks Obtained (%)* Part I/ 1st Year Part 2/ 2nd Year D. POST GRADUATE PROFESSIONAL EXAMINATION Completed at least the inter/first part * YesNo D.1 Give details of the last professional examinations you have taken (e.g. CA, ICWA, CS etc.) (if any) University/ Institute registered with * : Name of the course of study * :   Dates(dd/mm/yyyy) From* To* Mention subjects taken in each level * Maximum Marks/ GPA* Marks/ GPA Obtained* Marks Obtained (%)* Inter/ 1st part Final/ 2nd part E.  CAT/GMAT/GRE SCORE(Please fill atleast one of CAT/GMAT/GRE) Examination   Score Year of Appearing CAT :   GMAT :   GRE :   F.  WORKING EXPERIENCE   Whether employed/ had been employed in paid full time job after graduation/master degree * YesNo Achievement* (500 characters allowed) Weakness* (500 characters allowed) Strength* (500 characters allowed) Organisation Name* Dates(dd/mm/yyyy) From* To Monthly emoluments * Designation * Reason for leaving Foreign assignments     Your present /last job briefly describe your job responsibilities, achievements and failures * (500 characters allowed)     G. INTERVIEW LOCATION  Interview Location * : -Select- Kolkata Delhi Mumbai Bangalore Overseas

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