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Govt. of N.C.T. of Delhi

DELHI TECHNOLOGICAL UNIVERSITY(Formerly Delhi College of Engineering)

Shahbad Daulatpur,Main Bawana Road, Delhi-42

APPLICATIONFORM FORADMISSIONTO THE Ph.D. PROGRAMME 2012-2013

Full-time /Part-Time Sponsored (Please tick

Last date for receipt of applicationform is 08th May, 2012. Submit the completed Application to the

Joint Registrar (Admin.), Delhi Technological University, Shahbad Daulatpur, Bawana Road, Delhi-

110042.

Area of research in order of preference

Application No.

(i)

Paste (do not pin)

your recent

passport size

photograph duly

attested by a Gazetted

Officer / Director of

College last attended

(ii)

(iii)

1. Applicant's Name (in BLOCK LETTER)

2. Postal Address

3. Contact Details

Telephone No. Mobile No. Email address

4. Date of Birth 5. a) Sex(M/F) b) Religion c)Nationality

Day Month Year

6. Category (Please tick ST OBC GEN 7.Marital Status

8. Particulars of School and College Attended and Examination passed.

Examination Board/University School/College Year ofPassing

Agg. Marks

Obtained% age Subject

a) High Schoolb) SSCE or Equivalent

c) B.Sc. or Equivalent

d) B.Sc. Engg./B.Tech./B.E. or Equivalent

e) AMIE or Equivalent

f) M.Sc./ M.Tech orEquivalent

g) Any other

9. Details of Paper/Publications published(Attach separate sheet if required);

S.No. Title/Topic of Research

Published

Name of the

Journal

Single/Joint

Publication

MonthYear of

Publication

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10. Have you been employed, if so give the following particulars (Attach separate sheet if required);

Name of the Organization and Address Post Held Nature of Duties PeriodFrom To

11.Present employment Status (Employed/Not Employed) _________________________

12. Father's / Husband's Name

13. Mothers Name

14. Permanent Address

15. Whether candidate is opting for exemption from entrance exam. Yes/No

(If yes, please support the claim with relevant documents.)

16. Indicate the list of enclosures attached encircling the appropriate ones. (only attested / self attested

photocopies to be submitted at this stage).

(a) Mark-Sheet / Degree Certificate of all examinations passed. Yes/No

(b) Conversion formula if Result was in the form of Grades / C.G.P.A. Yes/No

(c) Proof of Date of Birth. Yes/No

(d) Certificate for SC / ST / OBC Candidates only. Yes/No

NOTE : Your Application will not be considered if not accompanied by appropriate certificate and documents.

UNDERTAKING BY THE CANDIDATE

(a) I hereby certify that the foregoing particulars are correct and I agree that admission may be granted to me on the terms, condition, rules and

the calendar of the Delhi Technological University or such modifications thereof as may be made by authorities concerned from time to time. I

understand that my admission may be cancelled and tuition fee paid by me forfeited if any of the particulars given by me in this application are

subsequently found to be wrong.

(b) I agree that Vice-Chancellor's decision in all matters concerning my admission, studies, discipline and conduct will be final and binding on me.

(c) On admission I undertake to submit myself to the disciplinary jurisdiction of the Vice-Chancellor and the authorities of the University.

(d) I understand that my association, active or passive, with any unlawful organization is forbidden.

(e) I certify that I am not registered as a provisional student of any other University.

(f) I agree that the University shall have the right to forfeit the security deposits inter alia on the ground of my failure to claim the refund within

three years of the date of my ceasing to be on the rolls of the University.

Date......../........../2012 Signature of the Applicant

Details of Demand Draft(Attach D.D in original) :

Demand Draft No. :___________________________ Amount in Rs.:__________________________

Date of Issue:________________________________ Bank Name____________________________