Office Reference No.

ANNA UNIVERSITY : CHENNAI - 600 025

CENTRE FOR RESEARCH

APPLICATION FOR ADMISSION TO RESEARCH PROGRAMME JANUARY 2013

Ph.D.

M.S. (By Research)

Strike out whichever is not applicable

Note: Regular Faculty members working in the University Departments/University Colleges/University Campuses/Affiliated Engineering Colleges/Architecture Schools within Tamil Nadu and Regular employees working in the R&D centres which are recognized as a Research Centre of Anna University, Chennai and erstwhile Anna University of Technology at Chennai, Coimbatore, Madurai, Trichy & Tirunelveli are only eligible to apply under Part-time mode. Others can apply only under Full-time mode. Refer the information brochure before filling the application form.
1. 2. 4. 5. 7. 9. 10. Name (in Block letters) : (As in UG/PG degree certificate) Sex: Male/ Female Affix recent Passport size Photo

3. Nationality: Indian/ Foreign

If foreign national: Country ________________ Passport No.________________ Social Status: ST/SC/SCA/MBC/BC/BCM/OC 6. Community _______________

Age & Date of Birth: ________________ 8. Marital Status: Married/ Unmarried Email ID Address : :
Photograph shall be attested by a Grade A/B Officer or Head of the Institution.

Office Address : Designation : ____________________________ Department : ____________________________ Organization : ____________________________ Place : ____________________________ Dist. /State : ___________ Pin code:__________ Phone :
11. Category applied for Full-time

Residential Address : _________________________________________ _________________________________________ _________________________________________ District : __________________________________ State : ______________ Pin code: ___________ Phone : Mobile :

Mobile :

: (Tick appropriate box, after referring the information to the candidates carefully)

Part-time (Refer Annexure I) 1. Regular Faculty members of University Departments/University Colleges/ University Campuses / Govt./Govt. Aided/Self-Financing Engineering Colleges and Govt./Govt. Aided Polytechnics All eligible situated within Tamil Nadu candidates as given in the 2. Teaching Research Associates information to 3. Regular employees working in R&D centres which are recognized as a Research Centre by the candidates Anna University, Chennai and erstwhile Anna University of Technology at Chennai, Coimbatore, Madurai, Trichy & Tirunelveli Please specify: 12. Details of current employment (if applicable) Name & address of the employer: Nature of employment : Regular/Approved Probationer/ Probationer/ Consolidated pay/ Contract/ Visiting Faculty/Temporary/TRA/Teaching Fellow Scale of Pay: _________________________ working since _________________ (Certificate from the employer should be enclosed) Details of employment in project (if applicable) Name of the Principal Investigator: ___________________________________________________________

13.

(copy of the project sanction order to the Principal Investigator should be enclosed)
Title of the Project: ________________________________________________________________________ Funding Agency: _____________________________________ Duration of the Project : _______________ Consolidated Salary : ____________ working since ____________ Date of Expiry of the Project : ____________ (copy of the project appointment order should be enclosed)

14.

ACADEMIC BACKGROUND

Candidates with UG/PG degree other than the Universities listed in the Annexure II and degrees obtained other than Regular mode shall obtain course equivalency certificate from The Director (Academic Courses), Anna University, Chennai 600 025. (Enclose copies of Degree Certificates and Mark sheets duly attested see Clause 8.0 of Information to Candidates) Start with the latest degree obtained: Sl. No 1. 2. 3. 4. 5. Year of Passing % of Branch / Class Marks / Specialization Obtained CGPA

*Regular
mode / Others (specify)

Degree

College

University

Additional Information, if any

*To be filled without omission

(i) The Qualifying Degree is under (ii) Whether Course Equivalence applied 15. Sl. No 1. 2. 3. 4. : : Full-time/Part-time day time/Part-time evening/Distance mode/Week end mode/Others (specify) YES/NO (If yes, proof for the same shall be enclosed)

Professional Experience (Start from the present employment) : Period From To Total Salary P.M. Additional Information, if any

College/Organization

Designation

Nature of Job

16.

Details of Publications in refereed Journal and Conferences, if any : (Photo copy shall be enclosed) Proposed Major area for Ph.D. / M.S. (By Research) programme Tentative research topic (One page write-up of proposed research work with signature of the candidate & Supervisor, Joint Supervisor (if any) shall be enclosed) : :

17. 18.

19.

i) Department in which the candidate proposes to register (Department of the Supervisor) ii) College in which the candidate proposes to register (College of the Supervisor) iii) Faculty (Refer Annexure III of information

: :

to the candidates)

: CIVIL/MECHANICAL/ELECTRICAL/ INFORMATION &COMMUNICATION/ TECHNOLOGY/ ARCHITECTIRE & PLANNING/SCIENCE & HUMANITIES/ MANGEMENT SCIENCES :

20.

