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(Please Consult The Before Filling Up The Form.) : National Institute of Technology Silchar Silchar 788 010, Assam

This document is an application form for admission to the Ph.D. program at the National Institute of Technology Silchar. It requests personal information from the applicant such as name, gender, address, contact details, educational qualifications, professional experience, publications, employment status, and other required documents. Upon completion, the form would be reviewed by the Departmental Ph.D. Admission Committee who would recommend applicants for admission and forward to the Institute Ph.D. Admission Committee for final approval.

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49 views3 pages

(Please Consult The Before Filling Up The Form.) : National Institute of Technology Silchar Silchar 788 010, Assam

This document is an application form for admission to the Ph.D. program at the National Institute of Technology Silchar. It requests personal information from the applicant such as name, gender, address, contact details, educational qualifications, professional experience, publications, employment status, and other required documents. Upon completion, the form would be reviewed by the Departmental Ph.D. Admission Committee who would recommend applicants for admission and forward to the Institute Ph.D. Admission Committee for final approval.

Uploaded by

amritaneogi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NATIONAL INSTITUTE OF TECHNOLOGY SILCHAR

SILCHAR 788 010, ASSAM

Application Form for Admission into Ph.D. Program


(Please consult the Regulations before filling up the form.)
1. Name: …………………………………….……….……………………...
Affix recent
...…….………………………………………........……………… passport size
distinct
2. Male/Female: ……….. colored
photograph
3. Father’s/Spouse’s name: ………………………….……….…………….
4. Mother’s name: ………………………………………….………………
5. Addresses:
(a) For communication (b) Permanent

Dist: State: Dist: State:

(c) Email id: (d) Phone no:


6. (a) DD No: ……………………… (b) Date ….………… (c) Amount: Rs. …………..
7. (a) Date of Birth: …………………………… (b) Marital Status: .……………………
(c) Age on 01.01.20____: ………………….. (d) Nationality: ……………………….
(e) Category (OP/SC/ST/OBC/PH): ……………………….
(if other than open category (OP), a self certified category certificate must be enclosed)
(f) Specify if you belong to any other Backward Class: …………………………………
(g) Mother Tongue: ………..…………………. (h) Religion: ………..………………..
8. (a) Department to which admission is sought: …… …………………………………….
(b) Specialization(s) to which admission is sought (in order of preferences):
(i) …………………………………………. (ii) …………………………………

(iii) ………………………………………… (iv) ………………………………..


(c) Are you also applying to any other Department? (Yes/No):
If yes, list the other Department(s):
(i) ……………………………………………
(ii) ……………………………………………
(iii)……………………………………………
1
(d) Category of Admission Sought for (Tick the appropriate one as per Regulations):

Regular Sponsored Part-time

Project Staff Sponsored (External Registration) Institute Employee

9. (a) Details of Universities/Institutions attended (from 10th Standard onwards)


(Self attested copies of certificates and mark sheets/grade cards must be attached)
University/College/ Degree obtained % Marks/ Class Obtained
Year Subjects
Board (with discipline) CGPA/CPI (if applicable)

(b) Professional Qualifying Examination Passed (attested copy of certificate must be


attached):
GATE UGC/CSIR NET
Subject Valid Score Valid upto Subject Qualifying Date Valid upto

(c) Any other source for fellowship/scholarship, if any:

(d) Professional Experience (Teaching/Research/Industrial), if any (proof to be attached).


Period
Name of organization Position held Type of work
From To
(i)
(ii)
(iii)

(e) Attach a list of publications/projects etc. separately, if any:


10. If presently employed, name of the present employer: ……………………………………….
( NOC in appropriate form (refer Regulations) to be attached)
11. List of Enclosures:

(a) (c)

(b) (d)

2
Declaration

I hereby declare that the entries made in this application form are correct to the best of my knowledge and
belief. If selected for admission, I promise to abide by the rules and regulations of the Institute as amended
from time to time.
I note that the decision of the Institute is final in regard to selection for admission and assignment to
a particular department and field of study. The Institute shall have the right to take any action it deems fit,
including expulsion, against me at any time after my admission, if it is found that information furnished by
me are false or incorrect. I shall abide by the decision of the Institute, which shall be final.

Place:
Date:
Signature of the applicant

For office use only

To be filled-in by Departmental Ph.D. Admission Committee

% of B.Sc./B.Tech. marks/Grade Performance of Selection Test


% of M.Tech./M.Phil/M.Sc. (marks/Grade) Position in order of merit
GATE/NET score Category(OP/SC/ST/PH)

Recommended for admission:

Signature of member Signature of member Signature of member Signature of member


Name Name Name Name

Chairman
Name:
Departmental Ph.D. Admission Committee

To be filled by Institute Ph.D. Admission Committee:


(i) Verified and found suitable and recommended to Chairman, Senate for admission
(ii) Not recommended for admission, with reason(s): ………………………………

(Signature of members): ……………… …………........ .......................

Admitted on approval of Chairman, Senate.

Date: Dean (R & C)

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