INSTITUTE OF MANAGEMENT TECHNOLOGYRecent

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Dubai International Academic City,
P.O Box 345006, Dubai, UAE

APPLICATION FOR ADMISSION (MBA)

1. PROGRAM INFORMATION:

When do you plan to join the MBA program? (Please check)

Fall 20_____ (September) Spring 20_____ (January) Day

Evening

2. PERSONAL DETAILS:

Family Name First Name

Sex: Male Female Nationality:

Date of Birth: (DD/MM/YYYY) Place/Country of Birth:

/ /

Present Address:
Contact Details:

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Permanent Mailing Address: Passport Details:

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Expiry Date:
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Visa Number: ____________________________
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3. PARENT / GUARDIAN DETAILS:
City: Expiry Date: ______________________________
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Father / Guardian’s Name: _____________________________________________________________________

Profession: _____________________________________________________________________________________

Address:
Contact Details:

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Mother / Guardian’s Name: _______________________________________________________________________

Profession:
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Address:
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4. ACADEMIC QUALIFICATION (Most Recent First):

Please fill in chronological order from the last degree till high school attended starting from date
of graduation:

Name of the Grade/

Subject/ Date
Title/ Qualification University/ Percenta
Discipline (mm/yyyy)
College/School ge

5. ENGLISH LANGUAGE PROFICIENCY (Please Tick):

TOEFL IELTS
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Date of Test Grade / Score
5. EMPLOYMENT HISTORY: (If Applicable)

Name of the Organization Designation Date

6. PROFESSIONAL QUALIFICATION: (If Applicable)

Subject/
Title/ Qualification University/ Institute Date
Discipline

7. REFERENCE: (Mandatory to be filled)

Referees should be strictly University professors/student counselors.

Name: Name:
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Address: Address:
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Phone: Phone:
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In what capacity do you know the referee? In what capacity do you know the referee?

8. DECLARATION: (Mandatory to be filled)

To be signed by the applicant

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I certify that the information that I have provided in this application is true and complete to the
best of my knowledge. I fully realize that omissions or falsifications of information will be sufficient
reason for rejection or dismissal.

Print name : _____________________________________________________

Signature : _____________________________________________________

Date : _____________________________________________________

9. INTERNAL VERIFICATION (Office use Only)

CGPA / TOEFL / ADMISSION STATUS

Eligibility Compliance
PERCENTAGE IELTS
Office of Admissions
YES / NO Full /
Conditional /
Office of Registrar Probation
YES / NO

10. FOLLOWING DOCUMENTS MUST BE SUBMITTED ALONG WITH THE

APPLICATION

• Original or certified copy of the under-graduate final/provisional degree.

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 • Certified copy of official academic transcript showing all courses studied and grades
awarded.
• Original or copy of TOEFL or IELTS score card.
• 2 passport-sized photographs.
• Copy of the passport (and Residence Visa, if resident in the UAE).

Please return the application form to,

DUBAI OFFICE

Office of Admissions
Institute of Management Technology
Dubai International Academic City
P. O Box 345006, Dubai
United Arab Emirates

Phone : 00971-4-3604844 /4227244

Fax : 00971-4-3604838
Email : [email protected]
Website: www.imtdubai.ac.ae

INDIA – GHAZIABAD OFFICE INDIA – DELHI OFFICE

Chairman (Joint Admission Committee) Office of Admissions

Institute of Management Technology Institute of Management Technology
IMT - A-16, Site 3, UPSIDC, Industrial Area, A-193, 2nd Floor, Okhla Industrial Area,
Meerut Road, Ghaziabad - 201003 - India Phase-I, New Delhi – 110020 - India

Phone : +91-120-2705628 Phone : +91-11-40547046-47 / 26811578-

Mobile : 09818116551, 09810214551 79
Fax : +91-120-2705625 Mobile : +91-9911856609 / 9999657973
E-mail : [email protected] Fax : +91-11-40527052
Website: www.imt.edu E-mail : [email protected]
Website: www.imtdubai.ac.ae

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