Visvesvaraya National Institute of Technology, Nagpur

South Ambazari Road, Nagpur 440 011

Application form for admission to Ph. D. Program

June 2013
(Preference will be given to Full Time Ph.D. Scholars by the Department)
Payment Details (To be submitted along with processing fee of Rs 500/-):
DD No
Date
Amount
Name of bank on which DD is drawn

Admission Category (Tick the appropriate)

1. Ph.D. (Full Time) with Teaching
Assistantship
3.

2.

Ph.D. (Full Time) Sponsored*

Ph.D. (Part Time)

*: Sponsored candidates will be required to submit a separate sponsorship certificate given in

Annexure I in the brochure.
Instructions:

All entries should be type written / written in capital letters only.

Strike out whichever is not applicable.

Photo

Name of Department / Discipline :

1. Name of the candidates in full (as

per last qualifying examination mark

________________________________________________
________________________________________________

sheet / grade card)

2. Address for Communication

________________________________________________
________________________________________________
Ph (STD): ________________Mob:___________________
Email : __________________________________________

3. Office Address (applicable in case

________________________________________________

employed) with designation

________________________________________________
Ph (STD): ______________Mob:_____________________

4. Date of Birth

VNIT Nagpur

______________________(DD/MM/YY)

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5. Academic Record (starting from graduation and onwards examinations)

SN

NAME OF EXAMINATION
PASSED / TITLE OF DEGREE

YEAR OF
PASSING

NAME OF THE UNIVERSITY.

DIVISION /
PERCENTAGE OF
MARKS / CPI OBTAINED

3
4

6. Appeared GATE in the past?

Yes / No

If YES then
Year of passing the GATE
7. Whether NET qualified

Score
Yes / No

Year of passing the NET

Mention the area in which you are
interested to carry your research
(non-mandatory)

:
________________________________________________
________________________________________________
________________________________________________

DECLARATION BY THE CANDIDATE

I hereby declare that the information submitted above is correct. If selected, I promise to abide by rules
and regulations of the institute in force and amended from to time. I have read the rules/ordinances of the
program for which I am applying and promise to abide by that.
Date :
(Signature of the Candidate)
EMPLOYERS CERTIFICATE
Mr/Ms. _____________________________________ is permitted to undertake the research work
proposed in this application at VNIT, Nagpur for the award of Ph. D. Degree.

Date :
Seal of organization

VNIT Nagpur

(Signature of the Employer)

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