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How did you get to know about IILM Institute? Personal Interview Evaluation Form Form No.
Newspaper : (Name) Internet :Website (For official use only)
Interviewee Name: Date:
Magazine: (Name) Friends/Relatives

Alumni Any other , please specify. Please circle the appropriate score
Coaching Institute : Name Counselor Code Characteristics Poor Fair Average Good Superior Affix Latest Passport
Size Photograph
Have any of your relatives or friends taken any of our Programmes?
Poise and maturity -1 1 2 3 4 5
Name
Articulate-ability to express ideas X 2 1 2 3 4 5

Programme Year
General Awareness - 1 1 2 3 4 5

Have you applied elsewhere? If yes, please give details: Communication in English-1 1 2 3 4 5

Energy & enthusiasm-1 1 2 3 4 5

Application Form
Personal Statement
Placement Potential X 2 1 2 3 4 5
Post Graduate Programme (2010-12)
This personal statement helps us become acquainted with you in ways different from courses, grades, test
scores and other objective data. It will demonstrate your ability to organize thoughts and express yourself.
Weightage as above 1:2:1:1:1:2 Total out of 40: (Pass mark: 20 )
We are looking for responses that will help us know you better as a person and as a student. Please describe
yourself to your classmates.
This candidate has expressed interest in Summer Internship in - Home town Metro

This candidate needs the English Foundation Course: Yes/No

Overall: This comment can be about overall employability if necessary, or a strong endorsement to
enrol.

Remark:
Declaration by Applicant:

I declare that all information in my application is complete , factually correct, and honestly presented. I have
read the rules and regulations mentioned in the prospectus and will adhere to the same. I also understand
that fees once paid will not be refunded under any circumstances.

Interviewer 1 Signature
Signature Date

Interviewer 2 Signature
This information contained in this form will be used for the purpose of processing your application and, if it is Student Name
successful, it will form the basis of your Institute record.
Please return the completed application will all required documents (please send copies of academic
Requirement qualification, not original documents) along with non -refundable Rs.1200 application fee (by Demand
Draft / no cash will be accepted) to : Father’s Name
1. Class X mark-sheet and date of birth certificate
2. Class XII mark-sheet and certificate
Lodhi Road Campus Gurgaon Campus
3. College/University degree or mark sheet for two years for provisional candidates 3,Lodhi Institutional Area, New Delhi-110 003. DLF Golf Course Road, Gurgaon-122 003
Test appeared for CAT MAT ATMA XAT JMET GMAT
4. CAT/MAT/ATMA/XAT/JMET/GMAT test results (if applicable) Tel : 011-30934456 Tel : 0124-3354456
Fax : +91-11-30934339 Fax :0124-3354390
5. One passport size photograph
Email : pgp@iilm.edu Website : www.iilm.edu Toll Free No: 1800-1804-456 Score
 2 3 4

Instructions Graduation Please give names and age of your brothers or sisters. If they have attended college, give the names of the
1. Read the application form carefully before you fill it. institutions attended, degrees and approximate date
2. We recommend you fill the form by hand. Name of the College
3. Please use tick marks (3) in a appropriate boxes wherever required, except for question on academic concentration / major where you need to list in numbers.
4. The application form will be attended to only if all the required information is included. Please re-check the form to ensure you have not left any data un-filled.
5. If there is not enough space for your answers, you can use additional paper. Ensure you have attached all the paper securely.
Name of the University
6. All information you provide will only be used by our Admission Department and will remain strictly confidential.
7. IILM Institute for Higher Education, Gurgaon is recognized by the joint committee of UGC- AICTE & DEC. IILM Institute for Higher Education is a partner institute Name of Degree awarded Specialization (if applicable)
under the IGNOU Convergence Scheme. On successful completion of the programme requirement students are eligible for the IGNOU-MBA award. Academic Honours
Total Marks / Aggregate %age till date Briefly describe any scholastic awards or scholarships you have won

Preferred Location Gurgaon Lodhi Road, New Delhi

Work Experience

Personal Data Organization

Surname
Designation Duration

First name
Job Profile

Gender Male Female Blood Group Date of birth (DD/MM/YY) Extracurricular Activities
Test Information
Briefly describe any extracurricular, personal and volunteer activities you have pursued
Correspondence Address If you have taken any of the following tests, please complete this section and submit official results. CAT, MAT,
ATMA, XAT, JMET, GMAT.

Test Date Taken / To be Taken Language Score Math Score Total Percentile / Score
City or town State

Country Pincode

Permanent home phone, STD code first

Family
E-mail address Mobile Preferences
Mother's full name Father's name
Would you be requiring any housing facilities? Yes No
Academic Qualification Home address if different from yours Home address if different from yours
Which of the following Activities would you like to be a part of (choose any two):
Class X details Class XII details
Subject Marks Subject Marks Event Committee Editorial committee Sports Seminar Committee
Occupation Occupation (Theater, Performing Arts,
Debating, Dance, Music,
Quiz)
Name of business or organization Name of business or organization
Why do you wish to join IILM Institute?

College attended (if any) College attended (if any)

Aggregate of all subjects (Marks / %age) Aggregate of 5 best subjects (Marks / %age)
Degree Year Degree Year

Year of passing Year of Passing Professional or graduate school (if any) Professional or graduate school (if any)

Name of School (Class XII) Degree Year Degree Year

Address of School Email / Phone Email / Phone