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QUAID-I-AZAM UNIVERSITY

Islamabad (Pakistan)

Application Form
For Split PhD Scholarship Program under the PSDP Project “Expansion Program of QAU”

Use Capital Letters (Forms may be typed using MS Word)

Attach original draft ofRs. 2000/- in favor of Treasurer QAU, Islamabad (in Original) No:

Name of Bank Branch: Date:

Personal Details

Full Name:

(as given in Matric/S.S.Certificate)

Father’s Name: Computerized National ID Card No:

Marital status: Single Married Domicile (City /District, give both): /

(Tick (one of the following):

Federal CapitalKPK Punjab Sindh Urban Sindh Rural

FATA FANA AJK Balochistan

Date of Birth: Age on (15-05-2015):

Day Month Year

Correspondence Address (Where you want to receive letters form HEC):

City:

Permanent Address(if different form the above Correspondence Address ):

City:

Telephone No (Office) (Residence) (Personal Cell): -

E-Mail Address (COMPULSARY):

Research Publication(Use extra sheet where required):

Sr. No / Title of Research paper / Area of Research / Published in International Journal (Give full name of Journal) / Published in Local Journal (Give full name of journal) / Date of Publication / Impact Factor of Journal in which your paper was published

Use Extra sheets where necessary

Academic Details

Educational Level / Name of Degree / Certificate / Year of Passing / Institution /
BoardUniversity / Major Subjects (Science/Arts/Engg:/Medical etc) / Grade/ Div. (as mentioned in you Final Year Certificate / Degree) / CGPA. (as mentioned in your final Transcript / Degree) / Marks obtained. (as mentioned in your final Transcript / Degree) / Out of (Total) / %age.
(as mentioned in your final Transcript / Degree) / Remarks if any
SSC/O-level
HSC/A-level
Bachelors Degree Below 16 years
Masters Degree 16 years
MS / M.Phil
Any Other

Note: Candidates must fill division/percentage or CGPA whichever is applicable in the respective examination and as per their certificates/degrees). In Column “%age of Marks” means that you have to give the actual percentage e.g. if your percentage becomes 60.52. You need to write down this actual percentage with decimal figures also. Do not round of your percentage, give exact number in two digits after decimal.

Name of University / Institution if any abroad where you intend to do PhD Doctoral Studies, and have established contacts / obtained placement.
Name of University / City (Optional)
Proposed Area of Ph D Research Studies
Who will supervise your research (Name of Supervisor’s & address)? (Optional)

Employment Details ( Startingform the Current Job, use extra sheet where necessary )

Name of Employer with Address (in case of more than one employment use extra sheets where necessary) / Category of Employer(Federal/Prov Govt, Semi-Govt, Autonomous, Corporation, Private) / Designation with Grade (BPS, Group etc. if applicable) / Period served / Nature of Job (Regular/ Contract etc.) / Job details (Teaching, R&D, Service, Technical, other
etc)
From / To

Total Length of Service:

Year(s) Month(s) Day(s)

If selected,will you be able to obtain study leave, from your employer, for the entire study period and serving QAU for 5 years after completion of PhD? Yes No

Nomination by the Employer:

Name:

Designation of the Authorized Officer

of Your Institution:

Official Seal:

Undertaking

I solemnly verify that the particulars listed above are correct to the best of my knowledge. In case any misrepresentation is identified by HEC/QAU at any stage, my scholarship will immediately be terminated. Consequently I'll be liable to pay back the entire amount with penalty, released by HEC/QAUunder various expenditure heads, against my scholarship (i.e. stipend, Grant to university, air fare etc.).

Name of Candidate:

Signature: ______

Date:

Note: Attach copies of all the relevant documents with application form mentioned in the advertisement.

FOR EMPLOYED APPLICATIONS ONLY

ATTESTATION BY THE HEAD OF DEPARTMENT

This is to certify that Mr./Ms. Son/Daughter of Mr. is regular employee of this Organization as Since .

His/Her educational, employment particulars and other statements as stated in the foregoing columns have been checked and verified with the original documents. It is hereby affirmed that in the event of his/her selection for the award of Split Ph.D. Scholarship’ under the Project “Expansion Program of QAU” he/she will be relieved on study leave for the total duration of the scholarship which on average is 4-years

Date:

Signature:

Name & Designation:

(Head of Department/Institution)

Full Address:

Office Stamp:

(Please Tick One)

Advance Copy
Forwarded Copy

(Please Tick One)

Advance Copy
Forwarded Copy

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UNDERTAKING BY THE APPLICANT(compulsory for all candidates)

I Mr./Ms. Son/Daughter of Mr. Certify that the statements made by me in this form are true, complete and correct to the best of my knowledge and belief. It is solemnly affirmed that I have read and understood the conditions of the award of this Scholarship advertised in the press and from the web page of QAU and that the decision of the Selection Committee would be final and binding. I understand that the award will be withdrawn as well as recovery of full amount spent on me along with any penalty in connection with the award if any misrepresentation or omission is discovered even after completion of Split Ph.D. under the Project “Expansion Program of QAU”.

Date:Applicant’s Signature