Welcome to NIT Manipur

Application Form

Payment Refrence No * Please Enter Payment Refrence No Please Enter Valid Payment Refrence No

Dated * Please Select Payment Refrence Date

First Name * Please Enter First Name Please Enter Valid First Name

Last Name * Please Enter Last Name Please Enter Valid Last Name

Department * Please Select Department

Specialization * Please Enter Specialization

Gender *

Male

Female

DOB * Please Select DOB

Part Time /Full Time * Please Select Course Type

NET/GATE Qualified* Please Enter NET/GATE Qualified Please Enter Valid NET/GATE Qualified

Score/Percentile * Please Enter Score/Percentile Please Enter Valid Score/Percentile

Journals * Please Enter No of Journals Papers Please Enter Valid No of Journals Papers

Conference * Please Enter No of Conference Papers Please Enter Valid No of Conference Papers

Mob No * Please Enter Mob No Please Enter Valid Mob No

Address * Please Enter Address

Email * Please Enter Email Please Enter Valid Email

Category * Please Select Category

Marital Status * Please Select Marital Status

Educational Qualifications

Course Class X*

Year * Please Enter Year Please Enter Valid Year

Percentage(%) * Please Enter Percentage Please Enter Valid Percentages

Board/University * Please Enter Board/University Please Enter Valid Board/University

Class Xll*

Please Enter Year Please Enter Valid Year

Please Enter Percentage Please Enter Valid Percentage

Please Enter Board/University Please Enter Valid Board/University

BTech/BSc*

Year * Please Enter Year Please Enter Valid Year

Percentage * Please Enter Percentage Please Enter Valid Percentage

Board/University * Please Enter Board/University Please Enter Valid Board/University

Discipline/Subject * Please Enter Discipline/Subject Please Enter Valid Discipline/Subject

MTech/MSc*

Please Enter Year Please Enter Valid Year

Please Enter Percentage Please Enter Valid Percentage

Please Enter Board/University Please Enter Valid Board/University

Please Enter Discipline/Subject Please Enter Valid Discipline/Subject

Note: - Print-out of filled-in online application with testimonials duely signed and payment proof must reach us on or before 31th May 2017.

Acknowledgment

Name :

Ref. No. :

Amount:

Ref. Date :

Department	Label	Specialization	specialization
Gender	Gender	DOB	dob
Part Time /Full Time	parttime	NET/GATE Qualified	qualifire
Score/Percentile	score	Journals	journal
Conference	conference	Mob No	mobile
Address	address	Email	email
Category	category

Educational Qualifications

Class	Year	Percentage	Board/University	Discipline/Subject
Class X	year	perecentx	boardx
Class	yearxii	perecentxii	boardxii
BTech/BSc	yearbtech	percentbtech	boardbtech	dicplinebtech
MTech/MSc	yearmtech	percentmtech	boardmtech	dicplinemtech