National Institute of Technology, Uttarakhand

Application Form for Admission to Ph.D. Programme

(Full Time (Sponsored) & Part Time only)
(Particulars to be filled by the Candidate only)

Particulars of the Online transaction

Transaction ID: ______dated Paste recent passport

size color photograph
Rs._________ here

1. Admission for the year: ODD Semester -2020.

2. Registration No: (For office use only)

3. Department / Subject in which Admission being applied for: (Please choose one with a tick)

Civil Engineering Computer Science and Engineering

Electronics Engineering Electrical Engineering
Mechanical Engineering Mathematics
Chemistry English
Physics
4. Area of specialization of the student in Master Degree:………………………………………………
5. Broad Area in which the candidate intends to work in the Ph.D. Programme.
1. …………………………………………………………………………………………………………
2. …………………………………………………………………………………………………………

6. Full name in Capital Letters: (as mentioned in the qualifying degree certificate)–
(keep one block blank between two words)

7. Date of Birth:(as per matriculation or equivalent certificate):

(Original certificate should be produced at the time of interview) (DD MM YYYY)

8. a) Category (Gen./ Gen-EWS/OBC–NCL / SC / ST):……………b) Physical Disabled (Yes / No): ……..

c) Marital Status (Single / Married): ……………

9. Gender (Male /Female): …………………… 10. Nationality:………………………

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11. Contact details*:

(a) Address for Correspondence / Present (b) Permanent Address:

Address:

City: Pin City: Pin

Code Code
State: State:
Telephone Number (with STD Mobile Number E-mail Address(s)
Code)

* It is the responsibility of the candidate to intimate change of address.

* Are you JRF Qualified(?): Yes No
If yes, then type of JRF:
Year of qualifying JRF:

12. Wish to pursue Ph.D. under (Please tick): Full-Time (Sponsored) Part-Time

Full Time Ph.D. Scholar’s Categories:

A. Sponsored Research Scholar (SRS) from
i. Industry / Research Organization/Project only
ii. CSIR/UGC/DST

SRS (Sponsored Research Scholar): Sponsored by:

13. Details of Educational Qualification from Matriculation onwards

(Original certificates should be produced at the time of interview)
Name of
Degree Year of % of Marks Class /
Specialization University /
obtained Passing / CGPA Division
Institute

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 14. Details of examinations like GATE or NET (CSIR/UGC/LS) or any other equivalent examination.
(Original certificates should be produced at the time of interview).
Number of
Name of Year of Validity Marks Score /
candidates AIR Rank
Examination Passing Period obtained Percentile
appeared

15. Details of Professional Work / Research Experience (in years & months):………..Years…………Months.
(Original certificate should be produced at the time of interview).
Date Nature of Work /
Organization Designation
From To Responsibilities

16. Present Employment status: (Employed / Not Employed):………………………………………….

If employed, then details of the employer:………………………………………………………
…………………………………………………………………………………………………..………..

17. Details of the Bachelors and Master’s Thesis (as applicable).

Name of the Name of the

Year of submission Title
University / Institute Supervisor

18. List of Publications*,if any(attach a separate sheet if required).Mention in the order of giving
name(s) of author(s), title of paper, details of the journal / conference, year, volume, page numbers, SCI/Non-
SCI Journals.

1.

2.

3.

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 19. Any other relevant information:
(Attach a separate sheet)

20. Contact Details of the Referees: (The referees may be contacted telephonically or through e-mail
to comment on your academic or professional capabilities)
Particulars Referee 1 Referee 2
Name
Designation
Organization
Office Address

Office Telephone (with STD

Code) / Mobile
E-mail

21. Declaration:
I do hereby solemnly declare that the information given above is correct to the best of my knowledge
and belief. I have read the Ordinances, Rules & Regulations for this program and undertake to abide
by them, and also to abide by the amendments made from time to time. I am not pursuing any
Degree/Diploma program at any of the Institutes/ Universities, and also will not pursue such a
program during the period of my Ph. D. Programme this Institute. I am also aware that providing
incorrect information in the application form and violation of norms of the Institute can result in the
cancellation of my admission at any stage. I also promise to refund the entire Fellowship amount
drawn by me in case I discontinue the Programme at any stage before completion.

Date: Signature of applicant:

Place: Name of the applicant:

The following Certificates/Degrees/Documents are enclosed along with the application form. (Please
enter the details of all the documents attached serial-wise)

Sr. Details of document Attached

No. (Yes/No)

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 Statement of Purpose (Attach separate sheet for details, if required)

Statement of Purpose (SoP) is an opportunity for the applicant seeking admission to the
Ph.D. Programme at NIT Uttarakhand, to share your thoughts with the Admissions
Committee about why you want to pursue Ph.D. studies. While writing the SoP, Please describe
briefly about the last project / research work done by you. The personal SoP will aid the
Admission Committee in evaluating your application.

Place: Signature of applicant:

Date: Name of the applicant:

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 NO OBJECTION-CUM-SERVICECERTIFICATE*

(CERTIFICATE TO BE SIGNED BY THE COMPETENT AUTHORITY/ HEAD OF THE INSTITUTE, IF COMPETENT)

I hereby certify that the application of Mr./Ms…………………………………………for admission to the

Ph.D. program, as a part-time scholar, at National Institute of Technology, Uttarakhand, is being
made with my consent and permission. He/ She has been serving in (Name of Institute/
Department) …………………………………………………...as……………………………………….
since…………………on……............................. basis. I also certify that the post on which he/she is
working in the Institute/Department is a Teaching/Non-Teaching post.

Mr./Ms……………………………………………….shall be relieved for the period required to be

spentatNITUttarakhandtocompletehis/herPh.D.requirements(includingcoursework,ifany).
Further certified that his/ her official duties permit him/ her to devote sufficient time for research.

*For self-sponsored research candidate and persons working in Central Govt./State Govt./PSU/
Autonomous Organizations.

Place………….. Signature of the Competent Authority/Head of

the Institute, if competent.

Dated…………. Name ………………………………………………

Seal: