Application No. Ph.D/Even/2011/....................................

JAYPEE INSTITUTE OF INFORMATION TECHNOLOGY, NOIDA (U.P.)
(Declared Deemed to be University u/s 3 of the UGC Act, 1956)

JAYPEE UNIVERSITY OF INFORMATION TECHNOLOGY, VAKNAGHAT (H.P.)
(Approved by UGC u/s 2(f) of UGC Act, 1956)

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JAYPEE UNIVERSITY OF ENGINEERING & TECHNOLOGY, GUNA (M.P.)
(Established under Madhya Pradesh Private University (Sthapana Avam Sanchalan) Samsodhan Adhiniyam 2010 vide Act No. 23 of 2010)

APPLICATION FORM FOR ADMISSION TO PHD. PROGRAM
Please fill in the Priority (Give serial e.g. 1,2,3) in the Boxes given against Programs :- ECE, CSE, Biotech, Bioinformatics, Pharmacy, PMSE, each Institute. Attach one Demand Draft of Rs. 500/- only, in favour of Physics, Maths, Civil, Chemistry & Chemical, Mechanical and JaypeeInstituteofInformationTechnology, PayableatNoida/Delhi. Management & Humanities. Choice of Institute JIIT (Noida) JUIT (Vaknaghat) JUET (Guna) Category (Tick ) Full Time Part Time# Sponsored@

Please Write Choice of Program
Please ensure that Institute you are opting is offering the Program (Details of program are available on website). @ Details of organization where serving & designation (attach separate sheet if required). # Part Time Ph.D programs in Engg. & Science are not available at JIIT, Noida

PLEASE FILL DETAILS IN CAPITAL LETTERS ONLY 1. Proposed Area of Work

2. 3. 4. 6.

Full Name Father’s Name Gender (tick ) Mailing Address M F 5. Date of Birth (DD/MM/YYYY)

State 7. 8. 9. Tele No. (Land Line) E-Mail ID Educational Qualification (Attach copy of marks sheet) Year of Passing 10th 12th Bachelor’s Master ’s Any Other Major Subject(s) Studied

Pin Mob

Board / University

% of Marks

P.T.O.

Publications.qualificationetc...... Project/Thesis details along with level as applicable 15. Enclosures (attach self attested photocopies of certificates) Important Dates Last Date for Submission of Application Form Entrance Exam Date of Interview - SIGNATURE 04 June.....IhavereadtheInformationBrochureandtheAdmissionprocedure andIshallabidebythem.Intheeventofsuppressionordistortionofanyfactlikedateofbirth.. Designation Company / Institute Duration 13.. Result of National level Exams (like SLET/UGC/CSIR(JRF) and attach copy of result card (Exemption from written test shall only be given if the candidate provides the proof for above exams). 2011 20 June...... if any 16.... No.herebydeclarethatalltheparticularsstatedinthisapplicationformaretruetothebestofmyknowledgeandbelief........myadmissionwouldstandcancelled. Any Training taken DeclarationbytheStudent: I.IalsounderstandthatthedecisionofJIIT/JUIT/JUETregarding myadmissionwillbefinalandbindingtome. 2011 18 June.............IamawareofUniversitiesapproachtowardraggingandthepunishmenttowhichIamliableiffoundguiltyofragging.. DATE. 11.nationality... Technical Skill Acquired 14.. Working Experience Ser..madeinmyapplicationform.category.10.. 2011 ..IunderstandthatIwill bedeniedtheopportunitytobeadmittedtoJIIT/JUIT/JUETandifalreadyadmitted... Membership of professional society 12.. PLACE........

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