INDIAN INSTITUTE OF MANAGEMENT CALCUTTA

Post Graduate Diploma in Management (PGP-PGDM), 53rd Batch (2016-2018)

TERMS AND CONDITIONS OF OFFER OF ADMISSION

1.

OFFER OF ADMISSION
This Offer of Admission (Offer) is for PGP-PGDM 53rd Batch only and is valid till the last date mentioned in
the offer letter. This Offer will not be extended to any subsequent academic session. All admissions to the
Institute are treated as provisional subject to the candidate fulfilling all the eligibility conditions, otherwise,
his/her candidature would automatically stand cancelled and he/she would be required to withdraw from the
Programme forthwith.

2.

ACCEPTANCE & PAYMENT OF DEPOSIT

The enclosed Acceptance Form, (Enclosure I) duly filled in must reach In-charge of Admissions Office,
Indian Institute of Management Calcutta, on or before the deadline mentioned in this offer letter.
Demand Draft / Bankers Cheque for Rs.1,00,000/- (Rupees one Lakh only) drawn in favour of
Indian Institute of Management Calcutta payable at Kolkata, has to be sent along with the duly filled
in Acceptance Form. Non-receipt of the Acceptance Form and the Demand Draft, on or before the due date
mentioned in the offer letter, would result in automatic cancellation of the Offer. The Indian Institute of
Management Calcutta will not bear any responsibility for postal delay or delay caused by any other factor.

3.

REPORTING AND REGISTRATION

A candidate who has accepted PGP-PGDM admission offer must report at the students hostel between June
11 and 13, 2016. Hostel facilities for the incoming batch will be available only from June 11, 2016 and not
before this date. He/she must also report at the Post-Graduate Programme (PGP) Office for registration as a
student between June 14 and 16, 2016. Details of the registration procedure will be available on arrival.
Failure to report at the PGP Office within Office hours of June 16, 2016 without prior permission would
result in automatic withdrawal of the PGP-PGDM admission offer.
Candidates who are employed must produce in original the letter of release from the employer
and submit a photocopy of the same during the registration process.

4.

LATE REPORTING/REGISTRATION
If a candidate who has been offered admission, is not in a position to report and register latest by June 16,
2016, he/she must obtain prior permission for late registration by applying in advance to the Chairman,
Admissions, giving reasons for the delay. The Chairman, Admissions, reserves the right to accept or reject
such applications for late registration without assigning any reasons. Late registration will not be allowed
under any circumstances after June 27, 2016. If a candidate gets permission to report late from the
Chairman, Admissions and then fails to report by June 27, 2016, the PGP-PGDM offer will be withdrawn
automatically.
Candidates who register after June 16, 2016 are required to pay a late registration fee of Rs.5,000/- plus a
late fine @ Rs.200/- per working day.

5.

MANDATORY PARTICIPATION OF STUDENTS IN MANAGEMENT GAME

Management Games for first year PGP students is scheduled on July 16 and 17, 2016. Participation of all
students in Management Game is mandatory.

6.

