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GLOBAL INSTITUTE OF CONSTRUCTION MANAGEMENT & RESEARCH

(A Unit of Shanti Educational Trust re.gd.(1998)) An International Secular,Non Government,Non-Political, Non Sectarian Organization Registered Registered under SocietiesRegistration Act XXI of I860 with Government of IMCT, Delhi

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APPLICATION FORM

Registration No. 2008 - 2009 - 2010 /.January/July /GICMAR / (to be given by the Office)

COURSE/ PROGRAM APPLIED FOR (Please tick mark)( )


(a) Graduate Certificate in Construction & Infrastructure Project Management ( (b) Post Graduate Diploma in construction and infrastructure Management (c) Post Graduate Diploma in Project Management (d) Professional Certificate in Construction Management & Infrastructure Project Management (e) Certificate course in Form work , Safety & Health ,Quality Control, Infrastructure Project, Real Estate Management etc.(3 Units Each) (f) Special Capsule Course for Construction Workers . ( ( ) ) ( ) ( ( ) ) )

1. Name: Mr. / Miss ...................................................................... ..


{In block letters- The name should be as in certificate of matriculation / last examination passed }

2. Date of Birth (in form of DD / MM/ YY) : ________/________/________ 3. Father's Name: Mother's Name : ......................... . Sponsor Company Name : . 4. Full Address for Communication :.. .. Pin code : ........................... Tel No

5. College / Institute, Last Attended:.. Year of Leaving: .................... 6. Nationality:.

7. Educational Qualifications: Exam Passed High School Intermediate B.E/MBA/PGDBA/Diploma Any Other Qualification 8. Extra Curricular Achievements: ................................................................ .................. 9. Source of Introduction to this Institute :- (Please Tick mark) (Newspaper/ Magazine/ Industry/Old Students/Internet) 10. Letter of Recommendation (L.O.R) a) Name: .................................. Designation .................... Tel No:.. b) Name: .................................. Designation .................... Tel No:.. 11. List of Documents Attached ....................................................................... Board Year of passing Subjects Appeared Aggregate s Mark %Age Achieved

12. Statement of Purpose (S.O.P) State briefly in not more than 200 words, your objective in pursuing this course. What are your looking for in your career & what is your vision 2020?

1. I declare that the above information in the application form is correct to the best of my knowledge. 2. I declare that the payment terms and conditions have been read & abide to follow the same:A) No amount will be refundable against fee deposited even if a candidate discontinues the course in mid way after joining the same, nor the money is adjustable in the name of others. Security is refundable on completion of the entire course only & getting Library & Accounts clearance. No security refund will be given in case student leave the course in between. B) 1st installment shall be payable within 7 days of Registration with the Institute and balance installment shall be payable within six months. C) All payments for Industry Visits /Tours/ Projects work/university Exams fees will be payable separately as per actuals.

(Signature of the Parents/Sponsors) Date: .....................

(Signature of Applicant)