Application Form for Ph.D.

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MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY BHOPAL– 462051 (M.P.) INDIA (Deemed University) Application form for Admission Ph.D. Programmes Please read the instructions given in the information brochure & on the website www.manit.ac.in before you fill up the form, Tick () the relevant box wherever provided. Attach attested copies of certificates/marksheet in support of following information.
Tick( ) the relevant box wherever provided

Photograph

For office use only

Sch. No. : _________________ Name of Branch ______________________Date___________

Full Time Part Time

Sponsored Self Supporting

Branch/Subject : At Graduation : _____________________ At post Graduation : _________________

Department : Applied for : _________________________________________________________ Interdisciplinary (If yes, Name other Deptt) ____________________________________________ (Fill separate forms for each Department, In case of Interdisciplinary, form should be filled in main deptt. only)

Proposed Research Area (Broad Area) _________________________________________________ (Enclose Brief description of proposed work _____________________________________________ In 500 words on a separate sheet)

Name(in capital) Gender/D.O.B. Father’s Name Mother’s Name Address for correspondence Male Female Date of Birth (dd/mm/yyyy)

PERSONAL

PIN Email Id : Telephone No. with STD Code :
Permanent Address

Mob.:

PIN Email : Telephone No. with STD Code : Category to which you belong Gen PAYMENT SC ST Mob.: OBC PH

Attach a crossed DD/IPO of Rs. 750/- payable to MANIT, Bhopal Payment Details Drawn on : Bank Draft No. Amount Rs. Date:

For official use Draft received Reg. No. Sign.

QUALIFYING DEGREE

Qualifying Exam ___________________________________________(Attach copy of degree) Discipline ______________________________ Duration of the course (Years) ______________ Name of University/Institute ________________________________ Year of Passing _________ CGPA/Marks obtained in qualifying degree Marks Obtained Max. Marks Aggregate %/CGPA (Mention Point scale also)

(MBA/M.Tech./MCA/M.Sc./ M.Arch. etc.)

_______________________

GATE/NET or any other equivalent exam passed

Name of Exam.

Year of passing

Marks obtained (attached certificates)

Details of Marks secured in the Examinations other than qualifying examination PREV. Acad. Rec. Exam/Degree 10+2/Equivalent B.Sc. B.Tech. Any other Experience (From date to date) Exp. If Any Designation Organization Specilisation Institute/ University Year of Passing % Marks/ CGPA

Have you ever studied and discontinued you studies at NIT Bhopal ______________________________ (If yes, give particulars of the programme earlier attended and the reason for discontinuation) Names and addresses of two referees who are familiar with your academic background. Name Address Name Address

PIN

Email

PIN

Email

Declaration a] I declare that all the information given by me in this application form is correct to the best of my knowledge and belief, and I understand that false or incomplete information would cause invalidation of the application. I shall abide by the decision of Maulana Azad National Institute of Technology, Bhopal in all matters pertaining to admissions. The decision of the institute shall be final and binding on me. I shall abide by the rules and regulations of the Institute. For all legal actions, suits and proceedings, the jurisdiction of court of law shall be deemed to lie exclusive at Bhopal. I understand the contents of this form and, particularly, this declaration being made here. I shall abide by the rules & Regulation as per Ph.D. advertisement and subsequent notification if any.

b) c) d) e) f)

UNDERTAKING

I, _____________________________ S/o,D/o _______________________________ State that I am aware that ragging in any form is banned in MANIT, Bhopal and do hereby undertake not to indulge in any form of ragging the course of my study at MANIT, Bhopal Signature of the Candidate Date : __________________ I am aware that ragging in any form is banned in MANIT, Bhopal and that I agree to abide by the punishment meted out to my ward in case he/she is found guilty of ragging. Signature of parent/Guardian Date: __________________

(Certificate and format from the employer duly signed & sealed)
1. Name of the Employing Organsation Type of Organisation : __________________________________

2.

:

Central Government State Government Government Autonomous Organization Public Sector Enterprise Private Sector Industry __________________________________________ __________________________________________ Phone : ______________Fax:__________________ Email : _____________________Mob.____________

3.

Address of Administrative Officer/HR Manager

:

4.

Designation of the employee : __________________________________________ Seeking admission in MANIT Employment Details a) First joined on (date) b) c) Holding the present Position since (date) Nature of Job : : :

5.

__________________________________________ __________________________________________

: __________________________________________ (R & D, Design, Production, Marketing, Administrative, Teaching) employed as

Certified

that,

Mr/Ms.___________________________________________

________________________ in this organization is sponsored for admission to Full Time/Part Time Ph.D. programme of MANIT, Bhopal. He/She has been employed in this organization for the

past_______ years in a regular cadre. If selected as a sponsored candidate the organization has no objection to his/her undergoing Ph.D. program at MANIT, Bhopal

__________________________ ____________________________ Signature of Applicant Signature of Competent Authority

Name, Designation

FOR OFFICE USE The candidate may be provisionally admitted / not admitted subject to the following : i) Production of attested copies of the qualifying degree certificate and marks sheet showing the required % of marks/CGPA by _______________________ ii) Production of proof from the University/ Head of the Institution of having appeared / passed in the qualifying degree examination by _______________________ iii) iv) v) vi) Production of relieving certificate sponsorship from Employer by ______________________ Production SC/ST certificate by ________________________________________________ Production of sponsorship certificate ____________________________________________ __________________________________________________________________________

Signature of AR (Admission)

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