Scribd
Upload
48 views

Punjabi University, Patiala: M.Phil / Ph.D. Application-Cum-Entrance Test Form-I 2012-2013

(1) The document appears to be an application form for admission to the M.Phil and Ph.D. programs at Punjabi University in Patiala, India for the 2012-2013 academic year. (2) The multi-page form requests information such as personal details, academic history, reservation category, contact information, payment details, and an undertaking signed by the applicant. (3) Instructions are provided at the beginning regarding filling out the form correctly and prospective candidates are advised to review the university prospectus before applying.

Uploaded by

Harkulvinder Singh
Copyright
© Attribution Non-Commercial (BY-NC)
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
48 views

Punjabi University, Patiala: M.Phil / Ph.D. Application-Cum-Entrance Test Form-I 2012-2013

(1) The document appears to be an application form for admission to the M.Phil and Ph.D. programs at Punjabi University in Patiala, India for the 2012-2013 academic year. (2) The multi-page form requests information such as personal details, academic history, reservation category, contact information, payment details, and an undertaking signed by the applicant. (3) Instructions are provided at the beginning regarding filling out the form correctly and prospective candidates are advised to review the university prospectus before applying.

Uploaded by

Harkulvinder Singh
Copyright
© Attribution Non-Commercial (BY-NC)
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
You are on page 1/ 4

A

SIDE - 1

PUNJABI UNIVERSITY, PATIALA


M.Phil / Ph.D. Application-Cum-Entrance Test Form-I
2012-2013
Read the Instructions and Prospectus carefully (available on
University website) before filling up this form

PUNJABI UNIVERSITY PATIALA

7.PHOTOGRAPH

To be filled in English only

INSTRUCTIONS :
Write with BLACK OR BLUE BALL POINT PEN
in boxes using English Capital Letters & Numbers.

Wrong Marking
yes

one

2. Gender
1. Male
2. Female

Correct Marking

self attested recent


Passport Size

5. State of Domicile / Residence


1.Punjab

1.yes

Paste a
3.5cm X 4.5cm

4. Roll Number (To be filled


by office) ..........................
..........................................

1. Nationality
1. Indian
2. Others

3. Course you want to Apply for


1. M.Phil.
2. Ph.D.
3. Both

Photograph

2. Others

DO NOT STAPLE OR
PIN PLEASE

6. Subject/Course Applied Code


Choice-1

Choice-2

8. NAME OF THE APPLICANT ( Name must confirm to that in the Matriculation Certificate )

9. FATHERS / GUARDIANS NAME

10. MOTHERS NAME

11. Roll Number (GATE)

12. Score / Merit

13. Year of qualifying


Entrance Test

1. 2011
2. 2010
15. Do you wish to reside in the University
Hostel?
1. Yes

2. No

If you have been a resident earlier, give dates of stay .............

............................................................

18. Date of Birth


Month
Day

Year

17. Do you wish to be considered in any of the categories?

16. Have you been involved in


1. NCC

1. Yes

2. No

Rural

1. Yes

2. No

2. NSS

1. Yes

2. No

NRI

1. Yes

2. No

3. Youth
Activities

1. Yes

2. No

Single Girl Child

1. Yes

2. No

Sports

1. Yes

2. No

Youth Festivals /
Cultural Activities

1. Yes

2. No

If yes specify(Years)

...................................

Kashmiri Migrants

1. Yes

2. No

19. Is there any GAP in studies after Matric


Exam
1. Yes
2. No

20. Reservation Category


1. SC/ST
2. Backward Classes/OBC
3. Border Area
4. Backward Area
5. Wards of Political Sufferers /
Freedom Fighter
6. Disabled Persons - Blind

14. Specify Category


1. UGC-CSIR (NET) 4. GATE
5. Teacher Fellow
2. NET (JRF)
3. SLET
6. M.Phil.

7. Disabled Persons - Deaf & Dumb


8. Disabled Persons - Other Handicapped
9. Children / Widow of Defence Personnel /
10. Children / Widow of Para-Military Forces
Personnel
11. Riots Affected
12. Widow / Divorced Women
13. Sports

21. Mailing Address

Category - 1
(if applicable)

Category - 2
(if applicable)

Category - 3
(if applicable)

Category - 4
(if applicable)

22. Permanent Address

Name ...................................................................................................

Name ...................................................................................................

Address ................................................................................................

Address ................................................................................................

Email ....................................................................................................

..............................................................................................................

Mobile

Fathers Mobile

Phone No.
(with STD code)

Phone No.
(with STD code)

Pincode

Pincode

A
SIDE - 2

M.Phil / Ph.D. Application-Cum-Entrance Test Form-I, 2012-2013


23. ACADEMIC DETAILS

Name of
Examination

University / Board &


Year of Passing

Subject Studies

Marks Obtained / Max Marks

%age of Marks

............................................................

............................................................
Matriculation
............................................................

............................................................

............................................................
............................................................

............................................................
Graduation

............................................................

............................................................

............................................................
............................................................

............................................................
Post Graduation

............................................................

............................................................

............................................................

............................................................

Any Other

24. Mode of Payment


1. Demand Draft
2. University Cash Receipt
3. Cash Deposit at State
Bank of Patiala

In case of Demand Draft, DD Number

25. In case you have applied for M.Phil Punjabi please mention your location
preference (1,2) from the following :

Punjabi University, Patiala

Regional Centre, Bhatinda

Date ....... / ........ / .....................

UNDERTAKING
I .................................................................................. S/o, D/o Shri .....................................................................................................
age ................ year ...........................Month R/o .....................................................................................................................................
District .................................................. State .............................................................................. hereby declare / certify that the
above information is true to the best of my knowledge and belief and nothing has been concealed therein. I am fully aware of
the fact that if the information given by me proves to be wrong, I will be punished under law and I will be summarily expelled
from the institution where I had got admission on the basis of the false information.

Dated : ................................

Signature of the Candidate

M.Phil / Ph.D. Application-Cum-Entrance Test Form-I, 2012-2013

Ph D
Ph D
Ph D
Ph D

Ph D

Ph D

Ph D

Ph D
Ph D
Ph D

Ph D

Ph D
Ph D

Ph D
Ph D

M.Phil / Ph.D. Application-Cum-Entrance Test Form-I, 2012-2013

Ph D
Ph D
Ph D

Ph D

Ph D
Ph D
Ph D
Ph D

You might also like