MODY INSTITUTE OF TECHNOLOGY & SCIENCE

(Deemed University under section 3 of U.G.C. Act, 1956)

FACULTY OF ENGINEERING & TECHNOLOGY

LAKSHMANGARH-332311, Dist. SIKAR (RAJASTHAN), INDIA
Phone: +91-1573-225001 (12 Lines), 09214288001-8004 Fax: +91-1573-225042
E-mail: dean.fet@mitsuniversity.ac.in Website: www.mitsuniversity.ac.in

APPLICATION FORM FOR Ph.D.

Please
affix a
Passport
Size
Photograph

Session: 2011-2012

1.

Name of the Candidate (Last Name First):

2.

Father's Name (Last Name First):

3.

Mother's Name (Last Name First):

4.

Address for Correspondence:

Cit y:

Pin:

State:
5.

Phone No. with STD Code: ......................................................

7.

E-mail ID: .................................................................................. 8. Blood Group: ....................................

9.

Date of Birth:

10.

Nationality:

11.

If Foreigner/NRI/PIO, Passport No.: ......................................12. Religion: ...............................................

13.

Guardian's Name & Occupation: ....

14.

Guardian's Annual Income: ..

15.
16.

Category you belong to:

Accommodation:

Day
Indian

Month
NRI

PIO

SC
ST
Hostel Seat Required

6. Mobile: .................................................

Year
Foreigner, Country...........................

OBC
GENERAL
Own Arrangement

17.

Application Fee Details (in case of downloaded form):

DD No.: .......................................................... Bank: .......................................................
Amount: .......................................................... Date: ........................................................

18.

RESEARCH CATEGORY APPLIED FOR:

FULL TIME RESEARCH STUDENT/ SCHOLAR
PART TIME RESEARCH STUDENT/ SCHOLAR
1. Govt. /Semi Govt./ ICCR Fellowship Awarded Candidate
2. Sponsored Candidate
3. Self-financed Indian Candidate
4. Self-financed Foreign Candidate

19.

ACADEMIC RECORDS:
Exam Passed

Year

Division/
CGPA

Board/University

Percentage
(Aggregate)

X
XII
All certificates/ diploma/ degrees beyond 10+2

20.

RESEARCH/ WORKING EXPERIENCE:

Institution worked at

Year

Period
From

Position held
To

21. Brief summary of your PG level Dissertation/ Project: (Use separate sheet(s) if required)

22. Have you done any research previously?

If yes, provide the following details:
(a) Papers presented in workshop/ symposium
(b) Papers published in refereed journals
23. Proposed Area(s) of Research:

Yes/ No

(use separate sheet(s))

(use separate sheet(s))
(Attach additional sheet(s) if required.

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

DECLARATION
I, .........................................................................................., declare that all the information given in this
application form is true to the best of my knowledge. I assure that I shall abide by all the rules and regulations of
the Institute, which are in vogue now as well as those, which come into force later. I further assure that I would
do nothing inside or outside the Institute that goes against the discipline and orderly working of the Institute. I
understand that if (1) any information herein is found to be incorrect, or (2) I am found indulging in any act of
indiscipline, or (3) I fail to pay the dues in time, I shall be liable to any punishment as awarded by the Institute,
which may even include striking off my name from the rolls of the Institute.

..........................................
Date

..........................................................
Signature of the Candidate

CERTIFICATE FROM THE FATHER/GUARDIAN

I, ................................................................................................... , father/...............................................of Ms.
........................................................................., who is a candidate for admission to the Institute, certify that I
am the bonafide guardian of the candidate. I assure that the candidate and I shall abide by all the rules and
regulations of the Institute, which are in vogue now as well as those, which may come into force from
time- to-time. Also, all the required fees shall be paid in time.

..........................................
Date

..........................................................
Signature of the Parent/Guardian

Admission Offered:

Yes

(For Office Use Only)

No

As:
Sponsored Candidate

Self-financed Indian Candidate

Self-financed Foreign Candidate

Govt./ Semi-Govt./ ICCR Fellow

Signature of the Registrar

ENCLOSURES:
[Please tick the items enclosed with this application]
1.
2.
3.
4.
5.
6.

Copy of Certificate of X standard

Copy of Certificate of XII standard
Copy of Degree of Graduation programme
Copy of Degree/ Marksheet of PG programme
Copy of any other programme you have undertaken
Demand Draft of Rs. 600/-

ADDITIONAL ENCLOSURES
For Sponsored Candidate:
Letter of sponsoring institution
For Self-financed Foreign Candidate:
Approval from the Ministry of External Affairs
No Objection Certificate from the Ministry of Human Resources

_________________

_____________________

Date

Signature of the Candidate

Please Note:
Demand Draft for Rs. 600/- should be drawn in favour of MITS-FET payable at Lakshmangarh or Sikar. You
are advised to keep on visiting our website for admission-related current information. Send your application form
to:
Dean,
Faculty of Engineering & Technology,
Mody Institute of Technology & Science,
Lakshmangarh- 332311, Distt. Sikar (Rajasthan),
India