M.Phil Application Form JAIN UNIVERSITY M.Phil APPLICATION FORM NOTE: Please tick only one programme of your choice & fil up the application form in block letters only Application No. 1 Biotechnology 1 Biochemistry 1 computer science LO Physics OO chemistry LO Electronics 1 Management Mathematies 1 Kannada Tassport sae 1 English 1 Hing 1] Ancient indian History & Culture 1 Sanskrit 1 commerce 1 cuttural studies 1 Psychology 1 Political science 1 dance 1 Economies CO Microbiology O music PERSONAL INFORMATION ‘Name of the Applicant, (@s per school records) Gender ME] FE] Nationality Religion Caste: Date of girth: DoW CLICLICLLL — Pace of arth Please tick the relevant group (enclose the recent caste and income certificates) Genel =F] sc CSTD) category] Category 28] category 28 7] category 3A] category 38 L]_—hysically Challenged [1 Father's Name Occupation Mother's Name Occupation Total annual income (in Rupees) : Permanent Address (Address for Communication) pin: CLETTT Ph Mobile: E-mail: Name of the local guardian: Occupation: (Address for Communication) Local Residential Address: PIN. Phi Mobile: E-mail: FS vu 2. > co} a2 = oo aa ° =} = ° Ss eIMPhil Application Form Highest Degree obtained with class and percentage: Academic Awards Work Research Experience: Yes] No [] If yes, provide details, accounting breaks, if any. From | To Job-Profile Name of Employer Last Salary Drawn Will you be sponsored by your employer for the programme? vs oO If yes, provide details Educational History Fillin all details from and including S.$.1.C or equivalent examination to your present degree. In case you have nat completed your present degree, mention all the marks / grades obtained tll now. Also mention scores from GATE, GRE, UGC Fellowship or equivalent exams if you have appeared in any of these exams. f your result i in terms of grades, also provide the equivalent conversion n percentage terms Examination Passed Year of Passing Institution / University Period Subjects: Main From & Ancillary % in aggregate & division Rank ifany Note: Originals of mark sheets, degree certificates, etc. must be produced at the time of admission. Date: Name: Signature:M.Phil Application Form Name and address with phone number of two referees of whom atleast one should be an academician. (For M.Phil candidates only) i) Name Designation Address PIN. Phio): Phi E-mail, ii) Name Designation Address PIN. Phio): Phi) E-mail, ‘Any other information that you think will help us to better assess your performance and potential (use separate sheet, if necessary) Declaration: | hereby certify that the statements made by me above are, to the best of my knowledge, true, correct and complete. | understand that any incorrect information or material omission on my part renders me liable to termination ‘without any notice or compensation. Date (Signature of the Candidate) STATEMENT OF PURPOSE (For M.Phil Candidates) \Write your statement of purpose in not more than 200 words indicating why you want to join the M.Phil programme at Jain University and what your future research plans are, Use the additional sheet provided at the back.M.Phil Application Form JAIN UNIVERSITY (std. u/s 3 of the UGC Act, 1956) (To be detached by the candidate and handed over to the Referee. The applicant should collect the completed recommendation duly signed and sealed by the referee in an official envelope and mail it along the completed application form) Referee's Report (For MPhil Candidates) Application No. Candidate's Name: (In BlockLetters) First) (widdie) (Surname) Name of the Referee: (inBlockLetters) Address: Telephone No. Mobile No. How long and in what capacity have you known himyher and how you rate hinyher compared to an average post-graduate student in terms of intelligence, academic achievements and abilities? Please give your assessment below. You may use additional sheet, if necessary. Kindly mail this form directly to the Institute using the enclosed envelope. We thank you in advance for your assistance in evaluating the applicant. Date: Signature JAIN UNIVERSITY (Estd. u/s 3 of the UGC Act, 1956) (fo be detached by the candidate and handed over to the Referee. The applicant should collect the completed recommendation duly signed and sealed by the referee in an official envelope and mail it along the completed application form.) Referee's Report (For M.Phil Candidates) Application No. ‘Candidate's Name: (in Block Letters) First) (wiiddle) (Surname) Name of the Referee: (in Block Letters) Address: Telephone No. Mobile No. How long and in what capacity have you known him/her and how you rate hinvher compared to an average post-graduate student in terms of intelligence, academic achievements and abilities? Please give your assessment below. You may use additional sheet, if necessary. Kindly mail this form directly to the Institute using the enclosed envelope. We thank you in advance for your assistance n evaluating the applicant. Date: SignatureM.Phil Application Form 1. Duration 1 year, 2 semesters 2. Eligibility forAdmission Masters Degreein relevant discipline 5.AdmissionProcedure + Application for admision in the university must bein the prescribed form + Students who want apply for different combinations must apply in Separate application forms GUIDELINES FOR 33 ADMISSION ‘Students who have graduated from Universities in foreign counties willbe considered as NRIinterationalstudents [Additonal documents to be produced by foreign students other ‘han the documents mentioned in 3.1 (should be atested by the Indian Embassy) Valid Student Visa Copy Passport Copy Residential Permit Copy HIVTestCopy + Reservation categary(SC//ST/ Cat |/2A/28/3A/38) and physically 3.4. Additional documents tobe produced by NRstudents other than the handicapped students must submit the photo copy of thei caste/_dacumentsmentionedin3.1 category /clsabily erica (attested by a gazetted offce) issued + Provisional elighiliy Cerificate Copy by the concerned authorties ofthe government of Karnataka alang + Passport Copy with te application form + PlOcard copy ‘The duly filed in application form has to be submited at the Univesity admission atficeas per theprescrived schedule 4, INSTRUCTIONS To FILLTHE APPLICATION FORM + The lst of provisionally selected candidates will De notified / + Formsmustbefiledin applicants own handwriting published on theunivestynatice board + UseonlyBLACKar BLUE H-Tecpoint ype pent filluptheform + AS part of the admission procedure students have to attend the + If themarks are not known at not avaiable atthe time of illng the personalintervew along with thei parents application, please indicate Results are awaited” in the marks/ grade Bdmission to various programmes will however be subject to column, Tecandidate is expected tsend te marks tothe university verification of facts from the orginal certificates documents of the as sanasitisavalabe to ascertain theelgiilty. The application wll Candidates. Incaseary discrepancy snoticed, evenatalaterpointot _be considered only if the marks are made avallable tothe university ‘imeatter admission, themanagementreserves allright to cancelthe _withinthestipulated date Candidate's admission and such a decision shale final and binging + Applicants must enclose cetifed photocopies of the qualiying onthe candidate ‘examination and category crtiates + Applicants must paste their most recent colour photograph (not 3.1.Documents tobe submitted a the time of admission ‘older than 3 months) in the appropriate place, Do not pn or staple ‘The following orginal cetfiates have to be produced with two thephotograph attested copies (Gazetted Officer) atthe time of admission: + Overwnitin,stiking off r erasing inthe form may lead to rejection + Satement of Marks ofPGor Equivalent and should be avoided. Any cscrepancy in the statement and /or + Tranefercereficate Submission of incomplete forms illead to rejection of application Migration Certfieate (applicable) ancelation of admission + conduct certieate + Keep a photocopy of the filled application for future reference. + casteor Category Certificate applicable) Application number mustbe quotedinall uture correspondence + Zpassportsizecolor photographs ‘Applicants are required to submit photocopies of marks cards, certificates orany other document and must ensure that 3.2 Categories International students ‘+ Thephotocopiesaretaken an Adsize paper only + Foreign students: students holding passport issued by foreign «+ _‘Theprintisclear.legibleand readable countries including people of Indian efgin who have acquired the + ‘Bath sides ae photocopied ifthe orginal marks card is printed nationality of foreign countries ae classified as foreign students conbothsides + Non Resident indians (NRI)An NR student is one whe has an NR» Application number mustbe written at top right come of lthe status Photocopies Person of Indian Origin (P10): Students of Indian origin but not 2 + Da not send any ariginal dacuments along withthe aplication ctizenofindia form + Do not fold the FORM. Do not staple or clip the FORM with any other enclosure. Keep it loose. Al photocopies of marks cards and cetieates,fany, mustbe stapled together Declaration \ have read the above mentioned guidelines for the admission to this university and will strictly adhere to the same, | promise ‘0 abide by the decisions taken by the authority. | understand that the amount once paid by me for the admissions will be nonrefundable, Signature of the Parent/Guardian Date: Signatureof the Candidate JAIN UNIVERSITY. Jain Global Campus, Jakkasandra Post Kanakapura Taluk, Ramanagara District - 562 112 Corporate Office 91/2, Dr. A. N. Krishna Rao Road, V. V. Puram, Bangalore - 560 004 Ph: +491 80.4343 1000, Fax: +91 80 2650 0895 URL: www jainuniversity acinMPhil Application Form Admit: Signature Director- Admissions loli ate aon Fees Details: ACKNOWLEDGEMENT Application No. Course Applied Name Board Date of Submision Percentage: Receivers Signature (Please preserve this slip carefully for further reference) 4006 Coreg Deon, Ofc THR SraleieConmunetos, J Js Unive