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FPM Applform 2015

The document is an application form for a fellowship program requiring personal details, education history, work experience, and a statement of purpose. It provides instructions for applicants and outlines eligibility requirements including exam scores and degree information. The deadline to submit the completed application is January 21, 2015.

Uploaded by

KaranGarg
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165 views3 pages

FPM Applform 2015

The document is an application form for a fellowship program requiring personal details, education history, work experience, and a statement of purpose. It provides instructions for applicants and outlines eligibility requirements including exam scores and degree information. The deadline to submit the completed application is January 21, 2015.

Uploaded by

KaranGarg
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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The completed application form must reach the Administrative Officer, FPM Indian Institute of Management, Prabandh

Nagar, IIM Road, Lucknow 226 013, India, latest by January 21, 2015. Page 1



Indian Institute of Management, Lucknow
Application for Fellow Programme in Management (2015-2016)

IMPORTANT INSTRUCTIONS
Before filling this application form read the instructions and programme
details provided online at http://www.iiml.ac.in
Fill in the Application Form in CAPITAL letters only
An applicant is eligible to submit applications to a maximum of two areas.
In such cases, candidates who choose to apply to two areas are required
to submit separate application forms with all supporting documents, to be
sent together
Please enclose copies of 10
th
, 12
th
and graduation, post-graduation mark
sheets along with each set of form. Also enclose a copy of scorecard of
CAT / GATE / GMAT / GRE and JRF. If short listed, all certificates
(originals) should be produced at the time of interview
The form should be complete in all respects. Incomplete forms will
not be considered. Strike out whichever portion is not applicable
Please enclose a Demand Draft of Rs.1000/-(Rs.500/- for SC/ST
Candidates) with the Application Form drawn in favor of INDIAN
INSTITUTE OF MANAGEMENT LUCKNOW payable at Lucknow. This
covers the application fee for applying to two areas





IMPORTANT ELIGIBILITY CATEGORY DETAILS
CAT GATE GMAT
Reg. No: Reg. No: Reg. No
Percentile Percentile Percentile
Score Score Score
Date (dd/mm/yyyy) Date (dd/mm/yyyy) Date (dd/mm/yyyy)
UGC JRF GRE
One/Two/Three Year Full-Time Classroom Based
PGDM From Any IIM/WMP Of IIM Lucknow
Reg. No Reg. No: CGPA
Date (dd/mm/yyyy) Percentile Date (dd/mm/yyyy)
XXXXXXXXXXXXXXXXXXXXX Score
XXXXXXXXXXXXXXXXXXXXX Date (dd/mm/yyyy) XXXXX XXXXXXXXXXXXXX
AREA OF SPECIALISATION (Tick the relevant Box)
Decision
Sciences
Information Technology &
Systems
Business Environment
(Economics)
Strategic Management
Marketing
Human Resources
Management
Finance & Accounting Operations Management


AFFIX PHOTO
5cm*4cm WITH
WHITE
BACKGROUND

The completed application form must reach the Administrative Officer, FPM Indian Institute of Management, Prabandh
Nagar, IIM Road, Lucknow 226 013, India, latest by January 21, 2015. Page 2



Please account for break in your academic career, if any

______________________________________________________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________
PERSONAL DATA
Name (in capital)
Date of Birth
(dd/mm/yyyy)
Sex Male Female
Nationality Marital Status Married Unmarried
Category SC ST GENERAL Blood Group
Academic Performance
Education
Stage

Name of the Board /
University/Institute
Month & Year of
Examination Subjects/
Specializati
on
Max.
Marks /
CGPA
% of
Marks/
CGPA
Obtained
Class/
Division
Obtained
(if any)
Month Year
Secondary
School
Examination(10
th
)

Higher Secondary
School
Examination
(10+2)



Bachelors
Degree



Masters
Degree



Professional
Degree
(CA/ICWA) etc.



Any Other



CORESSPONDECE INFORMATION
Address
Address
City PIN
Phone/Mobile Email
The completed application form must reach the Administrative Officer, FPM Indian Institute of Management, Prabandh
Nagar, IIM Road, Lucknow 226 013, India, latest by January 21, 2015. Page 3
Awards/Medals/Prizes/Scholarships/Certificates/Honors, etc. (Mention only those related to
Academic/Professional Activities)

No. Name of the Award Awarding Institution Year
1.



2.

Work Experience (Please mention full-time jobs only)
No.

Name of
Organization
Designation
Reporting to
(Designation)
Nature of
Duties
Period
Total
Experience
in months
Monthly
Salary
From To

1.



2.



3






I certify that the particulars given by me in this form are true to the best of my knowledge and
belief. I know that at any time if the information furnished by me is found incorrect, my
candidature will be cancelled immediately.

Place


Major Extra-Curricular Activities/Hobbies
No. Activity Your Role
Year Awards/Prizes
/ Honors
if any
Remarks
From To Total
1.
2.
Annexure
Write a 100 word Annexure for each of the following and attach as separate sheets with this application

1.

Statement of Purpose
Describe your career goals and the reasons for your interest in the Fellowship
Programme in about 100 words.

2.


Previous Research Experience

Have you done any research project/experiment/field work as a part of your Masters
degree? Please write a brief summary of one such work in 100 words.
3. Proposed Research Activity
This is not your research proposal. This is just your initial idea about the research
process.
Declaration
Date Signature of the Applicant

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