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Personal Details
First Name*	Please Enter First Name	Middle Name
Last Name*	Please Enter Last Name	Name in Hindi*	(for typing in hindi use spacebar key stroke) Please Enter Name in Hindi
DOB*DD/MM/YYYY	Please Enter Date of Birth	Gender*	Select FEMALE MALE TRANSGENDER Please Select Gender
Father's Name*	Please Enter Father's Name	Mother's Name*	Please Enter Mother's Name
Marital Status*	Select MARRIED UNMARRIED WIDOW/DIVORCEE Please Select Marital Status	Husband's Name
Blood Group*	Select A- A+ AB- AB+ B- B+ I DON’T KNOW O- O+ Please Select Blood Group
Category*	Select EWS OBC SC ST UR Please Select Category	Whether domicile of Madhya Pradesh	Select YES NO Please Select Domicile
Sub-Category	JKM JKR FREEDOM FIGHTER HANDICAPPED MINORITY NCC
Nationality*	Select INDIAN OTHER Please Select Nationality Please Enter Valid Nationality.	Religion*	Select CHRISTIAN HINDU JAIN MUSLIM SIKH Please Select Religion

PhD Degree Details
Name of Research Supervisor		Research Centre
Title of Thesis		Registration No.
Notification No. of degree		Date of awarded degree(DD/MM/YYYY)

Address
Permanent* Address Please Enter Permanent Address Please Enter Valid Permanent Address. District Select .OTHER AGAR MALWA ALIRAJPUR ANUPPUR ASHOKNAGAR BALAGHAT BARWANI BETUL BHIND BHOPAL BURHANPUR CHHATTARPUR CHHINDWARA DAMOH DATIA DEWAS DHAR DINDORI GUNA GWALIOR HARDA INDORE JABALPUR JHABUA KATNI KHANDWA KHARGONE MAIHAR MANDLA MANDSAUR MAUGANJ MORENA NARMADAPURAM NARSINGHPUR NEEMUCH NIWARI PANDHURNA PANNA RAISEN RAJGARH RATLAM REWA SAGAR SATNA SEHORE SEONI SHAHDOL SHAJAPUR SHEOPUR SHIVPURI SIDHI SINGRAULI TIKAMGARH UJJAIN UMARIA VIDISHA Please Select District State Select ANDAMAN AND NICOBAR ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHANDIGARH CHHATTISGARH DADAR AND NAGAR HAVELI DAMAN AND DIU DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU & KASHMIR JHARKHAND KARNATAKA KERALA LAKSHADEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ORISSA OTHER PONDICHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TELANGANA TRIPURA UTTAR PRADESH UTTARAKHAND UTTARANCHAL WEST BENGAL Please Select State Pincode Please Enter Pincode Please Enter Valid Pincode.	Correspondence * Address Please Enter Correspondence Address Please Enter Valid Correspondence Address. District Select .OTHER AGAR MALWA ALIRAJPUR ANUPPUR ASHOKNAGAR BALAGHAT BARWANI BETUL BHIND BHOPAL BURHANPUR CHHATTARPUR CHHINDWARA DAMOH DATIA DEWAS DHAR DINDORI GUNA GWALIOR HARDA INDORE JABALPUR JHABUA KATNI KHANDWA KHARGONE MAIHAR MANDLA MANDSAUR MAUGANJ MORENA NARMADAPURAM NARSINGHPUR NEEMUCH NIWARI PANDHURNA PANNA RAISEN RAJGARH RATLAM REWA SAGAR SATNA SEHORE SEONI SHAHDOL SHAJAPUR SHEOPUR SHIVPURI SIDHI SINGRAULI TIKAMGARH UJJAIN UMARIA VIDISHA Please Select District State Select ANDAMAN AND NICOBAR ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHANDIGARH CHHATTISGARH DADAR AND NAGAR HAVELI DAMAN AND DIU DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU & KASHMIR JHARKHAND KARNATAKA KERALA LAKSHADEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ORISSA OTHER PONDICHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TELANGANA TRIPURA UTTAR PRADESH UTTARAKHAND UTTARANCHAL WEST BENGAL Pincode Please Enter Pincode Please Enter Valid Pincode.
Phone Number(With STD Code) Mobile Number* Please Enter Mobile Number Enter Valid Mobile Number. Email Id* Please Enter Email Id Please Enter Valid Email Id.

Photo & Signature *	Upload Documents
Upload Images	1. PhD Registration Letter : (max size 250 KB, in JPG format) 2. PhD Notification : (max size 250 KB, in JPG format)

Declaration

घोषणा-पत्र:- मैं, घोषणा करता/करती हूँ कि मेरे द्वारा दी गई उपरोक्त जानकारी पूर्णतः सत्य है एवं मैं आवेदन हेतु निर्धारित शैक्षणिक योग्यता रखता/रखती हूँ। जानकारी असत्य पाये जाने की दशा में मेरा आवेदन-पत्र निरस्त किया जा सकेगा तथा मेरे विरूद्ध वैधानिक कार्यवाही की जा सकेगी।