ASSAM UNIVERSITY

ASSAM UNIVERSITYSILCHAR – 788011 (Assam)Affix latest passport sizephotograph dulyattested by the principal/ HOD of the School /College / University /Department lastAttended or by aGazetted officerAPPLICATION FORM FOR ADMISSION TO MBA PROGRAMME: 2011-2012(Please read the instructions given at the end of the form carefully before filling in the details.)A] QUALIFYING DEGREE: B.A/B.COM/B.Sc./B.E B] MAT DETAILS:Any other ( Specify in the box)`Total MarksMarksObtainedPercentage1 Roll No./ Bar Code2 Test Score3 Form No.4 Date of examinationC] PERSONAL DATA1. Name (in block letters as recorded in Matriculation or equivalent certificate)2.Father’s Name (in Block letters)3. Mother’s Name (in Block letters)4. Guardian’s Name (if Father / Mother is not alive)5. Name of the Spouse (if candidate is Married)6. Date of Birth: Date Month: Year:7. Sex (tick appropriate box) Male: Female: 8. Nationality:9. Category (tick appropriate box) SC ST PH OBC General

10. Permanent Address:11. Mailing Address (Local Address)STD Code & Telephone NumberMobile Number (If Any)e-mail address:D] ACADEMIC AND OTHER PARTICULARS1. Educational Qualification.ExaminationBoard/UniversityYear ofPassingSubject (s)MarksObtained Total Marks %10 th Standard12 th StandardGraduationP.G.Any other Exam2. Employment Status (If Employed, furnish details with No Objection certificate)Position Held Name and Address of Employer Working since Monthly Salary3. Other Particulars:i] Institution Last attended :ii] Is the Institution / College affiliated to Assam University? Yes:iii] If yes, state you A. U. registration Number:No:of Year:iv] If the result of the Qualifying Examination has not been announced, please State:Name of the ExaminationExamination Roll No.of University:v] Have you applied for admission in more than one Department? If so give details :…………………………………………………………………………………………………………………………………………………………………..

E. EXTRA CURRICULAR ACTIVITIESi] Proficiency in extracurricular activities, if any ………………………………………………………………………………………………………………………………………………………………………………………………………….. (furnish documentary evidence)ii] Scholarship/Prize/Medals or any other distinction won, if any ……………………………………………………………………………………………………………………………………………………………………………….. (furnish documentary evidence)………………………………………………………………………………………………………….. (furnish documentary evidence)F. ADDITIONAL INFORMATION:i] Were you ever disqualified in your educational career? If so, give details …………………………………………………….………………………………………………………………………………………………………………………………………………………………………ii] Was any criminal proceedings instituted against you, or were you ever subjected to any disciplinary action?If yes give details. …………………………………………………………………………………………………………………………………………….iii] if there is any gap discontinuity in studies, state the reason(s) …………………………………………………………………..…………………………………………………………………………………………………………………….. (furnish documentary evidence)G. Application Fees: Rs…………………………………………………..DD. No. …………………………..dt. ………………………………………Application Downloaded from website should be submitted with application fee of Rs. 500/- (Rs. 400/- for SC/ST)by demand draft drawn on any Nationalized Bank payable at Silchar in favour of Finance Officer, AssamUniversity, Silchar.DECLARATION BY THE CANDIDATEI, …………………………………………………………………………………………………………………. son/daughter/spouse/wardof Shri/Smti …………………………………………………………………………………….., hereby solemnly affirm that I shallstrictly abide by the rules and regulations of the University as mentioned and enforced from time totime. I also declare that I have carefully read the prospectus for Admission to MBA Programme and Iagree to follow the admission procedure in the Department of Business Administration, A. U. and abideby the instructions issued in this regard by the University, or the concerned Department from time totime. All the statements made in this application are true and if at any stage subsequent to myadmission it is found that I have made an incorrect statement or concealed any fact or used anyfraudulent means for securing admission, I shall be liable to such disciplinary action as the Universitywould deem fit.Place:Date:Signature of the Candidate

