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DISHA EDUCATION SOCIETY

SCHOOL OF MANAGEMENT REGISTRATION FORM FOR PGDM/MBA/DRM/DSLM/DPM/DHM CANDIDATES PERSONAL PROFILE ENROLLMENT FOR NAME OF CANDIDATE FATHERS NAME MOTHERS NAME AGE AS ON 1ST JULY 2010 GENDER MARITAL STATUS PRESENT ADDRESS FOR COMMUNICATION PERMANENT ADDRESS DOB : CATEGORY-GEN/SC/ST/OBC: PHOTO PGDM/MBA/DRM/DSLM/DPM/DHM

PHONE NO. /MOBILE NO. E-MAIL ID 10th MARKS & PERCENTAGE 12th MARKS & PERCENTAGE UG MARKS & PERCENTAGE GRADUATION IN PG MARKS & PERCENTAGE POST GRADUATE IN OTHER QUALIFICATIONS WORK EXPERIENCE, IF ANY, WITH DETAILS NAME OF QUALIFYING EXAM/ SCORE/PERCENTILE MAT/CAT/OTHER PERIOD DRAFT NO. DRAFT AMOUNT Domicile

Phone:

Mobile:

Marks:

Percentage:

B.Com/B.Sc./BBA/BA/BE/B.Tech./Other.. Marks: Percentage:

M.Com/M.Sc./MA/ME/M.Tech/Other.

Name:

Score:

Percentile:

Name of state:

Place:

I certify that the above information provided by me is true, correct & complete. I agree that in case the Institute finds at any time that the information in this form is not true, correct or complete, the Institute can take appropriate action against me.

DATE : PLACE :

SIGNATURE OF CANDIDATE

Enclosures: 1. 4.
Photo copy of 10th mark sheet Photo copy of MAT Score card 2. Photo copy of 12th mark sheet 5. Photo copy of PG mark sheet 3. Photo copy of UG mark sheet 6. Photo copy of Domicile

Important Note: - 1.Aggregate 50% is must in Graduation/PG and for SC/ST/OBC 45% minimum in Graduation/PG 2. For MBA Males as on 01.07.2010 should not to be more than 27 yrs and females not more than 30 yrs.

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