<p>S. No…………………..</p><p>Paste your photograph in this space and attest it yourself Plot No.10, Institutional Area, Vasant Kunj, New Delhi 110 070</p><p>APPLICATION FOR ADMISSION TO Ph.D. PROGRAMMES</p><p>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 </p><p>Name of the Centre/Department in which admission is sought ______Proposed Status Full Part -Time Sponsored</p><p>NAME : (in block letters, as given in the qualifying degree certificate) (IN ENGLISH) ______(IN HINDI) ______</p><p>Sex Male Female Category (GEN/SC/ST/OBC) Date of Birth ______Nationality ______Father’s Name ______Mother’s Name ______Permanent Address ______Pincode Address for ______Correspondence ______</p><p>______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) ______</p><p>Duration of the course ______Year of passing ______</p><p>Discipline ______</p><p>Name of the University/Institute ______</p><p>Details of Marks/GPA/CGPA secured in the qualifying examination</p><p>I Semester II Semester</p><p>I year ______</p><p>II year ______</p><p>III year ______</p><p>IV year ______</p><p>Maximum marks of all the years/semesters ______</p><p>Marks secured ______</p><p>Aggregate % of marks (of all the years/semesters) ______CGPA ______</p><p>On a ______point scale</p><p>NB : In case where semester system is not followed, the marks should be indicated in the first part against each year. </p><p>Details of marks secured in the examinations other than qualifying examinations</p><p>Main subjects Institute/Universit Year of passing % of marks/CGPA</p><p> y</p><p>10+2</p><p>B.Sc.</p><p>M.Sc./M.A.</p><p>B.Tech</p><p>Others (specify)</p><p>Relevant examination (strike off whatever is not applicable) Appeared/qualified a. GATE b. CSIR-UGC: JRF/LS/SRF c. ARS NET</p><p>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)</p><p>Do you want to be considered for the award of assistantship Yes No</p><p>Two referees who are familiar with your academic background and their addresses (Please enclose their recommendations in the prescribed format in a sealed envelope)</p><p>(a) ______</p><p>(b) ______</p><p>EMPLOYMENT RECORD:</p><p>Name of Employer(s) Period of Employment Designation & Salary Nature of Duties</p><p>Note : Sponsored/Non-sponsored (full time) candidates must submit NOC/Sponsorship Certificate from their employer at the time of interview.</p><p>Certified that the information given above is correct to the best of my knowledge and belief.</p><p>Signature of the Candidate</p><p>Details of Bank Draft drawn in favour of “Registrar, TERI University”, payable at New Delhi, enclosed with this application:</p><p>Name of Bank ______Draft No. ______</p><p>Dated ______Amount Rs ______</p><p>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.</p><p>Place: ______Date: ______Signature of Applicant TERI UNIVERSITY</p><p>Recommendation</p><p>This Section to be filled in by the applicant (please print or type): Statement concerning First Middle Last</p><p>Name of the person writing recommendation: ______</p><p>Title and Department: ______</p><p>Address: ______</p><p>I. ACADEMIC EVALUATION Please rate the applicant relative to other students you have taught in recent years.</p><p>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</p><p>LEADERSHIP POTENTIAL</p><p>SUITABILITY FOR PROPOSED PROGRAMME</p><p>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.</p><p>Date ……………………………………… Signature …………………………</p><p>Please return this statement in a sealed envelope, signed across the sealed flap, to applicant for inclusion in his/her application materials. </p>