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PH .D. Application Form-New

The document is an application form for admission to a Ph.D. program, offering options for full-time, part-time, or full-time with fellowship. It requires personal details, academic records, professional experience, and a proposed research topic, along with a declaration of accuracy. Additionally, it includes a certificate of employment and no objection from the applicant's employer if applicable.

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Sahana
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45 views5 pages

PH .D. Application Form-New

The document is an application form for admission to a Ph.D. program, offering options for full-time, part-time, or full-time with fellowship. It requires personal details, academic records, professional experience, and a proposed research topic, along with a declaration of accuracy. Additionally, it includes a certificate of employment and no objection from the applicant's employer if applicable.

Uploaded by

Sahana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 5

Office Ref.

No

Web www.crescent.education Phone +91-44-2275 1347, 48, 50


Admission Help-Desk: +91 95432 77888
Email: [email protected], [email protected]

APPLICATION FOR ADMISSION TO Ph.D. PROGRAMME

Full Time
Part Time
Full Time with Fellowship

Department / School for Registration :

1. Name (in Block Letters) :


Affix a recent
2. Date of Birth (DD/MM/YY) : Age : Passport - size
Photograph
3. Gender : Male / Female
4. Nationality : Indian / Foreign
5. If Foreign National, Country …… ……………………….
Passport No. ………………………..
6. Social Status : ST / SC / MBC / BC / OC
7. Marital status : Married / Unmarried
8. Contact details :
Telephone Email ID
Mobile No.
(with STD code) (Official & Personal)

a) Office Address b) Residential Address

Page 1 of 5
c) Address for communication : Office / Residence

9. Type of Registration:
Category Sponsored Not sponsored

Full Time

Part Time

b) If Part Time, what category:

i) University staff ii) Other Colleges / Universities

iii) Industry (Govt.) iv) Industry (Pvt.)

v) Research Centre

vi) Others (Specify) …………………………………...

10. Details of Academic record:

Month
Full Time / % of
&Year
S.No Degree Discipline Part Time/ University / College Marks / Class
of
CGPA
passing

1 UG

2 PG

3 M.Phil.

4 Others

Page 2 of 5
11. Academic Performance:
(Attach Separate Sheet, if required)

a) Bachelor’s Degree Discipline:…………………….

Semester I II III IV V VI VII VIII


Percentage of marks
/ CGPA obtained

b) Master’s Degree: Discipline:…………………….

Semester I II III IV V VI
Percentage of marks /
CGPA obtained

c) Additional Qualification (Specify if any) ………………………………..

12. Professional Experience (Teaching / Research / Industrial)


(Attach Separate Sheet, if required)

Period Regular /
Name of the
S.No Designation From To Temporary/
Organization
Contract

Total

13. Details of current employment (if applicable)


i) Name & address of the employer :

ii) Designation :

iii) Name of employment : Regular / Contract / Part time /


Temporary

iv) Scale of pay :

Page 3 of 5
v) Working since date :
vi) Total years of experience :

14. Details of publications in refereed Journal


(Attach Separate Sheet, if required)

15. Proposed Major Area for Ph.D.programme :

16. Tentative Research topic (A one page :


write up of the proposed research with
signature of candidate should be enclosed)

17. Particulars of Demand Draft:

Name of the Bank & D.D. No. Date Amount


Branch

18. List of enclosures :

i) Attested copies of mark sheets / ii) Employer’s certificate (NOC)


Grade cards (U.G & P.G)

iii) Passport size photo (4 Nos) iv) One page write up

vi) Whether DD enclosed

vii) Others if any (specify) ……………………………………………………..

DECLARATION

I hereby certify to the best of my knowledge and belief that the particulars
given above are true, correct and complete. I am aware that any wrong information
or suppression of information and facts may result in punitive action in addition to
cancellation of my candidature for Ph. D programme admission.

Place :

Date : Signature of Candidate

Annexure I

Page 4 of 5
CERTIFICATE OF EMPLOYMENT AND NO OBJECTION

1. Certified that Mr / Mrs / Ms. …………………………………………….. is


employed as …………………………………… in the Department of
…………………………… of ……………………….. for the last …………….. Years.

2. While forwarding his / her application, we certify that we have no objection


for him / her pursuing Ph. D. programme in B.S. Abdur Rahman University

3. As the applicant will be pursuing, Ph.D programme on Full Time basis, we


will sanction leave for the duration of the research programme and will be relieved
from his / her duties to undertake the research work.

4. As the applicant will be pursuing Ph.D programme on Part time basis, he /


she will be allowed to be present for discussions with the supervisor, attending
course work, conduct experiments and participation in seminars and all related
discussions. Further we will provide the required facilities at our Institution /
Organization to the applicant for doing research.

( NB : Strike out para 3 or 4, whichever is not applicable)

Signature of the Head of the


Organization with office seal

Place :

Date :

Page 5 of 5

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