Academic Programs & Admissions - Kochi ↑
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Participant Data Form

Advanced Certificate in Academic Research & Data Analysis

Faculty Development Programme - Online mode
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#

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
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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