Ekksrhyky usg: jk"Vh; izkS|ksfxdh laLFkku bykgkckn bykgkckn&211004 Hkkjr

MOTILAL NEHRU NATIONAL INSTITUTE OF TECHNOLOGY ALLAHABAD

ALLAHABAD 211004 (INDIA) APPLICATION FORM FOR ADMISSION TO PH.D. Application for Ph.D. Full Time
Name of the Department/Cell/Centre/School: 1. 2. 4. 5. 6. 7. Full Name (in capital): Date of Birth : Nationality: Fathers Name : Mothers Name : Address for Correspondence: ________ 3. Sex: Male
Female

Paste a recent Self-Attested Passport-Sized Photograph here

Part Time

Course code
Mark tick ( ) in appropriate Box

10. Category (A) Open (OP) (B) SC (C) ST (D) OBC (E) OBMC (F) Physically Handicapped

State: e-mail address: Phone No (with STD Code) Mobile No. 8. 9. 11.
SN 1 2 3 4

Pin Code:

Details of Demand Draft: b) Issuing Bank & Branch

a) Amount.. No. ....... Dated: _____(Enclose a copy of score card)

Subjects

/2012 City ______________________

GATE Score (percentile, if any ): Academic Qualification:

Examination 10th or equivalent 12th or equivalent Graduation (Specify) _________________ Any other (Specify) _________________ Board/University

Year

Marks/Grade and Percentage

12. i. ii. iii. iv. v. vi. vii. 13.

CHECKLIST: ENSURE THAT FOLLOWING ARE ENCLOSED WITH THE APPLICATION FORM

TICK ( )

The Demand draft of requisite amount in favour of Director, MNNIT Allahabad payable at Allahabad ----------------------Photocopy of High School (Class Ten) Certificate ----------------------------------------------------------------------------------------Photocopy of SC/ST/ OBC/OBMC Persons with Disability Certificate(in central Govt. Format), if applicable ------------Photocopies of mark/grade sheets of graduation/pre final year------------------------------------------------------------------------Certificate of sponsorship (If applicable)-----------------------------------------------------------------------------------------------------No. Objection certificate from employer (If applicable)-----------------------------------------------------------------------------------Certificate from the University concerning method of conversion of CGPA/CPI to percentage -------------------------------Declaration by the applicant: Certified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any wilful misrepresentation of facts will result in cancellation of my admission and dismissal from the Institute. If admitted, I shall abide by all the rules and regulations of the Institute.

Date:

/ d d /

/ m m /

Signature of the applicant

The Application Form, complete in all respects must reach at following address by May 25, 2012 up to 5.30 PM Address for Correspondence: Admission Cell Office of the Dean (Academic) Motilal Nehru National Institute of Technology Allahabad Allahabad 211004, Uttar Pradesh, India Phone: 0532-2271109,10 Email: admissions@mnnit.ac.in