FOR INTERNATIONAL STUDENTS ONLY

LAST DATE FOR RECEIVING COMPLETED FORM: 26 APRIL 2013

Registration No. (to be filled by office)

New Delhi ADMISSIONS 2013/14 Application form for MBA Programmes in Business Sustainability / Infrastructure 1. 2. 3. 4. 5. Except for GMAT score cards (see item 8), do not send any attested copies of certificates with this form. Original and attested copies Paste (do not pin) of degree certificates/marksheets will be needed later. your photograph Incomplete application forms are likely to be rejected. (with white Candidates who are in the final year of their Bachelors programme will background) in this space and attest it be considered for admission only if their provisional degrees are available yourself before 22 July 2013. This form can be mailed as a hard copy, or can be scanned and e-mailed to registrar@teri.res.in Use capital letters wherever possible. TYPE OR WRITE LEGIBLY IN ENGLISH 1. Name in full (as in School leaving certificate):

2. (a) Address of the candidate for communication

(b)

Name and Address of Parent/Present Guardian (i.e. Permanenent Address)

City ___________________________________ State __________Zip/Pin Country ________________________

City ________________________________ State _________Zip/Pin Country ________________________

3. Telephone Number (with International Code): ________________________________ 4. 6. Mobile: 5. E-mail: _____________________________

Date of Birth: (as in School Leaving Certificate) D D M M Y Y Y Y

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7. 9.

Sex (M/F)

8.Blood Group ______________ RH Factor __________________

Indicate only valid GMAT scores below. Test GMAT Year of exam Registration No. Score Percentile

10.

You may apply for more than one MBA programme; if you do not wish to, you may leave the second preference blank. Indicate your order of preference, Fill in B for Business Sustainability, I for Infrastructure First Preference Second Preference

NOTE: PLEASE ATTACH SELF ATTESTED PHOTOCOPIES OF THE RELEVANT SCORE CARDS WITH THIS FORM 11. 12. Status of Bachelors examination result: (write A: Appeared and result awaited, P: Passed) Details of Academic Record of the Bachelors programme: ____________ c) Year of Passing__________ e) City/State ________________

a) Programme done/ongoing (eg. B.S., B.A., B.Tech.) etc. b) College d) University

f) Country ___________________________________________________________________ g) Exam Passed/ Appeared I year II year III year IV year Subjects/courses taken (Please provide details) Month/ Year % Marks/Grade/ Class obtained

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h) Final aggregate marks/Grade point obtained 13. If you hold a higher degree/degrees, please mention the degrees here and give details in the format of item 11 on a separate sheet of paper. Higher Degree 1 Higher Degree 2 14. 15. 16. Are you being sponsored by any agency? (Y/N) If yes, indicate the name and address of the sponsoring agency: Declaration by the Applicant: If selected for admission, I undertake to abide by the rules and regulations of TERI University. I certify that the information given above is correct and I am aware that providing incorrect information in the application form may result in the cancellation of admission secured. I am further aware that, if the admission is secured before the results for the qualifying examination are published and if I fail to satisfy the minimum academic requirement for admission when such results become available, the admission will be cancelled. I also certify that I have not been convicted in any criminal case and that there is NO pending criminal case against me.

Place: _______________

Date: _______________

Signature of Applicant

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