Office Reference No.

ANNA UNIVERSITY : CHENNAI - 600 025

CENTRE FOR RESEARCH
APPLICATION FOR ADMISSION TO RESEARCH PROGRAMMES - JANUARY 2011

Ph.D. M.S. (By Research) Strike out whichever is not applicable

Note: Candidates working as faculty members in Engineering Colleges/Architecture Schools within
Tamil Nadu and Regular employees working in the recognized R&D centres of this University can apply
under Part-time mode. Refer the information brochure before filling the application form.
1. Name (in Block letters) :
(As in UG/PG degree certificate)
2. Sex: Male/ Female 3. Nationality: Indian/ Foreign (Affix Passport
size Photo
4. If foreign national: Country ________________ Passport No.________________ recently taken)
5. Social Status: ST/SC/SCA/MBC/BC/BCM/OC 6. Community ____________________

7. Age & Date of Birth: ________________ 8. Marital Status: Married/ Unmarried

Photograph shall be attested
9. Email ID : by a Grade A/B Officer or
Head of the Institution.
10. Address :

Office Address : Residential Address :

Designation : ____________________________________ _____________________________________________

Department : ____________________________________ _____________________________________________

Organization : ____________________________________ _____________________________________________
Place : ____________________________________ District : ____________________________________
Dist. /State : ___________________ Pincode:__________ State : ___________________ Pincode: ___________
Phone : Mobile : Phone : Mobile :

11. Category applied for : (Tick appropriate box, after referring Instructions carefully)
Full-time Part-time
All eligible 1. Regular Faculty of University Departments, University Colleges of Engineering,
candidates as Govt./Govt. Aided/Self-Financing Engineering Colleges within Tamil Nadu
given in the 2. Teaching Research Associates of this University
“information to 3. Regular employees working in Industries/ Research organizations which are
the candidates” recognized as research centres by this University (Refer: Annexure I sec V)
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
Scale of Pay: _________________________ working since date _________________
(Certificate from the employer need to be attached)
13. Details of employment in project (if applicable)
Name of the Principle Investigator: ___________________________________________________________
(copy of the project sanction order to the principle Investigator should be enclosed)
Title of the Project: ________________________________________________________________________
Funding Agency: _____________________________________ Duration of the Project : _______________
Stipend: ____________ working since date ____________ Date of Expiry of project : _____________
(copy of the project appointment order should be attached)

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14. Academic Background :
Candidates with UG/PG degree other than the Universities listed in the annexure III 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:

Regular Additional
Major % of
Sl. Year of Class mode / Information,
Degree College University Discipline / Marks /
No Passing Obtained Others if any
Specialization CGPA
(specify)

1.

2.

3.

4.

5.

15. Professional Experience (Start from the present employment) :

Additional
Sl. Period Total
College/Organization Designation Nature of Job Information,
No From To Salary P.M.
if any
1.

2.

3.

4.

2
16. Details of Publications in referred journal, if any :
(Xerox copy shall be enclosed)

17. Proposed Major area for Ph.D. / M.S (By Research) programme :

18. Tentative research topic (One page write-up of proposed :

research with signature of the candidate & supervisor,
Joint supervisor, if any should be enclosed)

19. i) Department in which the candidate proposes to register :

ii) College in which the candidate proposes to register :

iii) Faculty (See Annexure II of information : CIVIL/MECH/ELECTRICAL/I&C/

to the candidates) TECH/ARCH/S&H/MANGT. SCIENCE

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 industry / :

research organizations 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 Recognized Supervisors list.

21. Demand Draft Particulars:

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

DECLARATION OF THE CANDIDATE:

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 my admission to Ph.D./M.S. (By Research) programme.

Place :

Date : Signature of the candidate

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

Certified that Mr./Ms./Mrs._________________________________________________ is employed as

(Designation)_________________________________________________________ in the (Department/Division

Name)__________________________________________________of (Engineering college/Organization Name)

_____________________________________________________________________________________________

The College/Organization has no objection to forward his/her application for Ph. D./M.S. (By Research)
Programme.

FOR FULL TIME* :

The candidate will be sanctioned study leave for the entire duration of the research programme and

will be relieved from duty from ________________ to ___________________ to undertake Full-time research

work in the University Departments/recognized Departments of Engineering Colleges.

(or)
FOR PART TIME** :
The candidate 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

discussion with the supervisor, attending course works, conduct experiments and participation in seminars

and related discussion. Further, the required facilities at our Institute/organization will also be provided to

the candidate for doing research.