ACADEMIC ELIGIBILITY FOR ADMISSION

The candidate must hold a Bachelors Degree, with at least 50% marks or equivalent CGPA [45% in case of
the candidates belonging to Scheduled Caste (SC)/Scheduled Tribe (ST) or Persons with Disability (PWD)
category], from any of the Universities incorporated by an act of the central or state legislature in India or
other educational institutions established by an act of Parliament or declared to be deemed as a University
under section 3 of UGC Act, 1956, or possess an equivalent qualification recognized by the Ministry of HRD,
Government of India. In case a candidate fails to submit mark sheet/certificate within the due date that
he/she has completed graduation with 50% (45% in case of SC/ST/PWD) marks in aggregate, his/her
registration will be cancelled.
A candidate who has not yet obtained a Bachelors degree, will have to submit a certificate at the time of
registration (Enclosure II) relating to completion of graduation from the Head of the College/Institute (or
any other authorized official of the College/Institute), where he/she has studied for the graduate degree.
The certificate should mention the date by which he/she has completed all requirements of graduation. The
date should not be later than June 30, 2016. Any candidate who is unable to complete all requirements for
his/her graduation (B.A., B.Com., B.Sc., B.Tech. etc.) by June 30, 2016 is not eligible for
admission/registration. Every candidate must satisfy this eligibility criterion.
A candidate who has not received his/her graduation results at the time of registration will have to produce
certificates and mark sheets in original together with the photocopies as soon as the respective
University/Institute publishes the results, but NOT LATER THAN DECEMBER 31, 2016, failing which
his/her registration as a student of IIM Calcutta will be automatically cancelled and he/she will be required
to withdraw from the Programme forthwith. Any candidate who submits University Mark sheets which do
not clearly indicate that he/she has passed the Bachelors Degree course or equivalent, and also submits
Provisional Certificate from an affiliated College/Institute would, in addition, be required to produce an
authorization certificate from the University stating that such an affiliated College/Institute is
authorized/empowered to issue such a certificate on behalf of the University.

7.

QUALIFYING TEST ON MATHEMATICS

A Test on Qualifying Mathematics (QM) for all PGP-PGDM registered candidates will be held on June 28,
2016 between 4.00 p.m. and 6.00 p.m. after commencement of the session for the first year.
i.

Those who pass this Test will get waiver in QM for Term I.

ii. Those who fail the Test and/or those who do not appear for the Test will be required to continue with the
QM course in Term I, and will get two more chances to clear the Examination, failing which they will have to
leave the Programme.
The syllabus for Qualifying Mathematics (QM) is given in Enclosure III.
8.

Course Curriculum
Compulsory courses for Term I, II and III in the first year are detailed in Enclosure IV. All courses offered in
the second year are elective courses.

9.

GUARDIANSHIP
Declaration of Guardianship (Enclosure V) will have to be submitted at the time of registration.

10.

VERIFICATION
At the time of registration every candidate must produce for verification all original certificates and mark
sheets starting from the School Final Examination of a recognized Board to the Graduation/Post Graduation
Examination of a recognized University (or equivalent). One photocopy of mark sheet, duly attested, for
each examination should also be submitted. Reserved category candidates must also produce, for
verification, at the time of registration, Caste/Tribe certificates, in original, obtained from the competent
authority, together with a photocopy, duly attested.

The admission for Non Creamy Layer (NC) Other Backward Classes (OBC) candidates is provisional subject
to the community certificate being verified through the proper channels. If the verification reveals that the
candidates claim of belonging to Other Backward Classes as per the central list of OBC (www.ncbc.nic.in) or
non-creamy layer is false, his/her admission will be cancelled forthwith without assigning any further
reasons.
Differently abled (DA) candidates having not less than 40% disability are required to produce for verification
at the time of registration, disability certificate, in original, obtained from a medical authority as per the
provision of the Persons with Disabilities (PWD) Act, 1995 together with a self-attested photocopy.
11. Special DA Form
A special form has been designed by the Institute for DA candidates to understand their specific need and
requirements which is enclosed (Enclosure VIII). DA candidates are requested to send the same duly filledin to the Admissions Office along with the acceptance fees and form. This advance information will help us
in meeting the special needs of DA candidates to the best extent possible.
12. ACADEMIC REGULATIONS
All students are governed by the Academic Regulations of the Institute in respect of academic
performance/grade points, personal conduct, etc. A student who fails to satisfy the prescribed standard of
academic performance and/or personal conduct may be asked to withdraw from the Programme, any time
over the duration of the programme.
13. CAMPUS RULES
The Post Graduate Programme is residential. All students are required to abide strictly by the Campus Rules
and are required to sign a declaration at the time of registration agreeing to abide by these rules. Violation
of Campus Rules will invite disciplinary action.
Students are NOT allowed to bring their own motor vehicles (cars and motor cycles) inside the
campus.
14. ATTENDANCE
All students are required to stay at the Institutes Hostels and attend to all academic requirements in
accordance with the rules of the Institute. Absence from the Hostel is permissible only during authorized
holidays and during the recess, if any, between academic terms. PGP Rules and Regulations in connection
with attendance will be binding to all the students during the entire duration of the course.