DECLARANT BY THE PARENT/GURDIANI, …………………………………………………………………………………………… Father / Mother / Guardian of Sri / Smti.…………………………………………………………………………………………….., state that the above declaration has been made bymy son / daughter / ward in presence of me. I declare that I agree to meet the course fee and all other expensesof my son / daughter / ward in course of hi / her pursuing the MBA Programme and also to pay his her Hostel duesfor the period of his / her stay in the hostel. I shall compensate the University for any damage caused by him / herin the University or the Hostel.Place:Date:Full Signature of the Parent / GuardianFOR OFFICE USE ONLYCertified that the application of the candidate is in order / not in order.The candidate is recommended / not recommended for admissionDate:(Signature)ADMITTED / REGRETTEDChairman, Departmental Admission Committee(Signature with date)DeanSchool of Management Studies(Signature with date)HeadDepartment of Business AdministrationINSTRUCTIONS TO THE CANDIDATES1. All entries must be in candidate’s own handwriting and complete in all respects2. Put the appropriate tick (̌) mark wherever applicable.3. The form should be accompanied by attested copies of the following documents:a. Photocopy of MAT score card/certificateb. Mark sheets of all examination passed.c. Leaving certificate from the School/College/Institute last attended.d. Conduct certificate issued by the Principal of the college/ institution last attended.e. OBC/ST/SC/PH certificate if applicable.f. Certificate of good health registered medical practitionerg. No objection certificate from the present employer, If employed.h. Migration certificate in case of applicants who have passed their last examinationfrom other Universities / colleges / Institutions.i. Copy of Assam University Registration Certificate (if already registered)j. Certificate from Principal / gazette officer regarding intervening period of gap, ifany, as mentioned in point no. F (iii) in the application form.k. One self addressed envelope4. All the enclosed documents must be attested by any gazette officer / Principal of the collegelast attended

General Information• A graduate in any discipline from a recognized university with minimum 50% marks inaggregate in either honours or pass course or a graduate in Engineering, TechnologyPharmacy or Agriculture with at least 60% marks in aggregate is eligible for the Master ofBusiness Administration Programme. A relaxation of upto 5% marks in the qualifyingexamination is permissible in case of the candidates coming from SC/ST reserved categories.• Admission to the Programme is through MAT conducted by All India ManagementAssociation (AIMA)• The selection Procedure besides taking into account the academic record of the applicant,also aims at assessing his / her potential for a Management Career. Consequently, a multicriteria selection model is used.• The final selection is made on the basis of MAT score, Past Academic Records, GroupDiscussion and Personal Interview• Candidates appearing for degree (Final Year) examination are also eligible to apply foradmission. Such students, if selected, will be required to submit to the department the marksheet of their final examination positively before the last date notified by the department foradmission.• The intake capacity at First year level in the MBA (Full Time) Programme is 92.• Reservation of seats will be made as per the central government rule.• No admit card will be issued separately. Only eligible candidates can attend GD and PI.Fee structure• First Year (1 st & 2 nd Semester): ` 40,350/- (students having A.U. Registration No.)` 40,550/- (including ` 200/- for A. U. Registration)• Second Year (3 rd & 4 th Semester): ` 37,100/-Important Dates• Last date of submission of application: 20 th June, 2011• Group Discussion and Personal Interview: 5 th to 6 th July, 2011• Display of list of selected candidates: 7 th July, 2011• Classes to start: 15 th July 2011

PARTICULARS FOR STUDENTS’ IDENTITY CARDSTwo stampsize coloredphotographs1. Name (In Block Letters):2. Department:3. Course:4. Session:5. Father’s Name(in Block Letters) :6. Mother’s Name (in Block Letters):7. Permanent Address and Phone Number (In Block Letters):8. Identification Mark:9. Blood Group:FULL SIGNATURE OF THE STUDENT

ASSAM UNIVERSITY: SILCHAR(A Central University)PROVISIONAL IDENTITY CARDName:Department:Course: Session: 2011-13Date of Birth:Blood GroupAffixstamp sizephotoStudent’s SignatureSignature of HODThis card is to be filled in by the student at the time of submission ofapplication form. If the candidate is selected for admission this card willbe issued by concerned HOD.