(Note: Choose the appropriate * / ** marks)

Place :

Date : Signature of the Head of organization with office seal

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 CONSENT OF THE SUPERVISOR / JOINT SUPERVISOR
(Recognized supervisors working in the University Departments, Govt./Govt. Aided
Engineering colleges and recognized departments of Self-financing Engineering College
as given in Annexure I (sec I to IV) shall only function as Supervisor. Recognized
supervisors working in the organization as given in sec V of Annexure I and in the non
recognized departments of self-financing Engineering colleges are eligible to be only
Joint supervisor)
@ JOINT SUPERVISOR
SUPERVISOR
(should furnish the University Applicable only for candidates from
Ref. No. for Supervisorship Industry/Research Organizations
recognition) recognized as a research centre by this
University and for candidates undertake
interdisciplinary research

Name

Designation

Regular / Contract / Temporary /

Nature of Appointment
Visiting Faculty

Department

College / Organization Address

Mobile No.

Date of Birth

Date of Retirement

Area of Specialization

Whether the supervisor fulfills the YES / NO YES / NO

norms as per clause 7of Ph.D/M.S If Yes Please furnish Univ. Ref. No. If Yes Please furnish Univ. Ref. No.
(By Research) Regulations (R 2010) for Supervisorship recognition for Supervisorship recognition

No. of Research Scholars working Ph.D. M.S. Ph.D. M.S.

as on Date
As Supervisor
As Joint Supervisor

Signature

@
The Supervisor while giving his/her consent should furnish list of panel members for
DC/MC in the enclosed format (page 7). A supervisor shall guide only a maximum of
twelve [Ph.D./M.S. (By Research) put together] scholars as Supervisor/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.

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 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 REJECTION OF THE APPLICATION

Details of Ph.D. / M.S (By Research) Scholars:

SUPERVISOR
SL. Ph.D. / RESEARCH
NAME OF THE SCHOLAR REG. NO. / JOINT
NO M.S. STATUS
SUPERVISOR

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

Signature of the Supervisor

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 ANNA UNIVERSITY
CENTRE FOR RESEARCH
LIST OF DC/MC* PANEL MEMBERS Course Ph.D. M.S.*
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. :

Name of the Joint Supervisor, if any : Supervisorship recognition No. :

Sl.No. Name with full address Area of Research in Ph.D.
Members from University Departments and Engineering colleges
1. Name :
Designation :
Department :
Address :

Phone: E-mail:
2. Name :
Designation :
Department :
Address :

Phone: E-mail:
3. Name :
Designation :
Department :
Address :

Phone: E-mail:
Members from other Institutions (preferably within Tamil Nadu)
1. Name :
Designation :
Department :
Address :

Phone: E-mail:
2. Name :
Designation :
Department :
Address :

Phone: E-mail:
3. Name :
Designation :
Department :
Address :

Phone: E-mail:
* For M.S (By Research) scholars, only three panel members need to be given.

SIGNATURE OF THE HOD* SIGNATURE OF THE JOINT SUPERVISOR SIGNATURE OF THE SUPERVISOR
(NAME WITH ADDRESS SEAL) (NAME WITH ADDRESS SEAL) (NAME WITH ADDRESS SEAL)
*HOD of the Supervisor (If applicable)

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 Course Ph.D. M.S. Office Ref. No.

DATA SHEET FOR Ph.D./M.S. (By Research) ADMISSION

(TO BE FILLED BY CANDIDATE – ALL LETTERS SHOULD BE IN CAPITAL LETTERS)

1.NAME
(As in UG/PG Degree with
initials at the end)

2. Date of Birth 3. Sex M F 4. Nationality Indian Foreign

5. Community: ST SC SCA MBC BC BCM OC

6. Social Status Married Unmarried

7. Communication
Address with
Email ID

Mobile Number:

8. B.Tech./B.E./B.Sc.(Engg.)/ / Others
Major:

Year of Passing Percentage of Marks/CGPA Mode of Study R O

University

9. M.Tech./M.E./M.Sc.(Engg.)/M.Sc./M.S.(By Research)//M.Phil./M.A./M.B.A./M.C.A./ Others

Major:

Year of Passing Percentage of Marks/CGPA Mode of Study R O

University

10. Employed Yes No (If Yes, provide Office address with designation; If No, provide Residential address)

11. Category Full If Part

Applied time time
for
College Organization Regular Contract TRA Project

12. Proposed Department for Research

and Institution address

13. Supervisor Name, Designation & Address

14. Joint Supervisor Name, Designation & Address

(If applicable)

15. Area of Research (Topic)

R – Regular O – Others (please specify)

SIGNATURE OF THE CANDIDATE