Executive MBA Program

INSTITUTE OF BUSINESS ADMINISTRATION

UNIVERSITY OF DHAKA

Photo

Application for Admission

(Semester Spring 2015)
Instructions
1.

This application form comprises 3 (three) separate pages.

2.

After filling in the form, put your signature on the 4 (four) designated places.

3.

Attach 2 (two) recent colored Passport Size photos with the application.

4.

Do not write anything in the shaded areas designated For Office Use Only.

5.

Make a Pay Order / Bank Draft for Tk.1500, payable to Executive MBA, IBA.

6.

Submit the filled-in form & the Pay Order /Bank Draft to the EMBA Program Office by Sunday, February 15, 2015.

7.

After submitting this form, collect your Admit Card from EMBA Program Office on the assigned delivery date.

Personal Data
Fill applicants name in BLOCK letters. If currently unemployed, provide only one contact address.
Name:

Last/Family

First

Middle

Mothers Name:
Father's Name:
Date of Birth:

/ /
dd

Nationality:

mm

yyyy

National ID No / Passport No:

Gender:

Male

Female

Currently Employed?

Yes

No

Address 1:
(Home)

Address 2:
(Work)

Telephone #

Work

Email:

Home

Cell phone

Initials

Signature of Applicant

Receipt No.

Admit No.
Page 1 of 4

Work Experiences
Give details of all full-time employment, starting from the most recent.
Position

Organization

Duration

Major Responsibilities

(From - To)

Years

Total duration of full-time employment:

Months

Academic Qualifications
Please list all degrees earned, starting from the most recent.
Degree

Institution

Year Awarded

Area / Major

Class/CGPA

GMAT Information (if applicable)

Last Test
Scores:

Verbal
Raw Score:
Percentile:

Signature of Applicant

Signature of Applicant

Quantitative

Total

Test Date:
/ /
dd

mm

yy

Page 2 of 4

Achievements, Memberships & Activities

Please list all noteworthy achievements / distinctions / awards, professional / association memberships & voluntary
/ community activities (in order of perceived importance).
Achievement/Membership/Activity

Organization/Field

Year

Declaration
The information provided in this application form is true and correct. I accept that IBA reserves the right
to restrict my admission or cancel my registration at any time if any item of information given by me on
this form is found to be false or incorrect.

Date:
dd

Signature of Applicant

/
mm

yy

Application Fees Payment Information

Pay Order/Bank Draft #

Payable to Executive MBA, IBA

Bank:

Dated: / /
dd

Name of Applicant (in BLOCK letters)

mm

yy

Signature of Applicant

Executive MBA Program

Institute of Business Administration
University of Dhaka
(Semester Spring 2015)
Admit #

Photo

Page 3 of 4

Receipt No.

Signature of IBA Official

Page 4 of 4