Application Form (PDF) - Indian Institute of Public Administration

INDIAN INSTITUTE OF PUBLIC ADMINISTRATION
IP ESTATE, NEW DELHI-110002, INDIA
International Center for
Promotion of Enterprises
Ljubljana, Slovenia
Combined Application for Admission and Enrollment
In
Professional Programme in Public Management and Enterprise Development, IIPA
And
Masters Programme in Economics and Business Sciences, FEB
(Executive MBA Programme, 2012-2013)
Please send the completed application form to:
Programme Coordinator
PPPMED, (Executive MBA)
Indian Institute of Public Administration
Indraprastha Estate, Ring Road
New Delhi-110002
Phone: 011-23731791 and 23468352
Email: pppmed.iipa@gmail.com

Indian Institute of Public Administration
Page 2 of 7
Application Checklist
Application form duly completed (incomplete applications will not be considered).
Photocopies of all degree certificates (certified translations if degree is not in English)
Corporate Sponsorship Letter or Letter of Support. (the format is provided in the Programme Brochure).
Refundable Ernest Money Deposit of Rs 30,000/- * (Thirty Thousand only) by
demand draft favouring ‘DIRECTOR, I.I.P.A., New Delhi, India’.
THREE recent passport size color photographs (excluding One affixed on this form).
Clear attested photocopy of first and last two inner pages of applicant’s valid passport.
Please Affix Recent
passport size color
photograph here
Important Instructions to Applicants
1. Duly Completed Applications are to be accompanied by all documents and EMD.
2. Applications must be sent by Registered Post/ Speed Post/ Courier.
3. Last date for receiving applications is 6 th August 2011.
1. Personal Information
Mr. Ms. Last Name ______________________ First Name ______________________ Maiden Name _______________ (if applicable)
Sex Male Female Date of birth _________________ Place of birth _____________ Country __________________ Nationality ________________
Valid Passport No . in full .____________________ Issued on ________________________ Expires on _________________
2. Permanent Address
Street ____________________________ P.O. Box ______________ Town/City ____________________________ Post code ______________ Country______________
Home phone __________________ Mobile phone __________________ Fax ______________ E-mail (must be valid until program start) _____________________________
3. Business Address
Street ____________________________ P.O. Box ______________ Town/City ____________________________ Post code ______________ Country ______________
Home phone __________________ Mobile phone __________________ Fax ______________ E-mail (must be valid until program start) _____________________________
N.B. Please keep us informed, should your contact information change during the application process.
* Ernest Money Deposit will be refunded in full if candidate is not selected. It will be adjusted against programme fee if Candidate is selected. In the event of selected Candidate not confirming his candidature the
EMD will be forfeited.
PPPMED (EMBA) Application Form

Indian Institute of Public Administration
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How would you prefer us to communicate with you
By post By e-mail By telephone By fax
4. Academic Background
Please indicate below the three most important and recent degrees you have completed in reverse chronological order.
Level of highest degree obtained:
PhD/ Doctorate Master’s Undergraduate
Duration From To Name of University or College Field Degree received Full/Part time
5. Please indicate the area in which you obtained your bachelor's degree (Please mark one box only)
Science (e.g., Biology, Chemistry, Informatics, Computer)
Health & Medicine (e.g., Medicine, Pharmaceuticals, Dentistry, Veterinary)
Engineering (e.g., Electrical, Industrial, Architectural, Building, Mechanical)
Social Science (e.g., Economics, Law, Social Science, Political Science)
Business & Management (e.g., Management, Management Information Systems, Business Administration)
Arts & Humanities (e.g., History, Languages, Arts)
Others (e.g., Agriculture, Education, Media, etc) Please specify _______________________
In which language(s) was your university degree taught ___________________
PPPMED (EMBA) Application Form

Indian Institute of Public Administration
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6. Professional Background
Please list each full-salaried position after your first degree obtained in reverse chronological order, starting with your most recent position and accounting for any gaps.
a) Current Position
Duration From To Company City, country of Work Position
Briefly summarize your current job responsibilities
Number of employees in subsidiary ________________________________
Name and number of employees worldwide of parent company __________________________________
Number of direct and total subordinates ________________________________
Responsible for budget of GHC or US$ ___________________________________________________
Company Sector ______________________________________
Job Function ___________________________________
Do you belong to a project team Yes No
If yes, please describe briefly your team’s duties, sizes etc. (max. 50 words).
_______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________
PPPMED (EMBA) Application Form

Indian Institute of Public Administration
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Please draw a simplified organizational chart of your company. Mark your position in the chart with an “X.
Please indicate the name of the Human Resources Manager in your company.
Mr. Ms. Last Name ______________________ First Name ______________________
Business phone __________________ Mobile phone __________________ Fax __________________ E-mail __________________
Please indicate the name of the person in charge of Management Development/Training in your company.
Mr. Ms. Last Name ______________________ First Name ______________________
Business phone __________________ Mobile phone __________________ Fax __________________ E-mail __________________
b) Previous work experience
Duration From To Company City, country of Work Position
PPPMED (EMBA) Application Form

Indian Institute of Public Administration
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Total duration in years of full-time positions held (by the beginning of the EMBA program) ______________________
Of which years ________________ in a leadership position and ________________in international assignment
7. International Experience
Please list your most significant international experiences growing up, studying or working outside your own country.
Duration From To City, Country Activity
8. English Language Proficiency
To be admitted to the PPPMED EMBA program, you must be fluent in English.
Please indicate in the table below the level at which you situate your proficiency in English. Use the following for self-assessment.
Level 1 The ability to participate in a conversation about daily life
Level 2 The ability to understand, speak and write with structural accuracy, communicate and read newspapers, as well as to give adequate information about future career goals
Level 3
The ability to conduct business in English
Level 4 The ability to interact in any circumstances with the near-ease of a native speaker
Level 5
Native language
9. Awards, Honors, etc.
Please list any honors, distinctions, awards you have received in your academic, professional or extracurricular activities.
From To Awards, Honors, etc. Institution Explanation
PPPMED (EMBA) Application Form

Indian Institute of Public Administration
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10. Why did you choose PPPMED Executive MBA
Please indicate the reasons for applying for this program. In your opinion, what differentiates us from other programs
_______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________
11. Inscription Data
Inscription Data
Higher-education institute
Study programme
Programme-direction
Year of study
Study course 5
Study type 6
Details
University of Maribor, Faculty of Economics and Business
Economic and Business Sciences
Management, Organisation and Human Resources
1 st year
Master’s Programme
Part-time
Before submitting your application, please use the checklist on the first page of the application form to ensure that your application is complete and on time. We
encourage you to talk to your employer before applying for the program.
Statement of Accuracy:
I hereby certify that the information contained in this application is complete and correct to the best of my knowledge.
Date__________________ Applicant’s full signature_______________________________________ Place ____________________________
PPPMED (EMBA) Application Form