ADMISSION FORM

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Please tick the program you are applying for:

o
Part-time PhD (Management)
Energy
o
Oil & Gas
o
Power

Transportation
o
Aviation
o
Port & Shipping

Infrastructure
o
Infrastructure
o
Logistics & Supply Chain

o
Part-time PhD (Engineering/Science)
Energy

Transportation

Oil & Gas

Aerospace
o
o
Power
Port & Shipping
o
o
Health, Safety & Environment
o

Affix
Photograph

Infrastructure
Infrastructure
o
Information Technology
o

o
Part-time PhD (Legal Studies)

Personal Details:
IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please mention N/A wherever not applicable

1. Name (in Block Letters): ......................................................................................................................................................

2. Date of Birth: M M D D Y

Gender

3. Correspondence Address: ....................................................................................................................................................

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4. Permanent Address: .............................................................................................................................................................
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5. Telephone (Res.):

Mobile:

6. Email: .....................................................................................................................................................................................
7. Nationality: ............................................................................................................................................................................
8. Occupation: ............................................................................................................................................................................
9. Name of the Company: .........................................................................................................................................................
10. Designation: .........................................................................................................................................................................
11. Employers Address: ...........................................................................................................................................................
.....................................................................................................................................................................................................
12. Telephone (Off.):

Educational Qualifications
Stream/Degree

%/Grade

Year of Passing

Board/University

From

To

Class X
Class XII
Graduation
Post Graduation
Any Other

Work Experience
Designation

Name of the Organization

Years of Experience
From

To

Licenses Obtained (if any) - Technical/Non-technical

Agency

Name

Validity

Your interest in joining UPES?

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Special Achievements
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How did you hear about us?

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Website

o
Newspaper

o
Emailer

o
SMS
o
Magazine

o
Any Other .......................................

Declaration
I hereby state that the information given above is true to the best of my knowledge. In case any information is found to be incorrect, my candidature is liable to be
cancelled by the University. I shall abide by the rules and regulations of the University of Petroleum and Energy Studies, including dress code, and expected
behavioral norms in line with the Universitys special charter. I shall ensure timely payment of all applicable dues.

Date:

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Students Signature

INFORMATION FORM FOR IDENTITY CARD

IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please fill in BLOCK LETTERS.

1. Name of the Program:

o
Part-time PhD (Management)
Energy
o
Oil & Gas
o
Power

Transportation
o
Aviation
o
Port & Shipping

Infrastructure
o
Infrastructure
o
Logistics & Supply Chain
Affix
Photograph

o
Part-time PhD (Engineering/Science)
Energy

Transportation

o
o
Oil & Gas
Aerospace
o
o
Power
Port & Shipping
o
Health, Safety & Environment

Infrastructure
o
Infrastructure
o
Information Technology

o
Part-time PhD (Legal Studies)
2. Duration of the Program: January 1, 2013 to January 1, 2016
3. Enrollment No. (For Office use only): E
4. Students Name (in English Capital Letters): .........................................................................
........................................................................................................................................................
5. Fathers Name: ......................................................................................................................................................................
6. Mothers Name: .....................................................................................................................................................................
7. Correspondence Address: ....................................................................................................................................................
.....................................................................................................................................................................................................
........................................................................................................... Pin
8. Permanent Address: .............................................................................................................................................................
....................................................................................................................................................................................................
............................................................................................................ Pin
9. Telephone (Res.):

Mobile:

10. Telephone (Off.):

11. Emergency Contact No.:
12. Blood Group:

Authorized Signatory

Specimen Signature of the Student

INSTRUCTIONS FOR SENDING THE ADMISSION FORM

PhD Programs
Please send the filled in Admission Form along with:
1. Non-refundable Admission Form fees of `2,000/- (through demand draft) in favor of UPES,
payable at Dehradun.
2. Xth & XIIth class certificates and mark sheets (photocopies should be self attested).
3. Graduation certificate & mark sheets (photocopies should be self attested).
4. Post graduation certificates & mark sheets (photocopies should be self attested).
5. Any other degree/diploma/certificates (as mentioned in the application form).
6. 1 copy of Research Proposal
7. Bio-Data
8. 2 passport size photographs.
9. Work experience certificate(s).
10. Completed ID form.
All these documents should reach us at the earliest at the following address:
Mr. Vikas Narula
Dy. Director (Marketing)
Centre for Continuing Education
vnarula@upes.ac.in
University of Petroleum & Energy Studies
Marketing & Communication Office
PHD Chamber of Commerce & Industry
3rd Floor, PHD House, 4/2, Siri Institutional Area
August Kranti Marg
NEW DELHI 110 016
Tel: +91-11-41730151-53
Fax: +91-11-41730154

www.cce.upes.ac.in