Application No. Ph.D/Even/2012/....................................

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. 700/- only, in favour of Physics, Maths, Civil, Chemistry, Chemical, Mechanical, Management JaypeeInstituteofInformationTechnology, PayableatNoida/Delhi. and Humanities & Social Sciences. 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). @ Attach separate certificate as per Annexure-1. # Part Time Ph.D programs in Engg. & Sciences are not available at JIIT, Noida.

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

2. 3. 4. 6.

Full Name Fathers 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 Bachelors Master s Any Other Major Subject(s) Studied

Pin Mob

Board / University

CGPA/% of Marks

P.T.O.

10.

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).

11.

Membership of professional society

12.

Working Experience Ser. No. Designation Company / Institute Duration

13.

Technical Skill Acquired

14.

Project/Thesis details along with level as applicable

15.

Publications, if any (Attach separate sheet if required)

16.

Any Training taken

Declaration by the Student: I, hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read the Information Brochure and the Admission procedure and I shall abide by them. In the event of suppression or distortion of any fact like date of birth, nationality, category, qualification etc. made in my application form, I understand that I will be denied the opportunity to be admitted to JIIT/JUIT/JUET and if already admitted, my admission would stand cancelled. I also understand that the decision of JIIT/JUIT/JUET regarding my admission will be final and binding to me.I am aware of Universities approach toward ragging and the punishment to which I am liable if found guilty of ragging.

DATE............................. PLACE............................ Enclosures (attach self attested photocopies of certificates)

Important Dates Last Date for Submission of Application Form Entrance Exam and Interview -

SIGNATURE

26 May, 2012 02 June, 2012

for shortlisted candidates based (Based on written test or those who direlty qualify based on SLET/UGC/CSIR(JRF) exam)

Annexure-1

CERTIFICATE
(For Sponsored Candidates only)

1.

It is certified that Mr./Ms. ............................................................................... S/o/D/o. Sh. ................................................................... is currently working with ......................................................................................................... (Name of organization or Institution) in the designation ......................................................................... Since ........................

2. 3.

The organization has no objection to his/her applying for the Ph.D program with the Jaypee Education System institutions (JIIT-Noida/ JUIT-Waknaghat / JUET-Guna). It is also certified that, the candidates, if selected, shall be spared for the Ph.D program as and when required by the Institutes, in that the candidate shall be allowed to attend all the classes for the course(s) work and also interact regularly with the supervisor or DPMC as an when required or as per laid down periodicity or attend the seminars etc as per laid down schedules, by the institutes.

(Signature) Name of Head of Organization Designation Date Place ............................................. ............................................. ............................................. .............................................

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