Mk- Ckh vkj vECksMdj jk"Vh; izkS|

ksfxdh laLFkku]
tkyU/kj &144011
Dr B R AMBEDKAR NATIONAL INSTITUTE OF TECHNOLOGY,
JALANDHAR - 144011

APPLICATION FORM FOR ADMISSION TO

PhD/MTech/MBA/MSc PROGRAMMES 2014-2015 4
S.No.________
Application Fee : Rs.1000/- (Gen/OBC/Sponsored), Rs.500/- (SC/ST)
*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.

Self attested
Passport size
PHOTOGRAPH

Details of Registration fee:

Demand Draft No._________________

1.

Amount_______________ Bank/Branch ____________________

Programme to which admission sought (Please Tick)

(i)

2.

Dated ________________

Ph. D (Full time)

(i)

M.Tech (Part time)

(ii) Ph. D (Part time)

(ii)

M.Tech (Sponsored)

(iii) Ph D (Sponsored)

(iii)

MBA

(iv) M.Tech (Full Time)

(iii)

M.Sc

Discipline of study/Area of specialization

_________________________________

(AS PER ADVERTISEMENT)

3.

Department

_________________________________

4.

Whether you are an INTERNAL CANDIDATE?

_________________________________

5.

Name in full (in block letters as per matriculation certificate)

(In English)

_________________________________

(In Hindi)

_________________________________

6.

Fathers Name

_________________________________

7.

Mothers Name

_________________________________

8.

Date of Birth (as per matriculation certificate)

_________________________________

9.

Nationality

_________________________________

10. (a) Category (General/SC/ST/OBC/PH/Minority)

_________________________________

(Category once chosen shall not be changed at any stage)

(b) Sponsored (In-service)

Yes

No

11. Correspondence Address with telephone, Mobile No.

________________________________________
and Email
________________________________________
________________________________________
STD Code_______No._____________________
Mobile No _____________________________
Email___________________________________
12. Permanent Home Address with telephone, Mobile No.
________________________________________
and Email
________________________________________
STD Code_______No._____________________
Mobile No _____________________________
Email___________________________________
13. Educational Qualifications:
(In case of Internal candidates, additional information to be provided as per enclosed Performa, Annexure-I)
Examination

Year of
passing

Institution

University

Subject(s)

Marks
obtained/
Max Marks

%age of
marks (upto
one decimal
with division

10th
10+2
B.Sc/B.E./B.Tech
M.Sc
M.Phil/
M.Tech

Any
other
Exam.
14.

15.

(a)

Whether qualified in GATE/JRF etc.

____________________

(b)

If yes, GATE/JRF score:____________________ Year of passing___________________ Date of Validity ____________________

Experience (only for sponsored candidates) in chronological order starting form the latest:

Sr No.

Name of organization with address

From

To

Total
Period

16.

Was there any gap in your studies? If yes, mention period and reason:
a) Period (give dates) From________________To_______________
b) Reasons______________________________________________

17.

Have you passed the qualifying examination in the first attempt:

Yes/No

List of Enclosures:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Application Fee (Demand Draft)

Matric/Higher Secondary Part-I certificate (as proof of age)
+2 Examination certificate
B.Sc./B.Tech/B.E. Examination certificate indicating the detail marks
M.Sc. (as applicable) Examination certificate indicating the detail marks
M.Tech/M.Phil (of applicable) Examination certificate indicating the detail marks
Character certificate from the Head of the Institution last attended
Certificate in support of claim under reserved category on the prescribed Performa
No objection certificate from Employer (for sponsored candidates only)
GATE/JRF qualifying certificate
Medical certificate from a Medical Officer/SMO/CMO of a Govt. Hospital
Original Migration Certificate*
Write up (1-2 pages) on proposed area of research (for PhD candidates only)

Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No

UNDERTAKING BY THE APPLICANT

I clearly understand that my admission to_______________programme in the Department/Discipline of ____________________________
is SUBJECT TO THE RULES AND REGULATIONS OF Dr B R Ambedkar National Institute of Technology Jalandhar. I also
understand that the admission is being allowed to me on the basis of the certificates and documents produced by me. I also undertake
that the certificates and documents produced by me in original are correct, genuine and true to the best of my knowledge. If any
information/documents/particulars is found to be forged or false at any stage in future, then the NIT Jalandhar can cancel my admission
and all the fees deposited by me shall be forfeited. If any degree will be awarded based on my admission on the basis on my forged
documents then that certificate/degree awarded by NIT, Jalandhar shall be automatically cancelled. In such case, I shall have no claim,
whatsoever, in respect of my admission.
Witness:

1. (Full Signature of Witness with Address)

2. (Full Signature of Witness with Address)

(Full Signature of Parent/Guardian)

(Full Signature of Candidate)

Dated:
Place:
*Students may submit within one month after admission.

______________________________________________________________________________________________________
(FOR OFFICE USE ONLY)
The application form/documents has been checked and verified.
A.

The applicant is eligible for admission to M.Sc./MBA/M.Tech (Part-Time/Full Time/Sponsored)/Ph. D (part time) / Ph. D. (full time)
programme in the Department of _____________________________________.

B.

The applicant is not eligible.

Member, Admission Committee

Member, Admission Committee

Chairman, Admission Committee

(FOR ADMISSION COMMITTEE)

Ph.D (Full time)

Ph.D (Part time)

Ph D (Sponsored)

MTech (Full time)

MTech (Part time)

MTech (Sponsored)

MBA

M.Sc.

In the Department of _____________________________________________________.

Member, Admission Committee

Member, Admission Committee

Chairman, Admission Committee

Annexure I
Dr B R Ambedkar National Institute of Technology Jalandhar

(For internal candidates only)

APPLICATION FORM FOR ADMISSION TO M.Tech (Part time/Sponsored)
Ph. D (Full time/Part time) PROGRAMME
1.

Name and present Position

_____________________________________

2.

Whether regular or on contract basis

_____________________________________

3.

Department/Centre

_____________________________________

4.

Date of Joining the Institute

_____________________________________

5.

Date of joining the present position

_____________________________________

6.

Indicators of Research aptitude

a) Any R&D project sanctioned/handled/Submitted
(please enclose a copy of the sanction letter/project
proposal)
b) If project under Thrust Area of technical education
sanctioned/handled/submitted (please enclose a copy
of the sanction letter/project proposal)
c) If any patent registered (Please enclose a copy of the
registration letter)
d) No. of Research Publications in
(i) International Journals/Conferences
(ii) National Journals/Conferences
(please attach the list)

_____________________________________

7.

No. of short term courses organized/attended

(please attach the list)

_____________________________________

8.

No. of monographs/books published, if any

(please attach the list)

_____________________________________

9.

Any other relevant information

_____________________________________

Date:

_____________________________________
_____________________________________
_____________________________________
_____________________________________

Signature:
Name

Recommendation of Head of the Department:

_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

Date:

Signature

Name

Department: