University of Hyderabad

Entrance Examination Form - 2013

(For Instructions please refer Prospectus 2013-14, which is available on Website http://acad.uohyd.ac.in)

1. Application Number :

2. Name of the candidate :

3. Date of Birth : 4. Sex:

5. Nationality: 6. State of Domicile:

7. Category : 8. Whether DP : Yes/No 9. Whether PH: Yes/No PH Type: 10. Blood Group:

11. Position of Qualifying Exam: EP / RA/ NA 12. Percentage of Marks: 13.Dist in Sports: SL/NL

14. Centre: 15. Course: 16. Subject:
17. Choices:

18. For M.Tech. GATE Hall Ticket No.: Subject : GATE Score :
.

19. For M.Phil./Ph.D. Have you Qualified : J RF/ NBHM/ICMR/ICAR/DBT / RGNF / MANF /DST INSPIRE
Are you seeking exemption from appearing in the written test on the basis above J RF: Yes / No
Whether applying for Regular, Part-time or External Registration to Ph.D.: Regular / Part Time / External


20. For 5-year Integrated M.A./M.Sc courses
Are you a Scholar of : KVPY/Science Olympaid/ IIT J EE Ranker / I ranker at +2 Boards
Do you belong to any of the backward district (see the list of backward districts): Yes / No
If yes, Place of Birth: District : State:
Medium of Instruction in Intermediate : English / other ( )

21. Name of the Father:
22. Name of the Mother:
23. Annual Income of the Parents/Guardian : Rs.
24. Native Place: District : State:
25. Nearest Railway Station: Distance from Hyderabad: K.M.

26. Past Academic Record

RESULT Examination
Passed /
Course
Name of the
Univ / Board
Subjects
Studied and
Passed
Month &
Year of
Passing Max.
Marks
Min.
Marks
for pass
Marks
obtained
% of
Marks
Div. /
Class
Matric/ SSC/
equivalent

Inter /
HSC (10+2)



















i.exe


27 For Statistical Purpose only
Whether you are interested to enroll in NSS : Yes / No
Do you belong to LBC : Yes / No
Religion : Hindu / Muslim / Christian / Sikh / Buddhist / J ain / Other
Do you belong to any minority Community : Yes/ No
Do you belong to Kashmir Migrant : Yes /No
Are you a single girl child of your family : Yes / No

28. If applying for M.Phil., M.Tech., or Ph.D. programmes

a) Mention areas of research interests in order of preference:

1)................................................. 2).............................................. 3).................................................

b) Give details of publications & research work carried out, if any
...........................................................................................................................................................................................
...........................................................................................................................................................................................
...........................................................................................................................................................................................


c) Have you qualified/appeared in the UGC/CSIR National level test for J RF ? : Yes / No

If yes, give the following details:

Name of the Exam:...................................................... Qualified: Yes / No / Results Awaited
Roll No......................... Subject:................................... Year & Date of examination ...............................
If holding the Fellowship, the date from which it is held : Date _ _ _ _ Month : _ _ _ _ _ _ _ _ Year : _ _ _ _

d) Do you possess M.Phil/M.Tech degree ? Yes / No

Did you avail the exemption on an earlier occasion? Yes / No

Note: Candidates with UGC-NET for lectureship alone and possessing M.Phil./M. Tech. Degree are not exempted
from the written test


29 Present or previous employment, if any

Organisation & Address Position Held From - To Nature of Duties





30. Do you require Hostel Accommodation ? : Yes / No

31. Were you ever subjected to a disciplinary action by any authority ? : Yes/No

If yes, give details .
.




32. Any other relevant information:



33. Address

Permanent Address: Present Mailing Address:








e-Mail Id : Mobile No:

DECLARATION BY THE APPLICANT: I hereby declare that all the information furnished by me in this application and in
the documents I have submitted in support of my application are true, complete and correct. In case any information in this
application is found to be false or incorrect at any time (during or after completion of the course), this shall entail automatic
cancellation of my admission, if granted, cancellation of the degree if awarded , besides rendering me liable to such action as
the University may deem fit. In the event of any medical or other emergency, my parent/s or Guardian may be contacted at the
address given below


Signature of the Candidate

DECLARATION BY THE FATHER/MOTHER/GUARDIAN:

My daughter/son/ward Mr./Ms................................................................. is applying for admission to the University. In case of
her/his admission to the University, I shall be responsible for payment of all her/his fees and other charges including any
emergency, medical or other expenses incurred by the University. In case any information in this application is found to be false
or incorrect at any time (during or after completion of the course), this shall entail automatic cancellation of my daughters/sons
/wards admission, if granted, cancellation of the degree if awarded, besides rendering her/him liable to such action as the Uni-
versity may deem fit. I will also be responsible for her/his good conduct and behaviour during the period of her/his stay in the
University. Further, I may be contacted in the event of any emergency as determined by the University and I hereby promise
that I will make myself present before the University authority at my own cost whenever the University require my presence.


Signature of the parent / Guardian

Place Full Name .
Date Relationship with the applicant
Telephone Numbers (if any):
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Enclosures:
1. Demand Draft
2. Copy of Category Certificate
3. GATE score card (for M.Tech.)
4.


Affix your (candidate)
recent passport size
colour photograph
duly attested by a
Gazetted officer.
Mode of Payment: Demand Draft / Bank Challan

DD/Challan J ournal No.: Date:
Bank : Branch: Amount: Rs.