Pandit Deendayal Petroleum University: School of Petroleum Management

SCHOOL OF PETROLEUM MANAGEMENT
www.spm.pdpu.ac.in
PANDIT DEENDAYAL
PETROLEUM UNIVERSITY
Admissions 2011
APPLICATION FORM
Post Graduate Diploma in
Petroleum Management-Executive
For Working Executives in Oil & Gas/Energy/Allied Sectors
Raisan, Gandhinagar, Gujarat, India, Pin: 382007

Phone: 91-79-23275119 Fax: 91-79-23276364 Email: pgdpmx@pdpu.ac.in
Page 1 of 4
PANDIT DEENDAYAL PETROLEUM UNIVERSITY
www.spm.pdpu.ac.in
APPLICATION FORM: PGDPM-X

TO BE FILLED BY THE APPLICANT
Name: ____________________________________________________________________
Gender: ______________ (Male/Female), Age: ________, Date of Birth: _____________
Designation: _______________________________________________________________
Organization: ______________________________________________________________
Address of Communication: __________________________________________________
___________________________________________________________________________
___________________________________________________________________________
City: ____________________, Country: ____________________, Pin: ________________
Phone: (O) _________________________ (R) ________________________
Fax: _________________________, E-mail: ______________________________________
PRESENT AREA OF RESPONSIBILITY

Production Marketing HRD Personnel & IR F&A
Project management General management R&D MIS
Other (Specify): _______________________________________________________
Description of Present responsibility: ____________________________________________
___________________________________________________________________________
Designation of Executive to whom you report: ____________________________________
__________________________________________________________________________
Page 2 of 4
www.spm.pdpu.ac.in
QUALIFICATIONS
Degree Subject(s) Year College/University
WORK EXPERIENCE
Organization Position Year of Experience Gross Salary
OTHER PROGRAMMES ATTENDED

Organization Position Year of Experience Gross Salary
What are your expectations from this programme? : _____________________________________

___________________________________________________________________________
___________________________________________________________________________
Signature: ______________________ Date: ___________
Page 3 of 4
www.spm.pdpu.ac.in

TO BE FILLED BY THE SPONSOR
(To be filled only in case of candidate being sponsored by organization)
Name of the sponsor: _________________________________________________________
Designation: _______________________________________________________________
Address for communication: __________________________________________________

___________________________________________________________________________
___________________________________________________________________________
City: ____________________, Country: ____________________, Pin: ________________
Phone: (O) _________________________ (R) ________________________

Fax: _________________________, E-mail: ______________________________________
PRESENT AREA OF RESPONSIBILITY
Production Marketing Personnel & IR
F&A Project management General management
R&D MIS HRD
Other (Specify): _____________________________________________________________
Description of Present responsibility: ____________________________________________

___________________________________________________________________________
Designation of Executive to whom you report: _____________________________________
___________________________________________________________________________
Please return the completed form along with DD of Rs.2000/ in favour of “Pandit
Deendayal Petroleum University” payable at Ahmedabad to below address by
registered post or alternatively by DTDC Courier Services.

Pandit Deendayal Petroleum University
Raisan, Gandhinagar, Gujarat, India, Pin: 382007.
Phone: 91-79-23275119 Fax: 91-79-23276364 Email: pgdpmx@pdpu.ac.in
Page 4 of 4

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SCHOOL OF PETROLEUM MANAGEMENT

For Working Executives in Oil & Gas/Energy/Allied Sectors

Raisan, Gandhinagar, Gujarat, India, Pin: 382007

APPLICATION FORM: PGDPM-X

Gender: ______________ (Male/Female), Age: ________, Date of Birth: _____________

Address of Communication: __________________________________________________

City: ____________________, Country: ____________________, Pin: ________________

Phone: (O) _________________________ (R) ________________________

Fax: _________________________, E-mail: ______________________________________

PRESENT AREA OF RESPONSIBILITY

Project management General management R&D MIS

Other (Specify): _______________________________________________________

Description of Present responsibility: ____________________________________________

Designation of Executive to whom you report: ____________________________________

APPLICATION FORM: PGDPM-X

OTHER PROGRAMMES ATTENDED

What are your expectations from this programme? : _____________________________________

Signature: ______________________ Date: ___________

APPLICATION FORM: PGDPM-X

Name of the sponsor: _________________________________________________________

Address for communication: __________________________________________________

City: ____________________, Country: ____________________, Pin: ________________

Phone: (O) _________________________ (R) ________________________

PRESENT AREA OF RESPONSIBILITY

Production Marketing Personnel & IR

F&A Project management General management

R&D MIS HRD

Other (Specify): _____________________________________________________________

Description of Present responsibility: ____________________________________________

SCHOOL OF PETROLEUM MANAGEMENT

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