Govt. of N.C.T.

of Delhi DELHI TECHNOLOGICAL UNIVERSITY

(Formerly Delhi College of Engineering)
Shahbad Daulatpur,Main Bawana Road, Delhi-42

APPLICATION FORM FOR ADMISSION TO THE Ph.D. PROGRAMME 2012-2013 Full-time /Part-Time Sponsored (Please tick
Application No.

Last date for receipt of application form is 08th May, 2012. Submit the completed Application to the Joint Registrar (Admin.), Delhi Technological University, Shahbad Daulatpur, Bawana Road, Delhi110042.

Area of research in order of preference (i) (ii) (iii) 1. 2.

Applicant's Name (in BLOCK LETTER) Postal Address

Paste (do not pin) your recent passport size photograph duly attested by a Gazetted Officer / Director of College last attended

3.

Contact Details Telephone No. Mobile No. 5. a) Sex(M/F) Year 7.Marital Status
Agg. Marks Obtained % age Subject

Email address b) Religion c)Nationality

4.

Date of Birth Day Month

6. Category (Please tick ST OBC GEN 8. Particulars of School and College Attended and Examination passed.
Examination a) b) c) d) e) f) g) High School SSCE or Equivalent B.Sc. or Equivalent B.Sc. Engg. / B.Tech./ B.E. or Equivalent AMIE or Equivalent M.Sc./ M.Tech or Equivalent Any other Board/University School/College Year of Passing

9. Details of Paper/Publications published(Attach separate sheet if required); S.No. Title/Topic of Research Name of the Single/Joint Published Journal Publication

Month Year of Publication

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 From Period 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. (If yes, please support the claim with relevant documents.) photocopies to be submitted at this stage).
(a) Mark-Sheet / Degree Certificate of all examinations passed. (b) Conversion formula if Result was in the form of Grades / C.G.P.A. (c) Proof of Date of Birth. (d) Certificate for SC / ST / OBC Candidates only. NOTE : Your Application will not be considered if not accompanied by appropriate certificate and documents.

Yes/No

16. Indicate the list of enclosures attached encircling the appropriate ones. (only attested / self attested
Yes/No Yes/No Yes/No Yes/No

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. :___________________________ Date of Issue:________________________________ Amount in Rs.:__________________________ Bank Name____________________________