Application Form

The DHAN Academy T. Malaipatti, Thenkarai B.O., Mullipallam S.O., Vadipatti (TK), Madurai District 625 207, Tamil Nadu Cell: 96775 83405; email: [email protected], [email protected] Registration No : Application for 21th Post Graduate Diploma in Development Management (PGDDM) : 2020-2022 3rd Post Graduate Diploma in Community Health Management (PGDCHM) : 2020-2022 Instructions uPlease read carefully before completing. uFill in the application in your own handwriting with a ball-point pen uDon’t leave any box or column blank. Write NA if ‘Not Applicable’. uIncomplete application will not be considered. uLast date for the receipt of filled-in application is April 20, 2020. Name Mr. / Mrs. / Ms. (BLOCK LETTERS) Mailing Address (in Block Letters) Permanent Address / Home Address Name: Name: Father’s name: Course(s) being applied (Please Tick ( ü ) PGDDM PGDCHM 2. Personal Details 3. Details of application for one course registration fee payment ` 500 / Both Courses ` 1,000 Date Month Year Cash Paid on : ..................................................... Demand Draft DD No. : ..................................................... th Age : (as on 30 June 2020) Date : ..................................................... (in years, months and days) Bank & Branch : ........................................................................ Marital Status : Married Unmarried Bank deposit / transfer / through RTGS / NEFT Are you a first graduate from your family : Yes No Date of deposit / transfer : .................................................... If available, Universal Transaction Reference Number Voter ID No. : ................................................................................ UTR No.: ...................................................................................... Aadhaar No. : ................................................................................ Fee to be deposited / transferred to Account Name : THE DHAN ACADEMY Bank A/c No. : ................................................................................ Account No.: 1007101045516; IFS Code: CNRB0001007 Bank & Branch : ................................................................................ Bank and Branch: Canara Bank, Ramnad Road Branch, Madurai 4. Education Month & Year Marks / OGPA Qualification Name of the College/ Percentage of obtained University and Location From To Marks Secondary School (10th) Higher Secondary School (10 +2) Bachelor’s Degree in Master’s Degree in (Kindly attach photocopies of mark and degree (or) Provisional Certificate. Those who pursue final year, Please attach mark sheet up to previous semester) 5. Work Experience Date and Year Employer’s Name & Job Title Nature of Job Location From To (Kindly attach photocopies of work experience certificate) 6. Extra Curricular Activities (Games, Sports, Cultural etc.) 7. Languages Known 8. How did you come to know about this course? Languages Speak Read Write College / Faculty Poster Website / Facebook Friends Senior Others Pl. Specify A: Excellent B: Good C: Fair D: Poor/Bad 9. Selection (Group Discussion / Personal Interview Centre, Please Choose only three and mark your preference as 1, 2 and 3) Ahmedabad Bengaluru Bhubaneshwar Chennai Guwahati Madurai Mumbai New Delhi Ranchi Solapur Note : * Centres might get changed based on Applications. The venue address, centre and date of interview will be sent through call letter. 9.1 Write your commitments in the family and expectations of your parents 10. How do you describe yourself as a person? What are your priorities in the life? (Not less than 300 words) 11. Write about a person who inspired you most. (Not less than 300 words) 12. Why do you want to pursue your career in the development sector? Narrate an incident which made you to decide to be in the sector. (Not less than 300 words) 13. India is fast growing world economy in 21st century. The inequality between have and have=nots is widening. As per 2015 statistics. 1% of indians posses 76% wealth, while the bottom 20% possess less than 4% wealth. Kindly write your views on this and your suggestions to bridge the gap by 2030? (Not less than 300 words) The DHAN Academy Group Discussion & Personal Interview - 2020 ADMIT CARD Name : Registration Number : Centre Name & Address : GD & PI Date : Time : Admission Coordinator 15. Check the following before sending the filled in application (put a ü mark) Demand Draft, If registration fee is not paid in cash or by bank transfer Filled in admit card Self-attested photographs pasted in first page and in Admit Card Self-addressed envelope Photocopies of Marks Card, Degree (or) Provisional Certificate Signature 16. Declaration I hereby confirm that to the best of my knowledge, the information I have provided in this application is complete and true. If it is found that any of the information given here is false, then I understand that TDA has the right to cancel my admission to the Programme in Development Management (PDM) / Programme in Community Health Management (PCM) and also recover the cost incurred. Date : Signature (FOR OFFICE USE ONLY) Weighted Score for Academic Degree : ................................................. Remarks Group Discussion Score : ................................................. Personal Interview Score : ................................................. Aggregate Score : ................................................. Shortlisted : Yes No Instructions for GD & PI uReport at the centre by 9:30 a.m. uAdmit card has to be produced for attending Group discussion and Personal Interview.

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