Name, Designation and Address of the proposed a) Supervisor * (Recognized supervisors working in the recognized departments)

b)

Joint Supervisor (applicable only for candidates from : R&D centres which are recognized as a research centre by this University and for those candidates who propose to undertake Interdisciplinary research) * Refer http://www.annauniv.edu/research/supervisor.php for the list of Recognized Supervisors.

21.

Demand Draft Particulars: Name of the Bank & Branch Demand Draft No. Date Amount

22.

Whether at present registered or discontinued Ph.D./M.E./M.Tech. : / M.S.(By Research) programme in any other University Check list for enclosures : (Tick appropriate) 1. Attested photocopy of 10th or its equivalent 2. 3. 4. 5. 6. 7. 8. 9. Attested photocopy of HSC/Diploma or its equivalent Attested photocopy of UG Mark sheets Attested photocopy of UG Degree certificate Attested photocopy of PG Mark sheets Attested photocopy of PG Degree certificate Attested photocopy of M. Phil. Degree certificate (If applicable) Attested photocopy of Community Certificate (except for Forward community) Service certificate from the employer (if part-time)

YES/NO (If yes, please specify)

23.

[ [ [ [ [ [ [ [ [

] ] ] ] ] ] ] ] ] ] ] ] ] ]

10. Relieving order from the employer [ (Employed candidates, who want to pursue full-time study) 11. Demand Draft [ 12. One page Research topic write up 13. Proof for Course equivalence application (If applicable) [ [

14. Four Self Addressed covers stamped to the value of Rs.5/- [

DECLARATION BY THE CANDIDATE Mode of UG Degree: Full-time/Part-time day time/Part-time evening/Distance/Week end/Others (specify) Mode of PG Degree : Full-time/Part-time day time/Part-time evening/Distance/Week end/Others (specify) (Strike out whichever not applicable) This is to certify that the particulars given above are true, correct and complete to the best of my knowledge and belief. I am aware that any wrong information or suppression of information and facts may result in punitive action in addition to cancellation of Ph.D./M.S. (By Research) programme at any stage. Place Date : : Signature of the candidate

CERTIFICATE FROM ENGINEERING COLLEGE/RESEARCH ORGANISATION WHERE THE CANDIDATE IS EMPLOYED

Certified that Mr./Ms./Mrs._________________________________________________ is employed as (Designation)___________________________________ in the (Department/Division) __________________________________________________ of (Engineering College/Organization) ___________________________________________________________________________________ The College/Organization has no objection to forward his/her application for admission to Ph. D./M.S. (By Research) Programme. FOR FULL TIME*: The employee will be sanctioned study leave for the minimum duration of the research programme and will be relieved from duty from ______________ to ______________ in order to undertake Full-time research work in the University Departments/recognized Departments of Engineering Colleges. The necessary relieving order will be given during admission. (or) FOR PART TIME**: The employee will be permitted to undertake Part-time research in the University Departments/recognized departments of Engineering Colleges and he/she will be permitted to be present for attending course works, discussion with the supervisor, conduct experiments and participate in seminars and research related discussion. Further, the required facilities at our Institute/ organization will also be provided to the employee for doing research. (Note: Choose the appropriate * / ** marks) Place: Date: Signature of the Principal with office seal / Signature of the Head of the R&D organization with office seal

CONSENT OF THE SUPERVISOR / JOINT SUPERVISOR (i). Recognized supervisors who are working in (a) University Departments/University Colleges/University Campuses/Govt./Govt. aided Engineering Colleges (as given in Annexure I sec I to III). (b) Recognized research departments of Self-financing Engineering College (as given in Annexure I sec IV) and recognized research departments (within Tamil Nadu) of erstwhile Anna University of Technology at Chennai, Coimbatore, Madurai, Trichy & Tirunelveli shall only function as Supervisor. (ii) Supervisors working in recognized Nationalized Laboratories of this University such as SERC, IGCAR, etc., situated within Tamil Nadu shall function as Supervisor. However, for such Supervisors, recognized supervisor from University Departments or from affiliated Engineering Colleges as Joint Supervisor is mandatory. (iii) Recognized supervisors working in R&D centres (as given in Annexure I sec V) and in the non recognized departments of self-financing Engineering Colleges shall act only as Joint supervisor. SUPERVISOR Name Designation Nature of Appointment Department Regular / Contract / Temporary / Visiting Faculty Regular / Contract / Temporary / Visiting Faculty JOINT SUPERVISOR (If applicable)

College / Organization Address Mobile No. Date of Birth Date of Retirement Area of Specialization Whether the supervisor fulfills the norms as per clause 7 of Ph.D/M.S (By Research) Regulations (R 2010) of Anna University No. of Research Scholars working as on Date As Supervisor As Joint Supervisor Signature YES / NO If Yes, Please furnish Univ. Ref. No. for Supervisorship recognition YES / NO If Yes, Please furnish Univ. Ref. No. for Supervisorship recognition

Ph.D.

M.S.

Ph.D.

M.S.

