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  1. 1. SPECIAL FORM FOR PGP-ABM (2012-14) Indian Institute of Management Post-Graduate Programme in Lucknow Agri-Business Management Instructions 1. This form is to be filled in by CAT applicants with academic background in non- agricultural disciplines falling under eligibility criteria of PGP-ABM. 2. Please fill this form and bring at the time of GD/PI. 3. This form should be filled carefully by the candidate based on his/her own knowledge and experience. 1. NAME ______________________________________________________________ 2. Father’s Name ________________________________________________________ D D M M Y Y Y Y 3. Date of birth 4. CAT Registration Number1 5. Educational Background (Graduation onwords)Degree/ Specialization Institute / University Year of Major SunjectsQualification PassingGraduationPostGraduationAny otherAny other 6. Exposure to rural areas: Years Months1 See CAT Registration form for this.
  2. 2. Nature of exposure to rural areas2:7. Work experience in agriculture and allied sector, If any Years MonthsIn case of work experience in agriculture and allied sector, please fill up the following table:SNo. Name of Organization Type 3 Designation Nature of Job4 Experience in months123458. Is/Are your parents’ occupation(s) anyway related to agriculture and allied sector? Yes NoIf yes, how _______________________________________________________________________________________________________________________________________________________9. Please provide reasons (in descending order of importance) for your motivation and interestsfor applying to this specialized programme (PGP-ABM). i.ii.iii.iv.v.2 Specify whether it was your normal place of stay or you were there in connection with some duties /responsibilities.3 Organization: 01-Research; 02–Manufacturing; 03-Education; 04-Rural Development; 05-Agricultural Services;06-Others (specify)4 Nature of Job: 01-Marketing; 02-Finance;p 03-Production & Operation; 04-Human Resource; 05-RuralDevelopment; 06-Information Technology; 07-Academics; 08-Others (specify)
  3. 3. 10. What are your short term and long term career plans?11. Name three companies/organizations where you would like to work after successful completion of the PGP-ABM programme:i.ii.iii.12. How will you, as a PGP-ABM graduate, cater to the needs of the agri-sector and contribute to its growth and development ? (enclose separate sheet, if needed)13. Your publications related to agriculture and allied sector or rural development, if any (enclose separate sheet, if needed) : Title of Article Published in YearPlace:________________________ Signature:_____________________Date: ________________________ Name:________________________ The Admission Office Indian Institute of Management, Prabandh Nagar, Off Sitapur Road, Lucknow- 226 013 Phone : 0522 – 2736681/ 2736682 / 2734028 * Fax : 0522 – 2734025 * Email: