You are on page 1of 3

MEWAR UNIVERSITY

CHITTORGARH, RAJASTHAN - 312 901, INDIA


APPLICATION FOR ENTRANCE EXAM. CUM ADMISSION

Ph.D. /Post Graduate Research Interated Programme


Session 2015-16
Application Form :

1. PERSONAL
NAME
FATHER'S NAME
MOTHER'S NAME
AGE
DOB
Female
Male

Date
Category

ARE YOU PHYSICAL DISABLED?

PGRI Programme

Ph.D. Programme

Month
General
Backward
No

Year
Scheduled
Caste

Please go through
guidelines before
filling this form.
Please affix your
self-attested
recent photograph

Scheduled
Tribe

YES, if yes, Please specify

PERMANENT ADDRESS

COMMUNICATION ADDRESS

PIN

STATE
with area code

Mobile

E-mail

2. Discipline of Study (i.e. Management, Education, Science etc. ................................


3. Topic of Intended Ph.D. Study (only for Ph.D. candidates)
(ENCLOSE a research proposal of about 2000 words (format attached); word processed, 12pt Times Roman
line space 1.5, A-4 size paper)

4. Whether Qualified
If Qualified

Discipline

UGC NET

SLET

M.Phil

ICRA Test

Certificate No. & Date (enclose copy)

I affirm that all entries in application and the appended documents ARE TRUE IN ALL ASPECTS and that the
STUDY PROPOSAL HAS BEEN PREPARED BY MYSELF. I understand that any information/document if found
to be false, shall automatically cancel my candidature and render me liable for such action as the University may
deem proper.

Candidate's Signature :
Date :

5. ACADEMIC RECORD Please encloses self attested copies of mark-sheets & Degree Certificate.
CLASS10th

YEAR OF
PASSING

CLASS12th

INSTITUTION

Science

Art

Commerce

YEAR OF
PASSING
BACHELOR'S
(SPECIFY)

DISCIPLINE
YEAR OF
PASSING

MASTER'S
(SPECIFY)

DISCIPLINE
YEAR OF
PASSING

M.Phil.

CBSE
ICSE
STATE BOARD
% of marks

Marks Obtained
Maximum Total
INSTITUTION

CBSE
ICSE
STATE BOARD
% of marks

Marks Obtained
Maximum Total
INSTITUTION

UNIVERSITY
% of marks

Marks Obtained
Maximum Total
INSTITUTION

UNIVERSITY
% of marks

Marks Obtained

DISCIPLINE
YEAR OF
PASSING

UNIVERSITY

INSTITUTION

% of marks

Marks Obtained

6. RESEARCH / TEACHING EXPERIENCE


FROM
TO
ORGANISATION

POSITION

7. PUBLICATIONS (us a separate sheet if necessary) Enclose copies/Reprints


Title Paper
Journal
Vol. Month & Year

JOB DESCRIPTION

Co Author if any

8. FEEDBACK : how did you come to know about the Programme


MU advertisement in
Press Announcement in
Friends

Own Institute

Internet
CHECKLIST OF ENCLOSURES

Signature of Candidate

mark & TAG in this order

i. Research Proposal

Copies of mark sheets

iii. Copies of Publications

DD for Rs. 1100/-

Date :

MEWAR UNIVERSITY
Ph.D. Entrance Examination 2015-16
ADMIT CARD (Office Copy)
Ph.D. Programme

PGRI Programme

NAME : ...........................................................................................................................................
FATHER'S NAME : ........................................................................................................................
Address for Correspondence : .........................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................

Please affix your


SELF ATTESTED
recent photograph

..........................................................................................................................................................
Contact No. : (M) .......................................................... (R) ...........................................................
Last Qualification with percentage : ................................................................................................
Choice of Examination Center :

Chittorgarh (RAJ.)

Ghaziabad (U.P.)

Lusaka

(Please tick one)

Candidate's Signature :

(For Office Use Only)


Application form checked and found eligible / not eligible / exempted for Entrance Examination.
Remarks :
......................................................................................................................................................................................
......................................................................................................................................................................................
......................................................................................................................................................................................
..................................................................................
Checker
A fee of Rs. 1100/- (Rs. One Thousand One Hundred only) received as Application form and
processing fee.
Receipt No......................................... Date : ............................ DD/Cash

Cashier

MEWAR UNIVERSITY
Ph.D. Entrance Examination 2015-16
ADMIT CARD (Student's Copy)
Ph.D. Programme

PGRI Programme

NAME : ...........................................................................................................................................
FATHER'S NAME : ........................................................................................................................
Discipline of Research : ..................................................................................................................
Subject in Post Graduation : ............................................................................................................

Please affix your


SELF ATTESTED
recent photograph

Contact No. : (M) .......................................................... (R) ...........................................................


Last Qualification with percentage : ................................................................................................
Choice of Examination Center :

Chittorgarh (RAJ.)

Ghaziabad (U.P.)

Lusaka

Roll No. :.................................................................... Time : ..........................................................


Candidate's Signature :

University
Seal with
Signature

You might also like