INFORMATION REGARDING ADMISSION TO

FULL TIME Ph.D.(TECHNOLOGY) IN

ELECTRONICS & TELECOMMUNICATION
ENGINEERING

FOR THE ACADEMIC YEAR 2014-2015

APPLICATION FORM FOR ADMISSION TO Ph.D.(TECHNOLOGY)

in
Electronics & Telecommunication Engineering
Academic Year 2014 - 15

PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING THIS FORM :

INFORMATION OF CANDIDATE
1.

Full Name in Capital Letters

__________________________________________

2.

Date of Birth

__________________________________________

3.

Full Name of Father/

Guardian

__________________________________________

4.

Guardians relation with

applicant

__________________________________________

5.

Permanent Address

__________________________________________
__________________________________________
__________________________________________
__________________________________________

6.

Telephone No. with STD code

__________________________________________

Mobile No.

__________________________________________

Email ID

__________________________________________

Present Address
(for Communication)

__________________________________________
__________________________________________
__________________________________________
__________________________________________

Telephone No. with STD code

__________________________________________

Mobile No.

__________________________________________

Email ID

__________________________________________

7.

Do you belong to Reserved

Category (SC/ST/DT/NT).
If yes, specify category and
name of caste

Yes / No

8.

Score in PET
examination

__________________________________________

9.

Year and month of

qualifying PET examination

__________________________________________

10. Name of qualifying Post

Graduate Degree
Examination

__________________________________________

11. Whether passed final Post

Graduate Degree
Examination in first attempt

Yes / No

12. Name of Institution and

University from which Post
Graduate degree is obtained

__________________________________________

13. Month and Year of passing

Post Graduate Degree
Examination

__________________________________________

__________________________________________

14. Marks obtained in Post Graduate Degree Examination :

Semester

Marks Obtained

Grand Total

Overall % and class

Obtained

Ist Year
IInd Year

15. Details of Professional Experience :

Sr.
No.
1.

Name of the Industry/ Organization /Institution

Period of Working
From

To

2.
3.
4.
5.

16. Address of Present

Employer

__________________________________________
__________________________________________
__________________________________________
__________________________________________

Telephone No. with STD Code

__________________________________________

17. Copies of the following certificates should be attached strictly in order given below. (Tick
against the certificates attached)
(i)

Post Graduate Degree Passing Certificate

(ii)

Statement of marks of Post Graduate Degree

exam. (of all years/semesters)

(iii)

Statement of marks of Degree

exam. (of all years/semesters)

(iv)

PET score card (if applicable)

(v)

CONCOL letter for getting exemption (if applicable)

(vi)

Certificates showing experience claimed

(vii)

Certificate or any proof of Indian Nationality

(viii)

Institution Leaving Certificate

(After qualifying examination)

DECLARATION BY THE CANDIDATE

The information given by me in this application is true to the best of my knowledge and belief. I
understand that if any of the statements made by me in the application form or any information
supplied by me in connection with my admission is later on at any time found to be false or incorrect,
my admission will be cancelled, fees forfeited and I may be expelled from the college by the
Principal.
I have not been debarred from appearing at any examination held by any Government constituted or
statutory examination authority in India.
I fully understand that the offer of a course will be made to me depending on my inter se merit and
availability of a seat at the time of scrutiny of my application, when I will actually report to the
admission authority according to the schedule of admission. I am aware that college authority will not
make any correspondence with me regarding admission. I am also aware that it is entirely my
responsibility to see the notice board / website of the college.
I hereby agree to conform to any rules, acts and laws enforced by Government and I shall not
undertake any act either inside or outside the college which may result in disciplinary action against
me under these rules, acts and laws referred to. I understand that the Principal of the college has the
right to expel me from the college for any infringement of the rules of conduct and discipline
prescribed by the college or the university or Government and infringement of the undertaking given
above.
I am fully aware that I will not be allowed to appear for the examination if I do not attend 75% in
theory and practical. I am also aware that I will not be allowed to appear for the examination if I fail
to submit satisfactory assignments, jobs, journals, drawings, reports as specified by the University
within stipulated time limit.
I hereby agree that my admission to the First Year Ph.D.(Technology) in your college is provisional
and it is liable to be cancelled if not approved by the University of Mumbai or the Directorate of
Technical Education, Maharashtra State for any reason, and that I shall abide by the decision taken by
the College/University of Mumbai/Directorate of Technical Education, Maharashtra State in the
matter.

Date:

Signature of the Candidate

Place

Name of the Candidate

INSTRUCTIONS TO CANDIDATES
GENERAL
1.

Please read the complete application form carefully before filling it up.

2.

Fill in the application form legibly and submit the same at the college Administration
Office. The envelope should be super scribed Application for admission to
Ph.D.(Technology) in Electronics & Telecommunication.

3.

In the event of admission being offered, the candidate will have to produce provisional
eligibility certificate from the University of Mumbai before admission is confirmed.

4.

Candidates from other Universities, who join the institute on the basis of the provisional
statement of eligibility from the University of Mumbai, must produce the necessary
certificates required by the University for confirmation of eligibility within one month
from the date of their admission. Failure to do so may lead to possible cancellation of
admission.

5.

The application must be accompanied by necessary certified true copies/Xerox copies of

certificates as mentioned in the application form. Do not attach originals of certificates.

6.

Eligibility:
a) As per University of Mumbai rules for Ph.D.(Technology) Degree.
b) The candidate should have passed the qualifying entrance examination for
Ph.D.(Technology).