Registration No. ……………………………………. No.

………………………………………….

SANT LONGOWAL INSTITUTE OF ENGINEERING &

TECHNOLOGY,
LONGOWAL (SANGRUR) – 148106

APPLICATION FOR ADMISSION TO Ph. D PROGRAMME

Paste your
recent
passport
Semester ______________ size
photograp
Session ______________ h duly
attested

1. Category : Full time Regular with assistance Part time

ship/ sponsored / self Institute
financing employee/
2. Department : __________________________________________

3. Name of applicant : __________________________________________

(in block letters)
4. Father’s/Mother’s name : __________________________________________

5. Date of birth :

__________________________________________

6. Complete postal address : __________________________________________

__________________________________________

7. Permanent Address :

__________________________________________

__________________________________________

E-mail : ___________________________ Tel. No. _____________________________

8. Details of academic record starting from Higher Secondary Examination :

(Attested copies of the mark sheets/certificates to be enclosed)

Examination Year Name of %age of marks/ Division Branch/subjec

Passed university / CGPA obtained t studied
institution

9. Whether SC/ST? : YES/NO

(attested copy of certificate to be furnished)

1
10.Performance in GATE/NET

Name of Discipline Year of Score percentile

Examination examination

11.Experience, if any of service and/or research including present position held:

Name & Date of Total Designati Nature Salary Remarks

address joining period on held of work drawn
of upto
employin date
g
organizati
on

12.Publication, if any: ______________________________________________________

13.Whether the applicant is sponsored by any organization? : YES/NO

14.If “YES” the name and address of sponsoring organization:

__________________________

______________________________________________________________________________

15.Consent of the competent authority sponsoring the candidate:

__________________

______________________________________________________________________________

16.Declaration of the applicant:

I hereby declare that all the particulars furnished are correct. I understand
that my association direct or indirect with any unlawful organization and any
incorrect information may lead to cancellation of my admission/ selection. If
selected for admission, I promise to abide by the rules and regulations of the
institute. I am not registered for Ph.D degree at any other University/Institute.

Date: ____________________ ______________________________

(Signature of the candidate with
name)