Form No.

Doctoral Programme in Management

Application Form-2014
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Instructions
1. This form is an integral part of the admission process. Please provide correct
information. Admission granted on incorrect information will be ispo facto null and
void.
2. Fill in the application form legibly. Incomplete forms shall not be considered.
Applicants
3. Please attach true copies of certificates and mark sheets to this form.
Photograph
4. In all matters regarding admission to the programme, the decision of the
University will be final and binding on the applicant. No correspondence from
the applicant with respect to his/her non-selection will be entertained. The
admissions process at the University shall be subject to the Jurisdiction of the
courts of Ahmedabad.
5. *Form no. will be assigned by the Admissions office and the detail will be emailed to you.
6. The candidate who has passed The National Level Exam UGC / SLAT / Teacher
Fellowship / M.Phil or equivalent is not required to appear in the University Written Test.
7. Completed application form should be returned latest by April 30, 2014.
8. Enclose a draft for Rs. 1000/- drawn in favour of Institute of Management, Nirma University
payable at Ahmedabad. The Application fee is not refundable.

Demand
Draft
Details

Bank Name

Demand Draft
No

Demand Draft Date

A. PERSONAL DETAILS
Name (Block Letters):
_______________________________________________________________________
(As per your Last Marksheet)
Address (For
Correspondence):________________________________________________________________
________________________________________________________________________________
__________
________________________________________________________________________________
__________
City
:___________________________
________________________

Pin _______________

State :

Telephone : ________________________________
Mobile________________________________________
E-mail (Block Letters)
(1)____________________________________________________________________

(2)____________________________________________________________
________
Gender
:
Male [ ]
Female [
Group:_________________________________

Blood

Date of Birth: Date _____ Month _______ Year ______

_____ years

Age (as on May 31, 2014):

Nationality:_________________________ Caste
(GEN/OBC/ST/SC):_________________________________
Fathers/ Guardians Name:
_________________________________________________________________

B. EDUCATION
Yes

Have you completed your Masters Degree?

Name of Examination
(mention degree)

University

Year
of
Passi
ng

No

Major Subjects

Marks
Obtained
Average
Total
%

Class/
Division
Awarded
for the
Degree

Bachelors Degree

Masters Degree

Other Degree/
Examination

National Level Test

Like UGC / SLAT /
Teacher Fellowship
holder / M.Phil. etc. or
its equivalent

C. WORK EXPERIENCE (ONLY FULL-TIME JOB)

Sr.
No.

Position

Organisation

From
(month/year)

Period
To
(Month/year)

Total No. of
Months

D. SCHOLASTIC ACHIEVEMENTS (Prizes, distinctions, medals, etc.)

________________________________________________________________________________
__________
________________________________________________________________________________
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________________________________________________________________________________
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E. OTHER SIGNIFICANT ACHIEVEMENTS

________________________________________________________________________________
_________
________________________________________________________________________________
_________
________________________________________________________________________________
_________
________________________________________________________________________________
_________

F. RESEARCH EXPERIENCE (LIST SCHOLARLY PRESENTATIONS, PUBLICATIONS,

STUDIES, ETC.)
________________________________________________________________________________
_________
________________________________________________________________________________
_________

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________________________________________________________________________________
_________
________________________________________________________________________________
_________
(You may enclose an extra sheet, if needed)

G. FUTURE PLANS
1. What are your future career plans? Why would you like to join the Ph.D.?
________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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2.

Do you have any tentative ideas on the theme that you would like to explore for your Ph.D.
dissertation?

________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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H. ANY OTHER INFORMATION THAT YOU MAY WISH TO PROVIDE IN SUPPORT OF

YOUR APPLICATION?
________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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________________________________________________________________________________
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I.
CHOICE OF WRITTEN TEST CENTRE : (PLEASE MARK CLEARLY ONLY
ONE CENTRE)
1.
3.

Ahmedabad
( )
2.
New Delhi
( )
Jaipur
( )
4.
Mumbai
( )
The Institute reserves the right to cancel any of the centres at its discretion.

DECLARATION
I have carefully read the instructions and agree to abide by the decision of the Institute regarding my
selection to the programme. I certify that the information furnished in this application form is correct
to the best of my knowledge and belief.

Place: ________________________
Date: ________________________
__________________________
Signature of the Applicant

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ADMISSION TEST ADMIT CARD - 2014

Doctorate Programme in Management
Form No:_______________

The applicant
is required to
affix a recent
passport size
photograph
and sign

Name :_______________________________________

Test Date

: May 04, 2014

Time: 03:00 PM

Test Centre : Ahmedabad \ New Delhi \ Jaipur \ Mumbai

___________________
Signature of Candidate

________ _________
Deputy Registrar