Applicant's Details
Name of the Programme for Admission :*		SELECT PhD
Name of the Subject for Ph.D. Entrance Test:*
Faculty/Department :*		Proposed Center for Research Center :*	UTD, MAHARAJA CHHATRASAL BUNDELKHAND UNIVERSITY CHHATARPUR
Applicant First Name:* (In English)		Applicant Last Name: (In English)
Applicant First Name:* (In Hindi)	Click here for hindi translation	Applicant Last Name: (In Hindi)
Date Of Birth:(dd/mm/yyyy)*		Gender*	Select Male Female
Domicile of M.P.:*	Select Yes No	Blood Group:*	Select A+ B+ A- B- O+ O- AB+ AB-
Category:*	Select UR SC ST OBC EWS	Physically disabled :*	Select Yes No
Type of disability:	Select PHYSICAL IMAPAIRMENT VISUAL IMPAIRMENT SPEECH/HEARING IMPAIRMENT MENTAL DISABILITY OTHER DISABILITY	Disability Percentage:*
Nationality:*	SELECT INDIAN OTHER	Enrolment Number*
Name of Father/ Husband:*		Name of Mother:*
Are you UGC NET ELIGBLE OF ADMISSION TO Ph.D. *	Select Yes No	Are you UGC/CSIR NET With JRF Qualified?*	Select Yes No
Do you have Teacher Fellowship for Research?*	Select Yes No	Do you have Government/Foreign Research Fellowship?*	Select Yes No
Do you have M.Phil degree (as per UGC Regulation 2009 or amended thereafter) ?*	Select Yes No	If yes then select	Course work Without Course work
Are You UGC NET Without JRF Qualified?*	Select Yes No	Are You GATE,CEED or Similar Level Exam's with Fellowshop Qualified?*	Select Yes No
Permanent Address*
Applicant’s Address*
Select  State*	Select State ANDAMAN & NIKOBAR ISLANDS JAMMU & KASHMIR ORISSA LAKSHADWEEP PUNJAB RAJASTHAN DELHI KERALA ARUNACHAL PRADESH DAMAN & DIU TRIPURA NAGALAND SIKKIM UTTARAKHAND MEGHALAYA WEST BENGAL HARYANA GUJARAT TAMIL NADU MANIPUR CHANDIGARH JHARKHAND UTTAR PRADESH KARNATAKA CHHATTISGARH ANDHRA PRADESH MAHARASHTRA MIZORAM BIHAR HIMACHAL PRADESH PUDUCHERRY GOA DADRA & NAGAR HAVELI MADHYA PRADESH ASSAM Telangana	Select District*
Pincode*
Check If Both Address are same.
Correspondence Address
Full Address*
Select State*	Select State ANDAMAN & NIKOBAR ISLANDS JAMMU & KASHMIR ORISSA LAKSHADWEEP PUNJAB RAJASTHAN DELHI KERALA ARUNACHAL PRADESH DAMAN & DIU TRIPURA NAGALAND SIKKIM UTTARAKHAND MEGHALAYA WEST BENGAL HARYANA GUJARAT TAMIL NADU MANIPUR CHANDIGARH JHARKHAND UTTAR PRADESH KARNATAKA CHHATTISGARH ANDHRA PRADESH MAHARASHTRA MIZORAM BIHAR HIMACHAL PRADESH PUDUCHERRY GOA DADRA & NAGAR HAVELI MADHYA PRADESH ASSAM Telangana	Select District*
Pincode*
Mobile /Phone no. of Father /Husband:*		Mobile No. of the Applicant:*
Email ID of the Applicant:*

Teaching /Research Experience (if any)*	Select Yes No	Any Other Information related to research:
Upload image with Signature*
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Declaration*
नोट: मैं, घोषणा करता/करती हूँ कि उपरोक्त जानकारी मेरे द्वारा दी गई है वह पूर्णतः सत्य है जानकारी असत्य पाये जाने की दशा में मेरा आवेदन-पत्र निरस्त किया जा सकेगा तथा मेरे विरूद्ध वैधानिक कार्यवाही की जा सकेगी।