Application No .......................
(for official use only)
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The Shiv Nadar University has been established under U.P.Act No 12 of 2011
School of Engineering Admission Form for P.G. Program Session: 2012 • 2013
Instructions for filling the form Download the form, take a print, fill the form in English using CAPITAL LETTERS and post it • Please use only a Black or Blue pen •Do not fold form • Attach extra sheet, if required
Name Date of Birth Place of Birth Marital Status Father/Spouse Name Address for Correspondence (DD/MM/YYYY) Gender Nationality Male Female
Village Pin Phone with STD code State Mobile
City Country Email
Areas of specialization applied for in the Department/Program Pref. 1 Pref. 2
Details of Demand Draft
a) Amount Rs b) Issued by (Bank Name & Branch) No. Date
Academic Record/Work Experience
A. GATE, CSIR, UGC, other fellowship exam details
Exam Name Exam discipline GATE Score/CSIR/UGC Rank Exam Year
B. Qualifying Degree already obtained or in progress
Degree Institute/ College (Name & Address) University (Name & Address) Major Final results expected by Pass Marks % or Grade Average
C. Other Degrees obtained
Degree Institute/ College (Name & Address) University/Board (Name & Address) Major Marks or CPI Passing Year
D. Working Experience
Dates (from-to) Employer Position Nature of Work
E. Number of Technical Papers:
Provide details separately
F. Other academic achievements
G. Statement of Purpose ( 400 words ) optional *
Objective : To assess applicants motivation to pursue a particular field of study and is a self-assessment of his / her capabilities for completing the program successfully.
Please attach one/two sealed academic references with the application form
Names & addresses of the referees: 1. 2.
Declaration
I hereby declare that all the particulars in this form are true to the best of my knowledge and belief. I have read and understood all provisions of admissions and agree to abide by them. I also affirm that I fulfill the eligibility requirements for the course applied for. In the event of submission of fraudulent, incorrect or untrue information or suppression or distortion of any fact like educational qualification, marks, nationality etc., I understand that my admission/degree is liable for cancellation. I further understand that my admission is purely provisional subject to verification of eligibility conditions.
Date
Signature of Parent/ Guardian
Signature of Applicant
CHECKLIST: SEND ONLY ATTESTED COPIES (NOT ORIGINALS).
1. Date of Birth (DOB) Certificate or High School Certificate with DOB (Required for all candidates) 2. GATE/CSIR/UGC score card 3. Copies of qualifying degree/marks/grade sheets 4. Statement of purpose (maximum words 400) 5. The Demand draft for the application fee of Rs. 1000/- as applicable in the name of Shiv Nadar University, payable at Delhi
The completed Application Form must reach on or before May 15,2012 for admission in July Semester to the mailing address:
Shiv Nadar University Admissions Office A-5, Sector 24, Noida – 201301 Uttar Pradesh, India Contact No - +919871471200