Motilal Nehru National Institute of Technology

Allahabad – 211004, India

Application form for admission to Ph.D. Programme 2010-2011

1. Programme applied: Ph.D

2. Name of the Department/Cell/Centre/School: ___________________________________________

3. Full Name of the candidate: ____________________________________________

Paste your
recent
4. Date of Birth: __________________ 3. Sex: Male/Female passport
size
5. Father’s Name:_______________________________________________________ photograph

6. Nationality:________________________

7. Address for Correspondence (use block letters):_________________________________________

_________________________________________________________________________________
_____________________________________________________________Pin Code: ___________
Email ID: _______________________ ________ Contact number(Mobile)___________________
8. Detail of Demand Draft:
Amount Rs. ________ DD No. ___________ Date: __________ issuing bank and branch: _________
__________________________________________________________________________________
9. Category: General/OBC/SC/ST
(For OBC/ SC/ST category please attach relevant certificate issued by competent authority.)
10. Whether physically handicapped: Yes/No
(If yes, please attach certificate issued by the competent authority.)
11. Area of Research/ Area of Specialisation in the Department/Programme Specialisation (in order
of preference. Please refer Information Brochure for Ph.D programme.)
i) ______________________________________________________________________________
ii) ______________________________________________________________________________
iii) ______________________________________________________________________________
iv) ______________________________________________________________________________
v) ______________________________________________________________________________
12. Programme category: ____________________________________________________________
(Please refer Information Brochure)
Programme category code:

1
13. Educational qualification starting with the qualifying degree:

S. Examination Institute University Division Percentage/

No. Passed CGPA

14. Work experience:

Name of the Employer Position Dates (from-to) Nature of Work

15. Paper Publication/Research Experience/Short-term courses/Any other:

Please attach separate sheet with details.

16. 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 willful misrepresentation of facts will result in my dismissal from the
institute. If admitted, I shall abide by all the rules and regulations of the institute. I also agree that any
dispute arising out of my admission shall be subject to jurisdiction of the Courts of Allahabad. I also
undertake to be responsible for a good conduct and discipline in the Institute.

Place:
Date: Signature of the applicant
17. Certificate and forwarding note of the Employer (for those who are employed)
a. *Our Institution to which the applicant Mr./Ms………………………… belongs, is recognized
by AICTE (for Institution in India).
b. The applicant is a full-time regular/permanent faculty member / employee of our Institution /
Organization and is not on deputation to any other Institution/ Organization. The applicant has
……………….. years of teaching / work experience.
c. The applicant will be relieved full-time for the program during the tenure of his/her studies, if
selected for admission. The organization has no objection for his/her admission in Ph.D.
programme of MNNIT – Allahabad.
d. **Mr./Ms………………………….is being sponsored to get admission in Ph.D.
*For those who are teaching faculty.
** For sponsored candidates only
Office Seal:
Date: Signature of the employer
Instructions:
(i) Read carefully the Information Brochure before filling the form.
(ii) The status of application will be available in our website (www.mnnit.ac.in). Please check regularly the updates. You have to come
on the date for interview as mentioned in the Information Brochure if short listed. No separate interview letter shall be issued.
(iii) The filled up application should be dispatched/submitted at the following address:
Head of <Write - Name of the Department/Cell/Centre/School>Department
Motilal Nehru National Institute of Technology
Allahabad – 211004, INDIA.