Academic Programs & Admissions - IIMK ↑

Participant Data Form

Faculty Development Programme

Please read the programme brochure/website carefully to understand about the programme, expected participants and fee payments before filling up the application form.

SECTION 1(a): PERSONAL DATA
Name*
Gender*
DOB*
Age*
Address*


Communication Address* (Same as above)	(Same as above)



City*
State*
Pin Code*
Mobile Number#
E-mail#

SECTION 1(b): CURRENT EMPLOYMENT DETAILS
Name of Institution presently employed*
Current Designation*

SETION 2: ACADEMIC DATA
Exam / Degree	Year	Institution	Name of Board/University	% of Marks/ CGPA / Class	Program Name / Specialization
SSC / SSLC
HSC / Plus Two
Graduation
Post Graduation (1)
Post Graduation (2)
Other Qualification (1)
Other Qualification (2)

SECTION 3: TEACHING/WORK EXPERIENCE DETAILS
Name of Employer	Position/Designation	Years worked		Area/ Domain of work
		From (dd/mm/yyyy)	To (dd/mm/yyyy)

SECTION 4: UPLOADS
Self-Attested identification document* [Photo identity proof such as Passport or Driving License or PAN Card or AADHAR]
GST Registration Certificate* [If you want to avail GST input credit for yourself / Employer.]

Contact Details

Indian Institute of Management Kozhikode
IIMK Campus P. O., Kozhikode, Kerala,
India,
PIN - 673 570

Enquiries/Reception
Phone: +91-495-2809100
Fax: +91-495-2803010-11

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