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XIMJ, PGDM Application Form

1. The document appears to be an application form for Avinash Ekka to enroll in the PGDM program at Xavier Institute of Management, Jabalpur specializing in HR, Marketing, Finance, or Rural Management. 2. Avinash is a Christian male from Jharkhand who obtained 59% in his B.Com graduation from Gossner College, Ranchi University in 2010. 3. He has good computer and English skills and appeared for the MAT entrance exam in February 2011 where he scored 566 with 59% percentile.

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Shubhashish Kerketta
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72 views2 pages

XIMJ, PGDM Application Form

1. The document appears to be an application form for Avinash Ekka to enroll in the PGDM program at Xavier Institute of Management, Jabalpur specializing in HR, Marketing, Finance, or Rural Management. 2. Avinash is a Christian male from Jharkhand who obtained 59% in his B.Com graduation from Gossner College, Ranchi University in 2010. 3. He has good computer and English skills and appeared for the MAT entrance exam in February 2011 where he scored 566 with 59% percentile.

Uploaded by

Shubhashish Kerketta
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Xavier Institute of Management, Jabalpur (XIMJ)

(Xavier Institute of Development Action and Studies –


XIDAS)
4th Mile, Mandla Road, Tilhari, Jabalpur-482021 (MP)
Tel. +761-260-2483; Fax: +761-260-6341
xidaspgdm@gmail.com; www.xidas.in

PGDM Application Form – 2011-13


(Specializations: HR, Marketing, Finance, Rural Management)
N.B.: Use CAPITAL Letters only

01. Full Name: AVINASH EKKA


02. Sex: Male: [ √ ]; Female: [ ]; 03. Date of Birth: Day [ ]; Month [ ]; Year [ ]
04. Nationality: Indian [ √ ]; Other (Specify)
05. Information about Family members:
a) Father: Name, Qualification, Occupation/Profession:
i) Name: REV. MANMASIH EKKA
ii) Qualifications: B.D., M.TH. iii) Occupation/Profession: PASTOR, LECTURER IN
THEOLOGY
b) Mother: Name, Qualification, Occupation/Profession
i) Name: ASHAMANI EKKA
ii) Qualifications: MATRICULATE iii) Occupation/Profession: HOUSE WIFE
c) Number of Brothers [ 3 ]; d) Number of Sisters [ 1 ]
e) Full Postal Address: GOSSNER THEOLOGICAL COLLEGE, MAIN ROAD RANCHI
JHARKHAND, PIN-834001

06. Your Contacts: a) Your Email ID: avinashmailu@gmail.com


b) Landline: 06512332510 c) Mobile: 08797676309
07. Your Religion: Hindu [ ]; Muslim [ ]; Christian (Catholic) [ ]; Christian (Other) [ √ ]; Sikh [ ]; Other [ ]
08. Your Social Group: SC [ ]; ST [√ ]; OBC [ ]; General Category [ ]; NRI [ ]; Foreigner [ ]
09. The State to which you belong (MP, Orissa, etc.): JHARKHAND
10. Academic Qualifications:
a) Schooling :
i) Name of the School: OXFORD PUBLIC SCHOOL(10), MARWARI COLLEGE(10+2)
ii) Year of Passing: 2004(10), 2006(10+2)

b) Qualifying Degree:
i) Degree (Graduation or PG): GRADUATION (B.COM)
ii) Name of the College: GOSSNER COLLEGE, RANCHI
iii) Name of the University: RANCHI UNIVERSITY
iv) Year of Passing: 2010 v) Aggregate Percentage: 59%

11. Computer Knowledge: Very Good [ ]; Good [ √ ]; Poor [ ]; Nil [ ]


12. Home Language (Language spoken at home): English [ ]; Hindi [√ ]; Other [ ]
13. Medium of Instruction in School: English [√ ]; Other Language [ ]
14. Medium of Instruction in College: English [√ ]; Other Language [ ]
15. Proficiency in Spoken English: Very Good [ ]; Good [ √ ]; Poor [ ]; Very Poor [ ]
16. Proficiency in Written English: Very Good [ ]; Good [ √ ]; Poor [ ]; Very Poor [ ]
17. Other Academic Qualifications, if any:

18. Aptitude Test:


a) MAT [ √ ]; XAT [ ]; ATMA [ ]; CAT [ ]; MET [ ]; b) Date of Aptitude Test: Month [Feb ]; Year [2011]
]c) Scores Obtained, if it is available: i) Composite [ 566 ]; ii) Percentile [ 59 ]
19. Work Experience, if any
a) Number of Years: Less than six months [ ]; one year [ ]; two years [ ]; more than 2 years [ ]
b) Field of Experience: NGO [ ]; Corporate Sector [ ]; Government [ ]; Semi-Government [ ]; Other (Specify)

20. Hostel Room Choice: (Make two choices – first choice = 1 and second choice = 2)

For Women only Two-Bed Room with Attached Toilet


Three-Bed Room with Attached Toilet
Four-Bed Room with Attached Toilet

For Men only Single Bed Room with Attached toilet


Single Bed Room with common toilet 1
Two-Bed Room with common toilet 2

21 Name and Address of Guardian: (Father/Mother or other Person responsible for you and your studies):
a) Full Name: REV. MANMASIH EKKA
b) Your Relationship with your Guardian: (son/daughter/ nephew/niece/etc. -- specify) : SON-FATHER
c) Full Postal Address: GOSSNER THEOLOGICAL COLLEGE, MAIN ROAD RANCHI
JHARKHAND, PIN-834001

d) Phone: Landline/ Mobile: 09431326659 e) E-mail, if any: manmasihekka279@gmail.com


f) Profession:

Declaration by the Candidate:


AVINASH EKKA
I, (Candidate’s Name) ……………………………………………………………………………………………………….
hereby declare that the details given above are true and accurate. I am aware that in case I give any false
information, my application is liable to be dismissed summarily.

Sd/- Avinash Ekka Sd/- Manmasih Ekka

Signature of the Candidate: Signature of the Guardian

Date: 04/03/2011 Date: 04/03/2011

Enclosures:
01. One recent passport size colour photo of: a) the Candidate; b) the Guardian
02. Attested copy of Birth Certificate (School Certificate or any other legally valid document)
03. Attested Copies of: a) School Leaving Certificate and Marks Sheet; b) Qualifying Degree Certificate; c) Marks
Sheet of Qualifying Degree; d) Category Certificate, if belonging to SC, ST or OBC; e) Entrance Test Score,
as soon as it is available
04. Attested copy of work experience certificate, if any
05. Demand Draft for Rs. 800/-, in favour “XIDAS”, payable at Jabalpur

N.B.: If you are a Christian Candidate, attach a letter from the appropriate Church Authority as a proof

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