Jagan Institute of Management Studies, Rohini Delhi

3, Institutional Area, Sector-5, Rohini Delhi- 110085

E-mail: [email protected], [email protected], Website: www.jimsrohini.org Helpline: +91-9871097501

Online Application Form for Fellow Program In Management (FPM)

(Fields with * are compulsary and have to be filled completely.)

NOTE :

Please read the form carefully before filling it. Incomplete forms will be rejected without any intimation.

* Please check your eligibility before choosing the course.

Course Applied For *	Select the Priority
Fellow Program In Management (FPM)
PGDM[IB]
PGDM[Retail]
Fellow Program In Management (FPM)

MAT		Number or Decimal Number Only	Number Only.
CAT	Should be in DD/MM/YYYY	Number or Decimal Number Only	Number Only.
CMAT XAT ATMA	Should be in DD/MM/YYYY	Number or Decimal Number Only	Number Only.
Appearing

Personal Details:

First Name *

Character Only

Last Name *

Character Only

Date of Birth : *

Nationality

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Marital Status

Married

Unmarried

Other

Gender

Male

Female

Any Other Category

Contact Details:

Correspondence Address : *

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(10 digit Mobile Number only)

Permanent Address : * Same as above:

Family Details:

Educational Qualifications:

Examination Passed	Stream	Board/University	Year of Passing	Marks Obtained	% of Marks
10^th*
12^th*
Graduation*
Post Graduation*
Others

Details of Research Paper Published:

Any Paper Published:

Yes No (If, Yes ) Number of Paper Published :

Employment History:

Work Experience:

Yes No (If, Yes ) Total Experience : Years

Payment Mode: *

DD Online

DD No.	DD Date	Amount	Name & Address of Bank

Declaration:

I hereby certify that the information given in the Application is complete and accurate to the best of my knowledge. I understand and agree that misrepresentation or omission of facts will justify the denial of admission, cancellation of admission or expulsion.

Date (dd/mm/yyyy)