नैनो विज्ञान एिं प्रौद्योगिक संसथान (विज्ञानएिंप्रौद्योविकविभाि, भारतसरकारकाएकस्िायतसंस्थान)
INSTITUTE OF NANO SCIENCE & TECHNOLOGY (An Autonomous Research Institute of Department of Science and Technology, GOI)
Knowledge City, Sector 81, S.A.S Nagar - 140306, Punjab
APPLICATION FORM (For Admission to Ph.D. Programme- AUGUST 2021 Session) (Please fill the form in BLOCK CAPITAL LETTERS only) For Office use Application No: PhD/AUGUST-2021/
Affix latest colour Passport size Photograph here
Date of receipt of Application:
1. Name of the Applicant Mr./Ms. ___________________________________________________________ (In block CAPITAL letters) 2. Father’s Name: ________________________________________________________________________ 3. Mother’s Name: _______________________________________________________________________ 4. Gender: ____________________________
5. Date of Birth: __________________________________
6. Marital Status: _________________7. Spouse’s Name (If Married): _______________________________ 8
Do you belong to GEN/ SC/ ST/ OBC/ PH category*/EWS_______________________ *(Please enclose self-attested photocopy of the certificate, if applicable)
9. Permanent Address (Please enclose self-attested photocopy of the address proof) _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ State: ____________________________________________Pin code: ________________________________ Telephone and Mobile No. ___________________________________________________________________ E-mail ID: ________________________________________________________________________________
10. Present Mailing Address _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ State: ____________________________________________Pin code: ______________________________ Telephone and Mobile No. ___________________________________________________________________ E-mail ID: ________________________________________________________________________________ Page 1 of 4