Supervisor while giving his/her consent should furnish list of panel members for DC/MC in the enclosed format. A supervisor shall guide only a maximum of 12 [Ph.D./M.S. (By Research) put together] scholars as Supervisor and Joint Supervisor. Joint Supervisor is mandatory, if the supervisor is not a regular faculty member of the University Departments. A maximum of six Ph.D./M.S.(By Research) scholars only be permitted under such supervisors. A MAXIMUM OF 4 CANDIDATES SHALL ONLY BE ALLOWED TO REGISTER WITH A SUPERVISOR IN ANY ONE SESSION.

DETAILS OF RESEARCH SCHOLARS PURSUING RESEARCH UNDER HIS/HER GUIDANCE AS SUPERVISOR AND JOINT SUPERVISOR (Shall be furnished by the supervisor while giving his/her consent) INCOMPLETE DETAILS RESULTS IN REJECTION OF THE APPLICATION Details of Ph.D. / M.S (By Research) Scholars:
SL. NO NAME OF THE SCHOLAR REG. NO. Ph.D. / M.S. SUPERVISOR / JOINT SUPERVISOR NAME OF THE UNIVERSITY RESEARCH STATUS

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Certified that I have listed all the research scholars registered under my guidance as Supervisor / Joint Supervisor. Signature of the Supervisor (Name with seal) 6

LIST OF PROPOSED DC MEMBERS FOR Ph.D. PROGRAMME

(TO BE TYPED IN CAPITAL LETTERS)

Name of the Candidate Research Topic of the Candidate

(Abstract of topic duly signed by the supervisor should be enclosed)

: : Supervisorship recognition No. : Supervisorship recognition No. : Area of specialization

Name of the Supervisor : Name of the Joint Supervisor, if any : Sl. No. Name with full address

Members from University Departments/University Colleges/University Campuses/ Govt./Govt. Aided Engineering colleges 1.
Name : Designation : Department : Address :

Phone: 2.
Name : Designation : Department : Address :

E-mail:

Phone: 3.
Name : Designation : Department : Address :

E-mail:

Phone: 1.

E-mail: Members from other Institutions (preferably within Tamil Nadu)

Name : Designation : Department : Address :

Phone: 2.
Name : Designation : Department : Address :

E-mail:

Phone: 3.
Name : Designation : Department : Address :

E-mail:

Phone:

E-mail:

SIGNATURE OF THE SUPERVISOR (NAME WITH SEAL)

SIGNATURE OF THE JOINT SUPERVISOR (NAME WITH SEAL)

SIGNATURE OF THE HOD / DIRECTOR OF THE CENTRE

(If applicable)

of the Supervisor
(NAME WITH SEAL)

LIST OF PROPOSED MC MEMBERS FOR M.S. (By RESEARCH) PROGRAMME

(TO BE TYPED IN CAPITAL LETTERS)

Name of the Candidate Research Topic of the Candidate

(Abstract of topic duly signed by the supervisor should be enclosed)

: :

Name of the Supervisor

Supervisorship recognition No. : Supervisorship recognition No. : Area of specialization

Name of the Joint Supervisor, if any : Sl. No. Name with full address

Members from University Departments/University Colleges/University Campuses/ Govt./Govt. Aided Engineering Colleges 1.
Name : Designation : Department : Address :

Phone: 2.
Name : Designation : Department : Address :

E-mail:

Phone: 3.
Name : Designation : Department : Address :

E-mail:

Phone:

E-mail:

SIGNATURE OF THE SUPERVISOR (NAME WITH SEAL)

SIGNATURE OF THE JOINT SUPERVISOR (NAME WITH SEAL)

SIGNATURE OF THE HOD / DIRECTOR OF THE CENTRE

(If applicable)

of the Supervisor
(NAME WITH SEAL)

Programme

Ph.D.

M.S.

Office Ref. No.

DATA SHEET FOR Ph.D./M.S. (By Research) ADMISSION (TO BE TYPED IN CAPITAL LETTERS) 1. Name (As in UG/PG Degree with initials at the end) 2. Date of Birth 5. Community: 6. Communication Address with Mobile No. Email I.D. 7. B.E./B.Tech./ B.Sc.(Engg.)/B.Sc./ Others Major: Year of Passing University 8. M.E./M.Tech./ M.Sc.(Engg.)/M.S.(By Research)/M.Sc./ /M.Phil./M.A./M.B.A./M.C.A./ Others Major: Year of Passing University 9. Employed Yes No (If Yes, provide Office address with designation; If No, provide Residential address) Percentage of Marks/CGPA Mode of Study R O Percentage of Marks/CGPA Mode of Study R O ST SC 3. Sex SCA M MBC F 4. Nationality BC BCM Indian OC Foreign

10. Category Applied for

Full time

If Part time College Organization Regular Contract TRA Project

11. Name of the Supervisor: Designation : Department : College : 12. Name of the Joint Supervisor (if applicable) Designation : Department : College : 13. Tentative Research topic

14. Demand Draft Particulars Bank Name R Regular O Others

Amount

D.D. No. Branch

D.D. Date

SIGNATURE OF THE CANDIDATE