8/12/2019 Post 2014

http://slidepdf.com/reader/full/post-2014 1/6

Mk- Ckh vkj vECksMdj jk"Vªh; izkS|

ksfxdh laLFkku]

 tkyU/kj !#!!Dr B R AMBEDKAR NATIONAL INSTITUTE OF TECHNOLOGY,

JALANDHAR - 144011

APPLICATION FORM FOR ADMISSION TO

PhD/MTeh/MBA/MS PROGRAMMES !014-!01" 4

S.No.________  

Application Fee : Rs.1000/- (Gen/OBC/Sponsored) Rs.!00/- (SC/S")

*To be filled in by the Candidate in his/her own handwriting in capital letters

**Please attach attested copies of all the documents/certificates/testimonials.

***Please attach 1-2 pages write up on proposed area of research.

#etails o$ Re%istration $ee:

emand raft !o.""""""""""""""""" ated """""""""""""""" #mount""""""""""""""" $an%/$ranch """""""""""""""""""" 

1. Programme to which admission sought &Please Tic%'

&i' Ph. &(ull time' &i' ).Tech &Part time'

&ii' Ph. &Part time' &ii' ).Tech &ponsored'

&iii' Ph &ponsored' &iii' )$#

&i+' ).Tech &(ull Time' &iii' ).c

2. iscipline of study/#rea of speciali,ation """""""""""""""""""""""""""""""""  

&# P #T0)!T'

. epartment """""""""""""""""""""""""""""""""  

. 3hether you are an 0!T!#4 C#!0#T5 """""""""""""""""""""""""""""""""  

6. !ame in full &in bloc% letters as per matriculation certificate'  &0n nglish' """"""""""""""""""""""""""""""""" 

&0n 7indi' """""""""""""""""""""""""""""""""  

elf attested

Passport si,e

P78T89#P7

8/12/2019 Post 2014

http://slidepdf.com/reader/full/post-2014 2/6

. (ather;s !ame """"""""""""""""""""""""""""""""" 

<. )other;s !ame """""""""""""""""""""""""""""""""  

=. ate of $irth &as per matriculation certificate' """""""""""""""""""""""""""""""""  

>. !ationality """""""""""""""""""""""""""""""""  

1?. &a' Category &9eneral/C/T/8$C/P7/)inority' """""""""""""""""""""""""""""""""  

  &Category once chosen shall not be changed at any stage'

&b' ponsored &0n-ser+ice' @es !o

11. Correspondence #ddress with telephoneA )obile !o.

 """""""""""""""""""""""""""""""""""""""" 

and mail

 """""""""""""""""""""""""""""""""""""""" 

 """""""""""""""""""""""""""""""""""""""" 

T Code"""""""!o.""""""""""""""""""""" 

)obile !o """"""""""""""""""""""""""""" 

mail""""""""""""""""""""""""""""""""""" 

12. Permanent 7ome #ddress with telephoneA )obile !o.

 """""""""""""""""""""""""""""""""""""""" 

and mail

 """""""""""""""""""""""""""""""""""""""" 

T Code"""""""!o.""""""""""""""""""""" 

)obile !o """"""""""""""""""""""""""""" 

mail""""""""""""""""""""""""""""""""""" 

1. ducational Bualifications:

&0n case of 0nternal candidatesA additional information to be pro+ided as per enclosed PerformaA #nneure-0'

&'aination ear o$

passin%

*nstit+tion ,niersit S+ect(s) ar2s

otained/

a' ar2s

3a%e o$

ar2s (+pto

one decial4it5 diision

10t5

1067

B.Sc/B.&./B."ec5

.Sc

.85il/

."ec5

An

ot5er

&'a.

1. &a' 3hether Dualified in 9#T/E( etc. """""""""""""""""""" 

&b' 0f yesA 9#T/E( score:"""""""""""""""""""" @ear of passing""""""""""""""""""" ate of alidity """"""""""""""""""""

16. perience &only for sponsored candidates' in chronological order starting form the latest:

8/12/2019 Post 2014

http://slidepdf.com/reader/full/post-2014 3/6

Sr No. Nae o$ or%ani9ation 4it5 address Fro "o "otal

8eriod

1. 3as there any gap in your studies5 0f yesA mention period and reason:

a' Period &gi+e dates' (rom""""""""""""""""To""""""""""""""" 

 b' easons"""""""""""""""""""""""""""""""""""""""""""""" 

1<. 7a+e you passed the Dualifying eamination in the first attempt: @es/!o

8/12/2019 Post 2014

http://slidepdf.com/reader/full/post-2014 4/6

ist o$ &nclos+res:

1. #pplication (ee &emand raft' @es/!o

2. )atric/7igher econdary Part-0 certificate &as proof of age' @es/!o

. F2 amination certificate @es/!o

. $.c./$.Tech/$.. amination certificate indicating the detail mar%s @es/!o

6. ).c. &as applicable' amination certificate indicating the detail mar%s @es/!o. ).Tech/).Phil &of applicable' amination certificate indicating the detail mar%s @es/!o

