LAST DATE FOR RECEIVING COMPLETED FORM: 30 JUNE 2015

Registration No.
(to be filled by office)

New Delhi
Application form for Online program
ADMISSIONS 2015/16

1.
2.
3.
4.
5.

Paste (do not pin)

your photograph
(with white
background) in this
space and attest it
yourself

Do not send any attested copies of certificates with this form. Original and attested copies of
degree certificates/ marksheets will be needed later.
Incomplete application forms are likely to be rejected.
Candidates who are in the final year of their qualifying programme will be considered for
admission only if they have completed all requirements for award of the qualifying degree by
20 July 2015 and if their provisional degrees are available before 10 October 2015.
This form must be accompanied by a demand draft of Rs 1450/-.
Use capital letters wherever possible.
TYPE OR WRITE LEGIBLY IN ENGLISH

1.

Name in full (as in 10+2 certificate):

2. (a) Address of the candidate for

communication

(b)

Name and Address of Parent/Present

Guardian (i.e. Permanenent Address)

City ___________________________________

City _______________________________

State _____________Pin

State ____________Pin

3.

Telephone Number (with STD Code): ________________________________________

4.

Mobile:

6.

Date of Birth: (as in School Leaving Certificate)

5.

E-mail: _____________________________
D D

7.
2

GN/SC/ST/PH

8. Sex (M/F/TG)

General/Scheduled Caste/Scheduled Tribe/Physically Handicapped

M M

Y Y Y Y

9. Blood Group _______________________ RH Factor __________________________

10.

Status of qualifying examination (B.Sc/ B.Tech etc) result:

(write A: Appeared and result awaited, P: Passed)

11.

Are you a sponsored candidate ? (Y/N)

12.

If yes, indicate the name and address of the sponsoring agency:

13.

Select the program you want to register

Certificate in Energy Infrastructure & Efficiencies

Certificate in Renewables Energy Resources and policies
Certificate in Renewable Energy
Certificate in Software tools for energy analysis
PG diploma in Renewable Energy (note: one year duration)
Advance PG diploma in Renewable Energy (note: two years
duration)

14.

Declaration by the Applicant:

If selected for admission, I undertake to abide by the rules and regulations of TERI
University. I certify that the information given above is correct and I am aware that providing
incorrect information in the application form may result in the cancellation of admission
secured. I am further aware that, if the admission is secured before the results for the
qualifying examination are published and if I fail to satisfy the minimum academic
requirement for admission when such results become available, the admission will be
cancelled. I also certify that I have not been convicted in any criminal case and that there is
NO pending criminal case against me.

Place: _______________

Date: _______________

Signature of Applicant

Details of Demand Draft drawn in favour of Registrar, TERI University, payable at New
Delhi, enclosed with this application
Demand Draft No. ________________________ Dated ______________ Amount Rs____________
Bank Name_____________________________________________________________________

Please indicate how you got to know about the TERI University and its programmes (you
may mark more than one):
Website

Newspaper/Magazine advertisement
Month of January
Month of February
Month of March
Month of April

Word of month from friends

Word of mouth from Alumni*

Functions at TERI University

Magazine articles

Facebook/Twitter/other

Television channels

Social media
Radio (FM or other channel)

* Would you like to name the alumni

______________________________________

Newspaper story