15. IMPORTANT DATES

Reporting at IIMC

June 11-13, 2016

Registration & Orientation Module

June 14-16, 2016

Freshers Welcome

June 17, 2016

Commencement of Classes

June 20, 2016

First Qualifying Mathematics Test

June 28, 2016

Management Game

July 16-17, 2016

GENERAL INFORMATION

1. PHYSICAL INFRASTRUCTURE
The 135-acre picturesque campus is located at the southern end of Kolkata, about 15 kms from the city
centre. It has a cluster of administrative and faculty office blocks, fully equipped classrooms, seminar and
conference rooms, library, computer centre, an executive training complex, a 750-seat auditorium, fully
furnished student hostels with Local Area Network (LAN) connectivity, Residential Quarters, a Central
School, a modern Gymnasium, Swimming Pool, Kayaking, facilities for playing Indoor and Outdoor games,
well-equipped Dispensary, Coffee Corner, State Bank of India (SBI) Branch, SBI ATM, ICICI Bank ATM and a
Post Office. Stationery and basic day to day provision are available on campus at IIMC Consumers Cooperative Stores Ltd.
2. On Reaching IIMC Campus
On your arrival at the Institute, please report to the In-charge, Hostels at the Ramanujan Hall.
3. Hostel
All students will be provided single accommodation with common bath/toilet facilities.
A candidate is advised to bring the following items at the time of reporting at the hostel: bed linens, pillow,
mosquito net, stationery, padlock & keys, other items of personal use.
4. Student Mess
The Hostel Mess is run by the PGP Mess Committee comprising elected representatives of the students. The
expenses can vary between Rs. 4,000/- and Rs.5,000/- per month (based on actuals and to be decided by
the Mess Committee).
5. Fees for the PGDM 53rd Batch 2016-2018
The total fees for PGP-PGDM Batch 2016-18 Batch will be Rs.19,00,000/- (Rs. Nineteen lakh only). In
addition you will have to pay a refundable caution deposit of Rs.10,000/- (Rs. Ten thousand only) subject to
adjustments at the time of PGP Registration. Mess charges will be extra on actuals.
Acceptances Fees: Rs.1,00,000/- (Rs. One lakh only). You will have to send the acceptance fees by way of
Demand Draft in favour of Indian Institute of Management Calcutta along with the acceptance form on or
before the last date of acceptance of the admission offer. This amount of Rs.1,00,000/- paid as acceptance
fees will be adjusted against the balance amount of first term fees.
Balance amount towards 1st Term Fees to be paid during PGP Registration:
Rs.2,73,500/- (Rs. Two lakh seventy three thousand five hundred only) which includes Rs.10,000/- towards
caution deposit and excludes Rs.1,00,000/- (Rs. One lakh only) which you would have already paid towards
acceptance of your admission offer.
Term-wise fees are to be paid at the commencement of each term. Payment for 2nd Term to 6th Term will
have to be made through Institute Payment Gateway only
Fees Structure for the batch 2016-18 is attached as Enclosure (VI).

6.

Induction/Orientation for Freshers

The Chairman, PGP will organize the Induction/Orientation Programme for the Freshers on June 18 and 19,
2016.

7.

Financial Assistance
IIMC offers Need Based Financial Assistance for this purpose. Students admitted to IIMC, whose annual
gross family income is Rs.6,00,000/- (Rupees Six Lakh only) or below will be eligible for receiving financial
assistance amounting to less than or equal to full tuition fee waiver. The financial assistance scheme will be
available to both first and second year students.
Further, a number of scholarships/prizes/awards sponsored by different companies would be available for
the deserving students on the basis of merit and various criteria.
In addition, Financial Institutions and Commercial Banks provide loans to students at a concessional rate of
interest. Details will be available at their websites. Students who desire to avail of the loan facility should
contact banks directly. Although the Institute endeavours to facilitate the process of availing of loan from
financial institutions and banks, it is not directly involved in the process.