<. Character certificate from the 7ead of the 0nstitution last attended @es/!o

=. Certificate in support of claim under reser+ed category on the prescribed Performa @es/!o

>. !o obGection certificate from mployer &for sponsored candidates only' @es/!o

1?. 9#T/E( Dualifying certificate @es/!o11. )edical certificate from a )edical 8fficer/)8/C)8 of a 9o+t. 7ospital @es/!o

12. 8riginal )igration Certificate* @es/!o

1. 3rite up &1-2 pages' on proposed area of research &for Ph candidates only' @es/!o

  ,N#&R"A;*NG B "<& A88*CAN"

* clearl +nderstand t5at adission to_______________pro%rae in t5e #epartent/#iscipline o$ ____________________________

is S,B=&C" "O "<& R,&S AN# R&G,A"*ONS OF #r B R Aed2ar National *nstit+te o$ "ec5nolo% =aland5ar. * also

+nderstand t5at t5e adission is ein% allo4ed to e on t5e asis o$ t5e certi$icates and doc+ents prod+ced e. * also +nderta2e

t5at t5e certi$icates and doc+ents prod+ced e in ori%inal are correct %en+ine and tr+e to t5e est o$ 2no4led%e. *$ an

in$oration/doc+ents/partic+lars is $o+nd to e $or%ed or $alse at an sta%e in $+t+re t5en t5e N*" =aland5ar can cancel adission

and all t5e $ees deposited e s5all e $or$eited. *$ an de%ree 4ill e a4arded ased on adission on t5e asis on $or%ed

doc+ents t5en t5at certi$icate/de%ree a4arded N*" =aland5ar s5all e a+toaticall cancelled. *n s+c5 case * s5all 5ae no clai

45atsoeer in respect o$ adission.

>itness:

1. &(ull ignature of 3itness with #ddress' 2. &(ull ignature of 3itness with #ddress'

&(ull ignature of Parent/9uardian' &(ull ignature of Candidate'

ated:

Place:

*tudents may submit within one month after admission.

 """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 

(FOR OFF*C& ,S& ON)

The application form/documents has been chec%ed and +erified.

#. The applicant is eligible for admission to ).c./)$#/).Tech &Part-Time/(ull Time/ponsored'/Ph. &part time' / Ph. . &full time'

 programme in the epartment of """"""""""""""""""""""""""""""""""""".

$. The applicant is not eligible.

)emberA #dmission Committee )emberA #dmission Committee ChairmanA #dmission Committee

8/12/2019 Post 2014

http://slidepdf.com/reader/full/post-2014 5/6

  (FOR A#*SS*ON CO*""&&)

Ph. &(ull time' Ph. &Part time' Ph &ponsored'

)Tech &(ull time' )Tech &Part time' )Tech &ponsored'

)$# ).c.

0n the epartment of """"""""""""""""""""""""""""""""""""""""""""""""""""".

)emberA #dmission Committee )emberA #dmission Committee ChairmanA #dmission Committee

8/12/2019 Post 2014

http://slidepdf.com/reader/full/post-2014 6/6

Anne'+re ? *

#r B R Aed2ar National *nstit+te o$ "ec5nolo% =aland5ar

(For internal candidates onl)

A88*CA"*ON FOR FOR A#*SS*ON "O ."ec5 (8art tie/Sponsored)

85. # (F+ll tie/8art tie) 8ROGRA&

 

1. !ame and present Position """""""""""""""""""""""""""""""""""""  

2. 3hether regular or on contract basis """""""""""""""""""""""""""""""""""""  

. epartment/Centre """""""""""""""""""""""""""""""""""""  

. ate of Eoining the 0nstitute """""""""""""""""""""""""""""""""""""  

6. ate of Goining the present position """""""""""""""""""""""""""""""""""""  

. 0ndicators of esearch aptitude """""""""""""""""""""""""""""""""""""    a' #ny H proGect sanctioned/handled/ubmitted  &please enclose a copy of the sanction letter/proGect

 proposal'  b' 0f proGect under Thrust #rea of technical education """"""""""""""""""""""""""""""""""""" 

  sanctioned/handled/submitted &please enclose a copyof the sanction letter/proGect proposal'

  c' 0f any patent registered &Please enclose a copy of the """""""""""""""""""""""""""""""""""""   registration letter'

  d' !o. of esearch Publications in&i' 0nternational Eournals/Conferences """"""""""""""""""""""""""""""""""""" 

  &ii' !ational Eournals/Conferences&please attach the list' """""""""""""""""""""""""""""""""""""  

<. !o. of short term courses organi,ed/attended """""""""""""""""""""""""""""""""""""   &please attach the list'

=. !o. of monographs/boo%s publishedA if any """"""""""""""""""""""""""""""""""""" 

&please attach the list'

>. #ny other rele+ant information """""""""""""""""""""""""""""""""""""  

ate: ignature:

  !ame :

ecommendation of 7ead of the epartment:

 """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 

 """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 

 """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 

ate: ignature :

 !ame :

epartment: