Plot No.10, Institutional Area, Vasant Kunj, New Delhi 110 070

S. No…………………..

Paste your photograph in this space and attest it yourself Plot No.10, Institutional Area, Vasant Kunj, New Delhi 110 070

APPLICATION FOR ADMISSION TO Ph.D. PROGRAMMES

1. DO NOT SEND ANY ATTESTED COPIES OF CERTIFICATES WITH THIS FORM. BRING ORIGINAL AND ATTESTED COPIES OF THE DEGREE CERTIFICATE/ MARKSHEET(S)/EXPERIENCE CERTIFICATES AT THE TIME OF INTERVIEW 2. FILLING OF FALSE INFORMATION WILL LEAD TO CANCELLATION OF ADMISSION 3. Tick ( ) the relevant box wherever provided 4. An application which is incomplete in any respect is liable to be rejected 5. This form must be accompanied with a demand draft of Rs. 1250/- favoring “The Registrar, TERI University” payable at New Delhi

Name of the Centre/Department in which admission is sought ______Proposed Status Full Part -Time Sponsored

NAME : (in block letters, as given in the qualifying degree certificate) (IN ENGLISH) ______(IN HINDI) ______

Sex Male Female Category (GEN/SC/ST/OBC) Date of Birth ______Nationality ______Father’s Name ______Mother’s Name ______Permanent Address ______Pincode Address for ______Correspondence ______

______Pincode Tel. No. with STD code : ______Fax No. e-mail address: ______ACADEMIC RECORD Name of the qualifying examination (M.Tech./M.Phil./ M.Sc./M.A./B.Tech. etc) ______

Duration of the course ______Year of passing ______

Discipline ______

Name of the University/Institute ______

Details of Marks/GPA/CGPA secured in the qualifying examination

I Semester II Semester

I year ______

II year ______

III year ______

IV year ______

Maximum marks of all the years/semesters ______

Marks secured ______

Aggregate % of marks (of all the years/semesters) ______CGPA ______

On a ______point scale

NB : In case where semester system is not followed, the marks should be indicated in the first part against each year.

Details of marks secured in the examinations other than qualifying examinations

Main subjects Institute/Universit Year of passing % of marks/CGPA

M.Sc./M.A.

B.Tech

Others (specify)

Relevant examination (strike off whatever is not applicable) Appeared/qualified a. GATE b. CSIR-UGC: JRF/LS/SRF c. ARS NET

Year appeared ______Percentile/Other score ______Discipline chosen in GATE / NET ______Awards and scholarships received (if any) ______Any other relevant information, which you want to furnish ______Proposed area of research (Title) ______Write a paragraph on why you want to do research and how your past experience is relevant to the field of research (Please attach a separate sheet)

Do you want to be considered for the award of assistantship Yes No

Two referees who are familiar with your academic background and their addresses (Please enclose their recommendations in the prescribed format in a sealed envelope)

(a) ______

(b) ______

EMPLOYMENT RECORD:

Name of Employer(s) Period of Employment Designation & Salary Nature of Duties

Note : Sponsored/Non-sponsored (full time) candidates must submit NOC/Sponsorship Certificate from their employer at the time of interview.

Certified that the information given above is correct to the best of my knowledge and belief.

Signature of the Candidate

Details of Bank Draft drawn in favour of “Registrar, TERI University”, payable at New Delhi, enclosed with this application:

Name of Bank ______Draft No. ______

Dated ______Amount Rs ______

DECLARATION BY THE APPLICANT: If selected for admission, I undertake to abide by the rules and regulations of TERI University. I certify that the information given above is correct and I am aware that providing incorrect information in the application form may result in the cancellation of admission secured. I am further aware that, if the admission is secured before the results for the qualifying examination are published and if I fail to satisfy the minimum academic requirement for admission when such results become available, the admission will be cancelled.

Place: ______Date: ______Signature of Applicant TERI UNIVERSITY

Recommendation

This Section to be filled in by the applicant (please print or type): Statement concerning First Middle Last

Name of the person writing recommendation: ______

Title and Department: ______

Address: ______

I. ACADEMIC EVALUATION Please rate the applicant relative to other students you have taught in recent years.

Poor Fair Good Excellent Exceptional Unable to Bottom Middle Top third Top 10% Among 2 or Judge third third 3 best students ACADEMIC PERFORMANCE INTELLECTUAL ABILITY

LEADERSHIP POTENTIAL

SUITABILITY FOR PROPOSED PROGRAMME

3. Please comment on the applicant’s intellectual and personal attributes. Our Admissions Committee gives careful attention to your comments. Use additional pages if necessary.

Date ……………………………………… Signature …………………………

Please return this statement in a sealed envelope, signed across the sealed flap, to applicant for inclusion in his/her application materials.