8.

Medical Information
Each newly admitted student will be covered by a medical and accidental insurance scheme of Rs.1,00,000/each. Beside the insurance coverage as stated above, the Institute Campus is equipped with a small
dispensary and there is a Resident Doctor available from 8.30 a.m. to 1.00 p.m. and from 6.00 p.m. to 8.00
p.m. on all weekdays and Saturdays. Besides, a non-resident doctor is also available on all weekdays from
2.00 p.m. to 6.00 p.m. A qualified medical counsellor is also available to help the students.
Please note that you are required to submit some basic information about your health profile at the time of
registration in the prescribed from (Enclosure VII) which has to be countersigned by a Family
Physician/Doctor. However, the information provided by you will remain confidential and will be used in case
of medical emergencies only.

9.

Other Requirements
i.

Photographs: All students should bring eight (8) copies of recent passport size photograph for
records at the PGP Office (2), Library (1), Placement Office (2), Mess (1) and Bank (2);

ii.

Sundry Expenses: All students should have sufficient funds to meet the cost of local transport,
books, laundry, recreation and other personal expenses.

iii.

Bank Account: The State Bank of India has a Branch with ATM within the IIMC campus (IIM Joka
Branch, Branch Code No. 6210). A student should open a Bank Account with this Branch. There is
also an ICICI Bank ATM inside the Campus.

10. Mailing
Non-receipt of the Acceptance Form along with the Demand Draft before the due date mentioned in the
offer letter would automatically result in cancellation of the Offer of Admission. It is advisable to send
the Acceptance Form together with the Demand Draft by Courier/ Speed Post/ Registered
Post. Please mail early to avoid delay. Please find below the address where the Acceptance Form and
the Demand Draft has to be sent:
In-charge, Admissions Office
Indian Institute of Management Calcutta
Diamond Harbour Road, Joka
Kolkata 700 104, W.B.
5

11. How to Reach IIM Calcutta, Joka Campus

i.

The Joka Campus of the Institute is situated on the Diamond Harbour Road, about 20 kms. from the
Howrah Station, 18 kms. from the Sealdah Station, and 35 kms. from the Netaji Subhas Chandra Bose
International Airport. The campus is about 1.5KM south of the Thakurpukur Bus Terminus.

ii. To reach IIM Calcutta Joka Campus, you may avail the services as mentioned below:
Prepaid cabs/App-based cabs (Ola, Uber) are available from Howrah/Sealdah Railway Station and the
Airport to IIM Calcutta Joka Campus. Fares will range between Rs.400/- to Rs.800/- approximately.
iii. Contact Details:
Joka Campus
Tel. No.: (033) 2467 8300-04; 2467 8306; 2467 8313; Fax: (033) 2467 8062
Admissions Office
Tel. No.: (033) 2467 9178 (D); Fax: (033) 2438 0892

Indian Institute of Management Calcutta

ENCLOSURE I
PGP-PGDM ADMISSION ACCEPTANCE FORM

Please affix
your
photograph
Chairman, Admissions
Indian Institute of Management Calcutta
Diamond Harbour Road, Joka
Kolkata 700104, W.B.
Sir,
I accept your Offer of Admission to the Post Graduate Programme in Management leading to the Post
Graduate Diploma in Management (PGDM), 53nd Session of the Indian Institute of Management Calcutta.
I understand that this Offer is subject to the Terms and Conditions of Offer of Admission enclosed with your
letter.
I have read the Terms & Conditions of your offer carefully and accept the same.
I am enclosing a Demand Draft / Bankers Cheque for Rs. 1,00,000/- (Rupees One Lakh only) in favour of
Indian Institute of Management Calcutta payable at Kolkata.
Yours faithfully,

Signature of the Candidate

Date:
CAT-2015 User ID No:
Candidates Name:
Present Mailing Address:

Contact No:
E-Mail Address:
Demand Draft (DD) No. and Date:
Name of the Drawee Bank:

ENCLOSURE II
If a candidate has not yet obtained a Bachelors degree, then the following Certificate from the Head (or any
other authorized Official) of the College/Institute last attended, will have to be submitted at the time of
registration

TO WHOM IT MAY CONCERN

This is to certify that Mr./Ms. _________________________________________________________has
completed all examinations and all other requirements including projects, viva-voce, etc. for the Bachelors
degree by * _____________________ .
* Please indicate exact date.

Signature:
Name:
Designation:
Name and Address of College/Institute:

College/Institute Seal:
Date:

Indian Institute of Management Calcutta

ENCLOSURE III
SYLLABUS FOR QUALIFYING MATHEMATICS (OM-100)
1. Set Theory: Definition, Notation, Membership, Subsets, Supersets, Cardinality, Countable Sets, Uncountable
Sets, Finite Sets, Infinite Sets, Cartesian Product, Commonly used Sets, Basic Set Operations, and Venn Diagrams.
2. Functions: Definition, Linear Functions, Quadratic Functions, Cubic Functions, Plotting the graphs of functions
using horizontal and vertical shift, Asymptotes, Rational Functions, Exponential and Logarithmic Functions. One to
one, Many to one, Into and Onto functions, Inverse of a function (if exists), Zeros of a function. Limits, continuity
and differentiability of a function.
3. Differentiation: Introduction to Derivatives, Derivatives of some commonly used Functions, Chain Rule,
Derivatives of sum/difference/product of two functions, Derivatives of Rational Functions, Higher Order Derivatives,
Applications and Interpretation of Derivatives, Determining maxima, minima, points of inflection of a function,
Determining the curvature (convex/concave) of a function
4. Partial Differentiation: Differentiation of functions of more than one variable.
5. Integration: Introduction, Integration by Substitution, Integration by partial fraction, Integration by parts,
Introduction to Definite Integration and its properties. Applications of definite integration to determine the area
under a simple curve and the area enclosed between two curves
6. Differential Equations: Order and degree of differential equations, Solving first order linear differential
equations
7. Combinatorial Analysis: Permutations and combinations, Binomial theorem for a positive integral index,
properties of binomial coefficients.
8. Linear Algebra: Introduction to Matrices, Addition, Subtraction, Scalar and Matrix Multiplication, Transpose of a
matrix, Matrices with special characteristics such as Diagonal matrix, Scalar matrix, Identity matrix, Symmetric and
Skew-symmetric matrix, Determinants, Properties of Determinants, Solving Systems of Simultaneous Linear
Equations using Cramers Rule, Gaussian Elimination method, Gauss Jordan Elimination method.
9. Co-ordinate Geometry: Cartesian coordinates, distance between two points, shift of origin. Equation of a
straight line in various forms, distance of a point from a line, Lines through the point of intersection of two given
lines, equation of the bisector of the angle between two lines, Equation of a circle.
10. Progression: Arithmetic, geometric and harmonic progressions, arithmetic, geometric and harmonic means,
sums of finite arithmetic and geometric progressions, infinite geometric series, sums of squares and cubes of the
first n natural numbers

Indian Institute of Management Calcutta

ENCLOSURE IV
PGP-PGDM CURRICULUM
List of Term-wise Compulsory Courses
Group

Term I

Term II

Term III

Finance and
Control
Behavioural
Sciences
Marketing

Corporate Financial Reporting

& Analysis (3 )
Behavioral Sciences-I (3)

Cost Management (1.5)

Corporate Finance (3)

Economics

Microeconomics (3)

Behavioral Sciences-II
(1.5)
Marketing Management
II (1.5)
Macroeconomics (3)

Operations
Management

Statistics for Management (3)

Risk Management (1.5)

Marketing Management I (3)

Operations Research (3)

Information Technology
and Systems (3)

MIS
Strategic
Management
Human
Resources
Management
Public Policy
and
Management

Total
Qualifying
Non-credit
courses

4.5
4.5
India and the World
Economy (1.5)
Production &
Operations
Management (3)

Indian Economic & Political

History (1.5)

Indian Legal System

(1.5)

Environment & Development

(1.5)

Indian Social Structure

(1.5)
15
Managerial
Communication-II
(15 hours)

7.5
10.5

3.0
Strategic Management
(3)
Human Resource
Management (1.5)

18
Qualifying Mathematics

Total
credits
7.5

15
Business Ethics
(15 hours)

3.0
1.5

6.0

48.0

Managerial Communication-I
(15 hours)

Summer Project

Students who successfully complete the first year of the programme are required to do a Summer Project (of 3
credit points) as a compulsory Pass/Fail Credit course during the summer vacation between Terms III and IV.
Summer Interns are attached to firms and complete their project under the guidance of a firm representative.

Course Structure for PGP Second Year

All courses offered in the Second Year in PGDM are elective courses.

10

Indian Institute of Management Calcutta

ENCLOSURE V
DECLARATION OF GUARDIANSHIP
(To be submitted at the time of Registration)
I,

__________________________________________________

do

hereby

declare

that

Mr./Ms.

_____________________________________________ who has been offered admission to the Post Graduate

Programme in Management at the Indian Institute of Management Calcutta, is my _________________________
and I am his/her guardian. My contact address and telephone number(s) is/are given below. I also provide below
the name, address and telephone numbers of the local guardian.
Signature of the Guardian: _______________________________
Name of the Guardian: ___________________________________ Relationship: ___________________
Address of the Guardian
Residential:

Office:

________________________________
________________________________
________________________________
________________________________

_____________________________
_____________________________
_____________________________
_____________________________

Telephone No:

Telephone No:

Fax No.:

Fax No.:

E-Mail:

E-Mail:

Name of the local Guardian: ______________________________ Relationship: __________________

Address of the local Guardian:
Residential:

Office:

________________________________
________________________________
________________________________
________________________________

_____________________________
_____________________________
_____________________________
_____________________________

Telephone No:

Telephone No:

Fax No.:

Fax No.:

E-Mail:

E-Mail:
11

Indian Institute of Management Calcutta

ENCLOSURE VI
FEE STRUCTURE FOR PGP-PGDM (53RD BATCH)
The Fee Structure for the students of the Post Graduate Programme of IIM Calcutta, Batch: 2016-2018 is as
follows:
S.N.
1
2
3
4
5
6
7

S.N.
1
2
3
4
5

Particulars
Tuition Fees
Academic Charges
Room Rent
Development Fees
Medical Insurance Charges
Students Association Fees
Alumni Activities
TOTAL
*Caution Deposit

1st Term
199000
80000
15000
64500
2000
1500
1500
363500

Particulars
Tuition Fees
Academic Charges
Room Rent
Development Fees
Medical Insurance Charges
TOTAL

4th Term
199000
80000
15000
64500
2000
360500

2nd Term
199000
80000
15000

3rd Term
199000
80000
15000

294000

294000

5th Term
199000
80000
15000

6th Term
199000
80000
15000

294000

294000

Total (Rs.)
597000
240000
45000
64500
2000
1500
1500
951500

10000
Total (Rs.)
597000
240000
45000
64500
2000
948500

Notes:
1. *In addition to the total fees of Rs.19,00,000/- (Rs. Nineteen lakh only) for two years, a student will have to
pay a caution deposit of Rs.10,000/- (Rs. Ten thousand only) at the time of registration which is refundable
at the time of leaving the Institute subject to adjustments.
2. The amount of Rs.1,00,000/- (Rs. One lakh only) deposited at the time of accepting the offer of Admission
will be adjusted against the 1st Term Fees.
3. A student will have to bring a consolidated demand draft of Rs.2,73,500/- (Rs. Two lakh seventy three
thousand five hundred only) consisting of the balance amount of first term fees of Rs.2,63,500/- and
Rs.10,000.00 towards caution deposit. The demand draft must be drawn in favour of Indian Institute of
Management Calcutta. This amount by way of a demand draft will have to be deposited during
PGP registration process.
4. The term-wise amount indicated above is payable at the beginning of each term. Payment for 2nd Term to
6th Term will have to be paid through Institute Payment Gateway only.

