ICAR- INDIAN VETERINARY RESEARCH INSTITUTE (Deemed University) Izatnagar , Bareilly (UP) India

Transcription

1 Application Form No... ICAR- INDIAN VETERINARY RESEARCH INSTITUTE (Deemed University) Izatnagar , Bareilly (UP) India ADMISSION TO PhD DEGREE PROGRAMMES FOR (Note: Please read information Bulletin carefully before filling the application form and use correct code.) For office use only Roll No.... Examination Centre... Discipline Name... Discipline Code... Affix recent photograph with signature of the candidate 1. PhD Degree Programme Subject Code** Category of Admission:... i.e. Open or Sponsored by ICAR Institute, Central/ State Agricultural Universities, Central/State Government Departments 3. Full name of candidate in capital letters: (first, middle and surname): 4. Father's name: 5. (i) Mother's Name:... (ii) Husband's Name:... (in case of married women) 6. Date of Birth Age (as on )... (only completed years) 7. (i) Category Whether General/OBC/PH/SC/ST... (ii) Nationality: (i) Sex: Male/Female:... (ii) Marital Status: Married/Unmarried: (i) State/Union Territory of domicile:... (ii) Rural/Urban: Nearest Railway Station to Home town:... (can not be changed during study period) 11. Choice of Examination Centre:... (Izatnagar- 01, Bengaluru- 02, Bhopal- 03, Kokata- 04, Palampur- 05) 11. Educational Qualifications: Particulars Name of Examination High School Intermediate BVSc & AH MVSc or equivalent or equivalent (a) University/Board (b) Institution/College (c) Year of passing the exam. (d) Prescribed minimum duration of course in years (e) Medium of instruction (f) Division/Class/ OGPA obtained (g) Maximum Marks/Overall Grade Point attainable (h) Percentage of marks obtained (upto one decimal place) (i) Subjects taken (j) Date of final Viva-Voce in M.V.Sc. (k) M.V.Sc. Thesis Title: N.B.: Strike-off which is not applicable * For Sponsored candidates only ** Indicate one code out of the subject given in the Information Bulletin

2 12. Full Address for correspondence : 13. Permanent Home Address : P I N P I N 14. Whether employed: Yes / No. (i) If employed, give full Name, Address and Contact No. of employer Candidate's Telephone No. (with code) :... Mobile No.... Fax No.... address if any : Language Known (Read/Write/Speak) : Employment Record : Name of Institute/ Post held Temporary/ Scale of pay Date of Date of Dept./University/ Permanent joining leaving Organisation 21. Are you a receipient of any Scholarship/Fellowship from the ICAR/CSIR/UGC/Govt. of India for Ph.D./M.V.Sc. Degree?. Yes / No. If yes, please attach an attested copy of the letter indicating the same and the period upto which it is valid. 22. (a) Were you admitted at I.V.R.I. earlier?... Yes / No (b) If so, state the programme and year : Programme... Year... (c) State if you discontinued the programme : Yes / No (d) If yes, state the date from which discontinued and reasons thereof : Fees: Bank Draft No...Date...Amount... DECLARATION BY THE CANDIDATE I, the undersigned hereby declare that information furnished by me is correct and that no relevant information has been suppressed. I also declare that if any information or document furnished by me in this application is found to be wrong, I shall have no objection to my selection being cancelled outrightly. (a) I am not employed and, therefore, submitting this application directly. (b) I am an employee of the.... and, therefore, submitting my application through proper channel, as a sponsored candidate. (c) I am an employee of... & applying under Open Category, submitting a NOC. (d) If admitted, I undertake to abide by the rules and regulations of the Institute. (e) I have enclosed attested photo copies of all the required certificates and documents. Place:. Date:... (Signature of the Candidate) 2

