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Admission form upes 2013

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  • 1. ADMISSION FORM - JULY 2013 Date: / / 2 0 1 3 Please tick the program you are applying for: o Energy o Transportation o & Gas) MBA (Oil BBA (Aviation Operations) o o MBA (Power) MBA (Aviation) o Affix Photograph MBA (Port o & Shipping) o Infrastructure o MBA (Logistics & Supply Chain) o MBA (Infrastructure) o MBA (Health, Safety & Enviorment) Personal Details: IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please mention N/A wherever not applicable 1. Name (in Block Letters): ...................................................................................................................................................... 2. Date of Birth: M M D D Y Y Gender M F 3. Correspondence Address: .................................................................................................................................................... ..................................................................................................................................................................................................... ........................................................................................................... Pin 4. Permanent Address: ............................................................................................................................................................. ..................................................................................................................................................................................................... ............................................................................................................ Pin 5. Telephone (Res.): Mobile: 6. Email: ..................................................................................................................................................................................... 7. Nationality: ............................................................................................................................................................................ 8. Occupation: ............................................................................................................................................................................ 9. Name of the Company: ......................................................................................................................................................... 10. Designation: ......................................................................................................................................................................... 11. Employer’s Address: ........................................................................................................................................................... ..................................................................................................................................................................................................... ..................................................................................................................................................................................................... 12. Telephone (Off.):
  • 2. Educational Qualifications Stream/Degree % & Grade Year of Passing Board/University From To Class X Class XII Graduation Post Graduation Any Other Work Experience Designation Name of the Organization Years of Experience From To Your interest in joining UPES? ..................................................................................................................................................................................................... ..................................................................................................................................................................................................... ..................................................................................................................................................................................................... ..................................................................................................................................................................................................... Special Achievements ..................................................................................................................................................................................................... ..................................................................................................................................................................................................... ..................................................................................................................................................................................................... ..................................................................................................................................................................................................... How did you hear about us? o Website o Newspaper o Emailer oo SMS Magazine o ....................................... Any Other Declaration I hereby state that the information given above is true to the best of my knowledge. In case any information is found to be incorrect, my candidature is liable to be cancelled by the University. I shall abide by the rules and regulations of the University of Petroleum and Energy Studies, including dress code, and expected behavioral norms in line with the University’s special charter. I shall ensure timely payment of all applicable dues. Date: / / 2 0 1 3 Student’s Signature
  • 3. INFORMATION FORM FOR IDENTITY CARD IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please fill in BLOCK LETTERS. 1. Name of the Program: o Energy o Transportation o & Gas) MBA (Oil o BBA (Aviation Operations) o MBA (Power) o MBA (Aviation) o Infrastructure Affix Photograph o & Shipping) MBA (Port o MBA (Logistics & Supply Chain) o MBA (Infrastructure) o MBA (Health, Safety & Enviorment) 2. Duration of the Program: July 1, 2013 to July 1, 2016 3. SAP ID (For Office use only): 4. Student’s Name (in English Capital Letters): ......................................................................... ........................................................................................................................................................ 5. Father’s Name: ...................................................................................................................................................................... 6. Mother’s Name: ..................................................................................................................................................................... 7. Correspondence Address: .................................................................................................................................................... ..................................................................................................................................................................................................... ........................................................................................................... Pin 8. Permanent Address: ............................................................................................................................................................. .................................................................................................................................................................................................... ............................................................................................................ Pin 9. Telephone (Res.): Mobile: 10. Telephone (Off.): 11. Emergency Contact No.: 12. Blood Group: Authorized Signatory Specimen Signature of the Student
  • 4. INSTRUCTIONS FOR SENDING THE ADMISSION FORM Please send the filled in Admission Form along with: 1. Non-refundable Admission Form fees of `1,000/- (through demand draft) in favor of “UPES”, payable at Dehradun. 2. Xth & XIIth class certificates and mark sheets (photocopies should be self attested). 3. Graduation certificate & mark sheets (photocopies should be self attested). 4. Any other degree/diploma/certificate (as mentioned in the application form). 5. 2 passport size photographs affixed on the form. 6. Work experience certificate(s). 7. Completed ID form. All these documents should reach us at the earliest at the following address: K.K. Bhatnagar Associate Director (Marketing) Centre for Continuing Education kbhatnagar@upes.ac.in University of Petroleum & Energy Studies Marketing & Communication Office PHD Chamber of Commerce & Industry 3rd Floor, PHD House, 4/2, Siri Institutional Area August Kranti Marg NEW DELHI – 110 016 Tel: +91-11-41730151-53 Fax: +91-11-41730154 www.cce.upes.ac.in

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