SHRI MATA VAISHNO DEVI UNIVERSITY

Sub Post Office 182320, Katra, J&K.

[Recognised under section 12(B) & 2(f) of the UGC Act, 1956]

APPLICATION FORM FOR ADMISSION

PH.D. PROGRAMME
2011-2012

1. Area of Research:

Affix a recent
passport size
photograph here &
attach five more
with this form

2.

Name in full:________________________________________________________________________________
(In block letters as mentioned in matriculation certificate)

3.

Date of Birth: ___________________/________________________/______________________________

(Date)
(Month)
(Year)

4.

Name of the Father/ Guardian___________________________________________________________________

5.

Mothers Name ______________________________________________________________________________

6.

Permanent Address: (Street Address)_____________________________________________________________

(District)_________________________________(State)________________________ (Pin Code)____________
Phone____________________________________ Fax______________________________________________
(With STD code)
(With STD code)
Mob
Email

7.

Address for Correspondence: (Street Address)______________________________________________________

(District)__________________________________(State)________________________ (Pin Code)___________
Phone__________________ ________________
Fax
(With STD code)
Mob
Email

8.

State of Domicile: _____________________________

9.

Nationality: _________________________________

10. Please check (tick) the relevant box : Gender

(With STD code)

MALE

11. Please check (tick) the relevant box : Martial Status

Married

12. Please check (tick) the relevant box : Category : SC

ST

13. Medium of Instruction : English Medium

14. Whether Handicapped? Yes

No

FEMALE
Unmarried
OBC

Gen

Hindi Medium
If Yes, indicate whether physically /visually/any other .

15. *Bank Demand Draft Drawn on: ________________________________

Amount in Rs.___________________
(*This item pertains to the cost of the application form. In case the form is downloaded from internet, please attach a DD of Rs.
1000/-, in favour of, Registrar SMVDU, payable at Jammu.)
No:____________________________________

16. Educational Background:

Arts

Commerce

Date:___________________________________
Engineering/Technical
Science
(Please check (tick) the relevant box)

Others

17. Academic Qualifications: [Attach a separate sheet if space provided is insufficient]

School
Certificate/
Degree

Name of the
University/
Institution/
Board

Major Subjects

Year of
Passing

Marks

Obtained

Division/
Class

Percentag
e of
Marks

Out Of

Matriculation
(10th)
Higher
Secondary /
Intermediate
(10+2)
Bachelors
Degree

Masters
Degree

Technical
Qualification
(If Any)
18. Scholarships, Prizes, Medals and Awards you have received on the basis of your academic performance and/or any competitive
examinations at national/state level:

19. Details of extra - curricular activities:

20. Work Experience: [Attach a separate sheet if space provided is insufficient]

Organization

Designation

Duration
From

Salary

Reasons for leaving

To

21. Language Proficiency: [Please check (tick) the relevant box]

Language
English
Hindi

Read

Write

Speak

Foreign [Specify]

22.

List of Enclosures: [Please attach self attested copies of documents as proof against claims made / information divulged in the
application form.]
1: ________________________ 2: ________________________ 3: __________________________
4. ________________________ 5: ________________________ 6: __________________________
7. ________________________ 8: ________________________ 9: __________________________

I declare that the information given in this application form is complete and true to the best of my knowledge. I understand that if this
information is found incomplete / false, at any stage of the aforesaid Masters Program, it will lead to cancellation of my admission. I
also agree to comply with all the rules of the University.
Place: ___________________________
Date: ___________________________

(Signature of the Applicant)

-----------------------------------------------------------------------------------------------------------------------------------------------------------------For Office Use Only

Name & Designation of receiving officer / official

Place: ___________________________
Date: ___________________________

PS : Please fill separate form for each program applied.

(Signature)