12

Indian Institute of Management Calcutta

ENCLOSURE VII
MEDICAL INFORMATION FORM
The Institute maintains detailed medical records of each student in order to facilitate quick and effective treatment
in case of an emergency. The following details are required for this purpose.
Please note the information you provide will remain confidential and will be used in case of medical emergencies
only.
The form is to be countersigned by a registered medical practitioner, preferably your family doctor, and submitted
at the time of programme registration.
Name of the Student
PGP Registration No.
Blood Group
RH-Type

:
:
:
:

Medicines Causing Allergy :

(Please write Dont Know in case you dont know which drugs you are allergic to)
1)

2)

3)

Serious ailments during the last five years: (Please write NA if Not Applicable)
(e.g. Diabetes, Hypertension, Dyslipidemia, Asthma, Tuberculosis, Epilepsy, Anxiety Neurosis, Obsessive Compulsive
Disorder, Depression, etc.)
1)

2)

3)

Medicines you have been taking on a regular basis: (Please write NA if Not Applicable)
1)

2)

3)

Any other information including family history etc.:

Signature of the Doctor: --------------------------------------------Date: -------------------------------------------------------------------Name of the Doctor: ------------------------------------------------Registration number of the Doctor: ------------------------------Contact Address: ------------------------------------------------------------------------------------------------------------------------------Mobile / Landline Number: -----------------------------------------13

-------------------------------Signature of the Student

Date: ------------------------

Indian Institute of Management Calcutta

ENCLOSURE VIII

Student's Reasonable Accommodation Request Form for PGP Students with Disabilities
CONFIDENTIAL

Name:
First

Middle

Last

Current Address:

City/District:

State:

Pin code:

Phone no. with STD code: Mobile No(s):

E-mail ID:
Nature of Disability/Medical Condition:
Percentage of Disability:

Documentation Attached?

Yes

No

Any aids/appliances/assistive technology that you use:

Is there anything we should know about your disability or condition that would aid us in meeting your needs?

A. Do you have any special preference for rooms in hostel for example, rooms in ground floor, closer access to academic
buildings and so on? Please specify your needs:

B.
i) What academic accommodations/support* have you used in earlier academic life? Please give the details of assistive
equipment or technology that you use?

ii) Any specific academic accommodations/support that you require at IIMC? (Note: we may need a reasonable amount

of time to respond to some accommodations/support request.)

14

iii) Will you prefer having a faculty mentor or a senior PGP/FPM student who you could reach out for guidance and
assistance? Tick your preference(s)
a) Yes, Faculty mentor

CAT 2015 User ID:

b) Yes, Student mentor

c) No, Thanks

Signature:

Date:

*Academic Accommodations are individualized and determined according to the nature of the students disability.
Accommodations include, but are not limited to, note-takers, scribes, readers, test aides, sign/oral language
Interpreters, and access to specialized software and equipment.
NOTE: All information provided on this form will be kept confidential. However, this information may be shared with
appropriate personnel in order to facilitate the implementation of academic or physical accommodations for the
student, but only on a need-to-know basis. Specific information may be released to first aid personnel or Public Safety
as a preventive safety measure and in the event of a medical emergency. Also, this information may be used in
aggregate form for reporting purposes. Finally, under certain circumstances, we may be obliged to report this
information to government officials investigating IIM-Calcuttas compliance with regulations protecting persons with
disabilities.

15