3 FOR SPONSORED CANDIDATE Application forwarded for consideration under SPONSORED CATEGORY. He/She has (in words).... years of experience in Teaching/Research/Extension at this Organisation. In the event of his/her selection, he/she will be relieved so as to enable him/her to join at IVRI on The candidate will be fully sponsored on Deputation terms/study leave entitling him/her for salary and allowances. Date:... Seal (Signature of the Sponsoring Authority) Note: No Scholarship/Fellowship will be granted to the sponsored candidates. (For Office use only) Index No... Bank Draft for Rs.... received dated: Checked by INSTRUCTIONS FOR CANDIDATES TO FILLUP THE APPLICATION FORM FOR ADMISSION TO Ph.D. PROGRAMMES 1. The candidate should carefully go through the Information Bulletin before filling-up the application form. 2. The application form should be filled legibly in candidate's own handwriting without any cutting/ overwriting/erasing, etc. 3. The candidate should ensure that he/she fulfills all the eligibility requirements for appearing in the entrance examination before filling-up the application form. 4. Admit Cards will not be sent by post. Candidates have to retain a copy of Admit card with them and noted down the Roll No. as displayed on website. The List of Students along with Roll No. will be displayed on Institute's website ( 5. No candidate will be allowed to appear in the entrance examination without Admit Card. 6. First semester of Academic Session will commence on

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5 ICAR- INDIAN VETERINARY RESEARCH INSTITUTE (Deemed University) Izatnagar , Bareilly (UP) India ADMISSION TO PhD DEGREE PROGRAMME FOR VERIFICATION SHEET Affix recent photograph with signature of the candidate Roll No.... (to be filled by Office) Full name of candidate in capital letters: (first, middle and surname): Father's name: PhD Degree Programme... Examination Subject Code Signature of Candidate The above candidate has been permitted to appear in the written entrance examination for admission to Ph.D. degree programmes (FOR OFFICE USE ONLY) EXAMINATION SCHEDULE Date & Time of Written Exam Signature of the Signature of the Candidate Invigilator 17th May, 2015 (Sunday) (11:00 a.m. to 1:00 p.m.) Examination Centre: IVRI Izatnagar, Bengaluru, Bhopal, Kolkata, Palampur. N.B.: The Invigilator should check the photograph of the candidate and obtain his/her signature. If the candidate is not present, the word 'ABSENT' should be recorded and signed by the Invigilator. REGISTRAR 5

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7 ICAR- INDIAN VETERINARY RESEARCH INSTITUTE (Deemed University) Izatnagar , Bareilly (U.P.) India Sl.No. ADMISSION TO PhD DEGREE PROGRAMME FOR OFFICE COPY (For ofice use only) ADMIT CARD (To be filled-in by the Candidate) Affix recent photograph with signature of the candidate Roll No Name: Programme: PhD Discipline: Date of Entrance Examination: 17th May, 2015 (Sunday) 5. Examination Centre for written examination :... Signature of Candidate Registrar Instrutions 1. You must report at the examination centre atleast 30 minutes before the commencement of the examination. 2. Show your admit card to Supervisory Staff otherwise you will not be allowed to appear in the exam. 3. Use of unfair means will disqualify you from the examination. ICAR- INDIAN VETERINARY RESEARCH INSTITUTE (Deemed University) Izatnagar , Bareilly (U.P.) India ADMISSION TO PhD DEGREE PROGRAMME FOR Sl.No. CANDIDATE COPY (To be retained by the candidate and produced at the time of examination) Affix recent photograph with signature of the candidate ADMIT CARD (To be filled-in by the Candidate) Roll No Name: Programme: PhD Discipline: Date of Entrance Examination: 17th May, 2015 (Sunday) 5. Examination Centre for written examination :... Signature of Candidate Registrar Instrutions 1. You must report at the examination centre atleast 30 minutes before the commencement of the examination. 2. Show your admit card to Supervisory Staff otherwise you will not be allowed to appear in the exam. 3. Use of unfair means will disqualify you from the examination. 7

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