Form No.

Ph. D Programme in Management/Engineering

Application Form
Instructions
1. This form is an integral part of the admission process. Please provide correct information. Admission
granted on incorrect information will be ipso facto null and void.
2. Fill in the application form legibly. Incomplete forms shall not be considered. 3.
Please attach true copies of certificates and mark sheets to this form.
4. In all matters regarding admission to the programme, the decision of the University will be final and
binding on the applicant. No correspondence from the applicant with respect to his/her non-selection will be
entertained. The admission process at the University shall be subject to the Jurisdiction of the courts of
Jaipur.
5. Enclose a demand draft for Rs. 500/- drawn in favour of "JK Lakshmipat University" payable at Jaipur. The
Application fee is non-refundable.
DD Details:
DD No.:

Bank:

Date:

A. Personal Details
Name (Block Letters): ______________________________________________________________________
First Name
Middle Name
Last Name
Address
(For Correspondence):

_________________________________________________
_________________________________________________

PHOTO

_________________________________________________
____________________________ Pin _________________
Telephone (with STD Code): ____________________ Fax: ________________
Mobile:

...

E-mail:

Gender:

Male

Female

Blood Group: ______________

Date of Birth:

Date ________ Month ________ Year ________

Age (as on 1.6.2012): __________ years

Nationality:
Father's /Guardian's Name:

___________________________________________________________
____________________________________________________

B. Education
Have you completed your Master's Degree?

Name of Examination
(mention degree)

University

Yes

Year

Major Subjects

No

Max.
Marks

Marks
Obtained
Total

Class/
Division
Awarded
for the
Degree

Master's Degree

Bachelor's Degree

Other Degree/
Examination

C. Work Experience (Only Full-Time Job)

Sr.
No.

Position

Organisation

From
(month/year)

Period
To
(Month/year)

Total No. of
Months

D. Research Experience
(List scholarly presentations, publications, studies etc.)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
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(You may enclose extra sheets, if needed)
E. Scholastic Achievements
1. Prizes, distinctions, medals etc.
_________________________________________________________________________________________
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_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

F. Other Significant Achievements

_________________________________________________________________________________________
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_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

G. Future Plans
1. What are your future career plans? Why would you like to join the Ph. D. Programme?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

2.

Do you have any tentative idea/s on the theme that you would like to explore for your Ph.D. Thesis?

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

H.

Any other information that you may wish to provide in support of your candidature?

_________________________________________________________________________________________
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_________________________________________________________________________________________
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I. Declaration
I have carefully read the instructions and agree to abide by the decision of the Institute regarding my selection to
the programme. I certify that the information furnished in this application form is correct to the best of my
knowledge and belief.

Place: ________________________

Date:

________________________

__________________________
Signature of the Applicant