Tata-Dhan Academy

Application for Programme in Development Management (PDM X): 2009-2011

Instructions

All fields are compulsory.
Don't leave any box/column blank unless specified as optional.
On receipt of the DD for Rs 100/- drawn in favour of Tata-Dhan Academy, payable at Madurai alongwith two self attested photographs, we will issue admit card after scruitinising your application.
Please mention your name and online application number given to you (on submission of this form) clearly on the reverse side of the DD and photographs.
Last date for the receipt of filled in application is January 25, 2009.

Name:

Mailing Address

Pincode:

Telephone No. with STD code:

Email:

Name of the nearest Courier Service:

Nearest Telegraph Office:

Permanent Address ( Same as mailing address)

Pincode:

Telephone No. with STD code:

Email:

Name of the nearest Courier Service:

Nearest Telegraph Office:

1. Date of Birth

- -

Age: (As on 1st June, 2009)

Marital Status:

Are you a first graduate from your family?

2. Registration Fee

Send a demand draft of Rs.100/- in favour of "Tata-Dhan Academy", payable at Madurai.

3. Education
Qualification	Name of the Institution and Location	Month & Year		Marks/OGPA Obtained	Percentage of Marks
Qualification	Name of the Institution and Location	From	To	Marks/OGPA Obtained	Percentage of Marks
Secondary School (10th)		(mm-yyyy)	(mm-yyyy)		%
Higher Secondary School (10-12)		(mm-yyyy)	(mm-yyyy)		%
Bachelor's Degree in		(mm-yyyy)	(mm-yyyy)		%
Master's Degree in (if applicable)		(mm-yyyy)	(mm-yyyy)		%

4. Work Experience (if applicable - fill in only as many rows as required)
Date		Employer's Name & Location	Job Title	Nature of Job
From	To	Employer's Name & Location	Job Title	Nature of Job
(mm-yyyy)	(mm-yyyy)
(mm-yyyy)	(mm-yyyy)
(mm-yyyy)	(mm-yyyy)
(mm-yyyy)	(mm-yyyy)
(mm-yyyy)	(mm-yyyy)

5. Extra Curricular Activities (optional)

6. Languages Known

7. Advertisment: How did you come to know about this programme?
(Check at least one box)

The Hindu

Times of India

The Indian Express

Down to Earth

Economic and Political Weekly

New Indian Express

College/Faculty

Website

Others

8. Why are you interested to undergo this course? (Write in this box not exceeding 200 words.)

9. Choice of test centre:
1. Ahmedabad 2. Allahabad 3. Bangalore 4. Bhopal 5. Bhubaneswar	6. Chennai 7. Cochin 8. Coimbatore 9. Dharwad 10. Guwahati	11. Hyderabad 12. Jaipur 13. Kolkatta 14. Lucknow 15. Madurai	16. Mumbai 17. New Delhi 18. Patna 19. Pune 20. Ranchi
Choose two centres indicating your order of preference*
Choice 1:		Choice 2:
* Examination centre is subject to change, if enough candidates do not prefer a centre.

10. Declaration

I hereby confirm to the best of my knowledge, the information I have provided in this application is complete and true.