Postgraduate Institute of Agriculture

Ref. No. (for office use only)

Please affix 4cm x 3cm color POSTGRADUATE INSTITUTE OF AGRICULTURE Photograph UNIVERSITY OF PERADENIYA (Background should be sky blue) APPLICATION FOR ADMISSIONS - 2017 IMPORTANT:  Employees of government department, corporations or private enterprises should submit their applications through the respective head of the institute/ corporation/ enterprise.  Only photocopies of certificates in support of age (English version of the birth certificate) and educational/ professional qualifications should be annexed to this application.  Students applying for M.Phil. / Ph.D. should submit their research proposal and research budget together with the application.  Incomplete applications in any respect will be rejected.

1. National ID / Passport No:

Rev. / Mr. / Miss. / Mrs. / Dr.

Name with initials:

Full name:

(Your name should be tallied with the name appearing in the birth certificate and note that this is how your name will appear in your degree certificate. Further, you should submit the english version of the birth certificate.)

2. Home address:

Telephone: Mobile No:

Personal email:

Official address:

Telephone: Email:

Address for correspondence (Home/Official):

,,, Deputy Registrar should be informed immediately of any changes in contact details:

Date of birth: Place of birth:

Nationality: Sex : Male Female

3. Present employment (Name of designation):

4. Name and address of employer:

5. Employment record (List your most recent position first):

Name and address of Period Position / Rank Nature of duty employer From To 8. Proposed programme of study: Please refer to section 2,4 and 5 of the student hand book and prospectus before completing this section. Board of Study Name of the Degree Program Offered Tick off () only ONE (01) program M.Sc. Degree in Plant Biology Conservation and Breeding (CW) M.Sc. Degree in Plant Biology Conservation and Breeding (CW & R) Agricultural Biology M.Sc. Degree in Biotechnology (CW) M.Sc. Degree in Biotechnology (CW & R) M. Phil Ph. D. M.Sc. Degree Agricultural Economics (CW) M.Sc. Degree Agricultural Economics (CW & R) M.Sc. Degree Environmental Economics (CW) M.Sc. Degree Environmental Economics (CW & R) Agricultural Economics M.Sc. Degree Natural Resource Management (CW) M.Sc. Degree Natural Resource Management (CW & R) PG Diploma in Development Practice & Management M. Phil Ph. D. M.Sc. in Agricultural and Bio-Systems Engineering (CW) M.Sc. in Agricultural and Bio-Systems Engineering (CW & R) M.Sc. in Geo-Informatics (CW) M.Sc. in Geo-Informatics (CW & R) Agricultural Engineering M.Sc. in Integrated Water Resources Management (CW) M.Sc. in Integrated Water Resources Management (CW & R) M. Phil Ph. D. M.Sc. Degree in Development Communication & Extension (CW) M.Sc. Degree in Development Communication & Extension (CW & R) M.Sc. Degree Organizational Management (CW) Agricultural Extension M.Sc. Degree Organizational Management (CW & R) M. Phil Ph.D. M.Sc. Degree in Animal Science (CW) M.Sc. Degree in Animal Science (CW & R) M.Sc. Degree in Aquatic Bio-Resource Mgt. & Aquaculture (CW) M.Sc. Degree in Aquatic Bio-Resource Mgt. & Aquaculture (CW & R) M.Sc. Degree in Dairy & Meat Product Technology (CW) Animal Science M.Sc. Degree in Dairy & Meat Product Technology (CW & R) M.Sc. Degree in Poultry Science & Technology (CW) M.Sc. Degree in Poultry Science & Technology (CW & R) M. Phil Ph. D. M.Sc. Degree in Applied Statistics (CW) M.Sc. Degree in Applied Statistics (CW & R) M.Sc. Degree in Bio-Statistics (CW) Bio-Statistics M.Sc. Degree in Bio-Statistics (CW & R) PG Diploma in Applied Statistics M. Phil Ph. D. Master of Business Administration (CW) Master of Business Administration (CW & R) Business Administration DBA Ph. D. M.Sc. Degree in Crop Science (CW) M.Sc. Degree in Crop Science (CW & R) M.Sc. Degree in Environmental Forestry (CW) M.Sc. Degree in Environmental Forestry (CW & R) M.Sc. Degree in Floriculture and Landscape Architecture (CW) M.Sc. Degree in Floriculture and Landscape Architecture M.Sc. Degree in Tropical Agriculture (CW) Crop Science M.Sc. Degree in Tropical Agriculture (CW & R) M.Sc. Degree in Plantation Crop Management (CW) M.Sc. Degree in Plantation Crop Management (CW & R) M.Sc. Degree in Horticulture (CW) M.Sc. Degree in Horticulture (CW & R) M. Phil. Ph. D. M.Sc. Degree in Food & Nutrition (CW) M.Sc. Degree in Food & Nutrition (CW & R) Food Science & M.Sc. Degree in Food Science & Technology (CW) Technology M.Sc. Degree in Food Science & Technology (CW & R) M. Phil. Ph. D. M.Sc. Degree in Molecular and Applied Microbiology (CW) M.Sc. Degree in Molecular and Applied Microbiology (CW & R) M.Sc. Degree in Plant Protection Technology (CW) Plant Protection M.Sc. Degree in Plant Protection Technology (CW & R) M. Phil Ph. D. M.Sc. Degree in Environmental Soil Science (CW) M.Sc. Degree in Environmental Soil Science (CW & R) M.Sc. Degree in Topical Soil Management (CW) M.Sc. Degree in Topical Soil Management (CW & R) Soil Science M.Sc. Degree in Soil & Environmental Microbiology (CW) M.Sc. Degree in Soil & Environmental Microbiology (CW & R) M. Phil Ph. D. Note: CW- Course Work CW & R – Course Work & Research.

9. References: (Give names and addresses of two referees, at least one of whom should have been your teacher at the university)

Name :...... Name :...... Address :...... Address :...... Email ...... Email ...... Contact no...... Contact no......

Note: Forms for referee reports annexed hereto should be handed over to the referees indicated above. They should be requested to send their reports duly perfected, directly to the Director, Postgraduate institute Of agriculture under confidential cover. However, if the sealed envelopes are given to you personally, Such reports should be attached to the application.

I do hereby declare that particulars provided by me in this application are true and accurate to the best of my knowledge, and that I am not registered for any postgraduate degree program in any university in Sri Lanka at the time of this application. In the event of my being selected for the program of study I have applied for, I hereby agree to abide by such regulations of the institute as applicable to me.

Date: ...... Signature of applicant