PH D Applicationform-2011
PH D Applicationform-2011
PH D Applicationform-2011
Photograph
(Accredited by NAAC With A grade) APPLICATION FORM FOR ALL INDIA ENTRANCE TEST 2011 FOR Ph. D. PROGRAMME 1. Specialization : 2. Faculty:
(Name)
PIN 9. Mobile No. 10. Landline No.(with STD Code) 11. E-mail ID
PIN
12. Whether belonging to SC/ST/DT(A)/NT(B)/NT(C)/NT(D)/OBC/SBC Categories (Strike out whichever is not applicable) 13. Details of Fee Payment : D. D./ Cash (Strike out whichever is not applicable) D. D. No. Amount in Rs. Date of Issue
Yes / No
15. Educational Background (attach attested copies of statement of marks and certificates):
Degree University Year of Passing Specialization Class/ Grade Percentage / Grade Points Average
18. Is the Proposed topic of Doctoral Research related to or an extension of the M. Phil. Dissertation? (Strike out whichever is not applicable)
Yes
No
19. Particulars of Publications in Peer reviewed/ Indexed National/ International Journals: (Please attach additional sheet, if required)
Sr. No. 1 2 3 4 Title of the Paper / Book Name of the Journal/ Publisher Details of the publication Volume Issue Year
21. Details of Work Experience: Sr. No. 1 2 3 4 Name of the Organisation Designation From Period To
24. Declaration :
a) I hereby declare that the above information is true and complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected/ admission will be cancelled. b) If admitted to Dr. D. Y. Patil Vidyapeeth, Pune, I shall abide by its Rules and Regulations. c) I have read and understood all the provisions contained in the brochure and hereby agree provisions. to abide by these
Place : Date: