Application Form Fee Rs.

100
UNIVERSITY OF MUMBAI
DEPARTMENT OF COMPUTER SCIENCE
APPLICATION FORM FOR ADMISSION TO M.PHIL./PH.D. – INTERVIEW
(As per circular no. Exam/COE/Thesis/2891 of 2011 dated 21st April, 2011)

To,
The Head, Recent
Department of Computer Science passport size
University of Mumbai, Vidyanagari colour
Santacruz (East), Mumbai – 400098 photograph

Madam,
I hereby apply for interview for admission to the M.Phil./Ph.D. (Computer Science) in the Department of
Computer Science. I am giving below the necessary particulars:

1. Name: __________________________________________________________________________________
SURNAME FIRST NAME FATHER’S/HUSBAND’S NAME MOTHER’S NAME

2. (a) Sex: _________ (b) Marital Status: ____________ (c) Religion: ___________ (d) Nationality: ___________

3. (a) Date of Birth: _______________________ (b) Place of Birth: ________________________

4. Local Address: ____________________________________________________________________________

_______________________________________________________________________ PIN _____________

5. Permanent Address: _______________________________________________________________________

_______________________________________________________________________ PIN _____________

6. Telephone No.: _____________________ Mobile No.: ____________________ /_______________________

E-Mail: _______________________________________________________________________ ___________

7. Category: GEN  SC  ST  DT  NT1  NT2  NT3 

OBC  SBC  PH  MINORITY  Caste: ____________________

8. Particulars of Qualification: (Graduation and onwards)

Month and Year Marks Obtained / Name of the
Examination Subject
of Passing Out of College/University
9. Employed/Unemployed (if employed, give details): ______________________________________________
________________________________________________________________________________________

10. Have you gained any professional experience in the subject after obtaining Master’s Degree? If yes, give
details (attach necessary certificates): _________________________________________________________
(i) Name of the Institution where professional experience was gained: ______________________________
_____________________________________________________________________________________
(ii) Period of professional experience: _________________________________________________________
(iii) Nature of professional experience: ________________________________________________________
_____________________________________________________________________________________

11. Topic of interest for Ph.D./M.PHIL, if any: ____________________________________________________

________________________________________________________________________________________
________________________________________________________________________________________

12. Basis on which admission is sought (attach necessary certificates): ________________________________

________________________________________________________________________________________

I hereby declare that the above entries made by me are correct to the best of my knowledge.

Place: ______________ _____________________

(Signature of the Student)
Date: _______________