Gujarat Technological University
APPLICATION FORM FOR
“POST GRADUATE DIPLOMA IN IPR” (Off Campus Program)
Passport size recent
photograph
1.
Full Name of applicant (In
CAPITAL letters starting with
surname)
2.
3.
Are you a Student of GTU OR
Faculty of GTU OR
Working professional? (Please
specify)
For GTU Student / Non GTU Student
Course of Study:…………………………………………………
Branch of Study:…………………………………………………
Semester of Study:……………………………………………….
Enrollment number:……………………………………………..
Institute Code:…………………………………………………..
Institute Name:………………………………………………….
Address of Institute: ……………………………………………
……………………………………………..
Gujarat Technological University, Ahmedabad
Contact: [email protected], (O) 079-23267537 / 9909961894
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For GTU Faculty
Institute Code: …………………………………………………..
Institute Name: ………………………………………………….
Designation: ……………………………………………………
Address of Institute: ……………………………………………
……………………………………………..
For Working Professional
Name of the Your current employer: ………………………………………………
Designation: …………………………………………………………
Address of Employer: ……………………………………………….
………………………………………………...
5.
Qualification Possess
(Like
UG/PG/PhD
Degree
possess)
6.
Specialization possess (if any)
7.
Date of Birth (dd/mm/yyyy)
8.
Permanent Residential Address
9.
Your contact details
(R )
(O)
(M)
E-mail ID:
Gujarat Technological University, Ahmedabad
Contact: [email protected], (O) 079-23267537 / 9909961894
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10.
Write
briefly
about
your
objective to join in this PG
Diploma in IPR program
(Not more than 100 words)
Encl: 1) Degree Certificates (UG/ PG/ PhD, whichever is applicable)
2) Photo ID proof
3) Residential proof
4) 01 passport size photograph
5) Bank Challan of Rs. 25,000/- paid in favor of “Gujarat Technological University”
using online SBI.
Note:
1) Payment in Cash/DD/ Cheque will not be accepted. Regarding payment using online SBI
refer below mentioned link:
http://gtu.ac.in/ImpCircular/SBIPayment%20Instructions.pdf
Date:
Sign of student/Faculty/Other person:…………………
Place:
Name of student/Faculty/Other person:………………..
Gujarat Technological University, Ahmedabad
Contact: [email protected], (O) 079-23267537 / 9909961894
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