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Form No. _ _ _ _ _ _ _ _ _ _ _ _ _ _
TEZPUR UNIVERSITY
APPLICATION FORM
For admission to Spring Semester 2013
Controller of Examinations
1. Category of candidature
sought (Please tick 9)
Full time
Part time
Sponsored
(i)
(ii)
(iii)
(Provide one page write up on your area of interest)
a) i) ......................................................................................................
ii) Occupation
ii) ......................................................................................................
b) i) Mothers Name
b) i) ......................................................................................................
ii) Occupation
ii) ......................................................................................................
..........................................................................................................................
6. Correspondence Address
..........................................................................................................................
..........................................................................................................................
Pin : ................................................ E-mail : ...................................................
Phone No (with STD code): ..............................................................................
..........................................................................................................................
7. Permanent Address
(if different from the above)
..........................................................................................................................
..........................................................................................................................
Pin : ................................................ E-mail : ...................................................
Phone No (with STD code): ..............................................................................
11. Religion:
12. Category (Please tick 9)
Gen
SC
ST
OBC (NCL)
PWD*
KM**
** Kashmiri Migrant
13. Are you employed? (Please tick 9) : Unemployed / Employed temporarily / Employed permanently
(If employed, Employers Sponsorship / No Objection Certificate in prescribed format should be attached)
14. Gender :
(M / F) :
Form No. _ _ _ _ _ _ _ _ _ _ _ _ _ _
TEZPUR UNIVERSITY
APPLICATION FORM
For admission to Spring Semester 2013
Controller of Examinations
1. Category of candidature
sought (Please tick 9)
Full time
Part time
Sponsored
(i)
(ii)
(iii)
(Provide one page write up on your area of interest)
a) i) ......................................................................................................
ii) Occupation
ii) ......................................................................................................
b) i) Mothers Name
b) i) ......................................................................................................
ii) Occupation
ii) ......................................................................................................
..........................................................................................................................
6. Correspondence Address
..........................................................................................................................
..........................................................................................................................
Pin : ................................................ E-mail : ...................................................
Phone No (with STD code): ..............................................................................
..........................................................................................................................
7. Permanent Address
(if different from the above)
..........................................................................................................................
..........................................................................................................................
Pin : ................................................ E-mail : ...................................................
Phone No (with STD code): ..............................................................................
11. Religion:
12. Category (Please tick 9)
Gen
SC
ST
OBC (NCL)
PWD*
KM**
** Kashmiri Migrant
13. Are you employed? (Please tick 9) : Unemployed / Employed temporarily / Employed permanently
(If employed, Employers Sponsorship / No Objection Certificate in prescribed format should be attached)
14. Gender :
(M / F) :
Remarks
HSLC
(10th std)
10+2 std.
Degree*
PG
Others
* Please mention the name of the Degree e.g. BSc / BA / BV Sc / BE etc.: if appeared enter the marks secured in last examination.
18. Have you qualified UGC-CSIR NET - JRF / SRF / NET (LS) / SET / GATE ? If yes, give score : .....................
19. Academic Distinction / Medals / Prizes, if any :
(May attach extra sheet, if required)
: ............
:
22. Any other point you wish to add that will support your candidature for the Programme including your
publication (may attach extra sheet, if required)
..
Full signature of the candidate
Date: ..
Enclosures check list (tick whichever is applicable):
1.
2.
3.
4.
5.
Valid SC / ST / NCL (OBC) certificate / Person With Disability (PWD) certificate (if applicable). Recent (issued not
earlier than 6 months) Non-Creamy Layer certificate( NCL) is a must in case of candidate claiming seat under OBC
category,
Sponsorship / No Objection Certificate (if applicable),
Bank Draft of prescribed amount (if the form is downloaded),
Attested photocopies of the certificates supporting educational and other qualifications.
Acknowledgement cum Admit card
_________________________________________________________________________________________
N. B. No acknowledgement will be sent for non-eligible candidates.
Eligibility fulfillment is the responsibility of the candidate. Please Note the eligibility criteria carefully.
Form No.
For Ph.D. Programme
Date:
Signature________________________________
Place:
Name___________________________________
Designation______________________________
2.
TEZPUR UNIVERSITY
Ph.D. Entrance Examination for Spring Semester - 2013
Form No...............................
To be filled by candidate
Offering Department
Paste one
recent
passport size
colour
photograph
...............................................................
...............................................................
...............................................................
...............................................................
Candidates Signature
To be filled by Office
Name and Address of
Examination Centre
TEZPUR UNIVERSITY
Ph.D. Entrance Examination for Spring Semester - 2013
Form No...............................
To be filled by candidate
Offering Department
...............................................................
...............................................................
...............................................................
Paste one
recent
passport size
colour
photograph
...............................................................
Candidates Signature
To be filled by Office
Name and Address of
Examination Centre
To :
The Head,
Dept. of .....................................................
Tezpur University
Napaam, Tezpur
Pin : 784 028
Dist : Sonitpur, Assam