visvesvaraya technological university (vtu) …

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APPLICATION FORM FOR FULL TIME PHD/ M.SC. (ENGG) BY RESEARCHFOR THE ACADEMIC YEAR 2019

Self attested photograph to be pasted

Applied for : Ph.D M.Sc. (Engg.)

Name :

Father’s Name:

Email :

Date of Birth :

Category : GM SC ST Cat-I Physically challenged Others

Gender : FemaleMale

Marital Status : Married Unmarried

Qualifications : GATE Score (if available) Valid Up to :

VISVESVARAYA TECHNOLOGICAL UNIVERSITY (VTU) RECOGNIZED RESEARCH CENTRE

ProgrammeDegree

ObtainedBoard/

UniversityRegular / Distance

Specialisation% Marks

obtained with Class

Year of Passing

PG

UG

Diploma *****

XII/PUC***** *****

X / SSLC ***** *****

Experience (in years)

Fresher Industry Teaching

Research

Publications / Recognitions

Number of Research papers Patents Awards

Area of Interest :

Declaration by the Applicant:

I hereby acknowledge that all the information given by me are true ______________________________________________

to the best of my knowledge.

Signature of the Candidate Date :

Enclose self attested copies of the following along with the application

1 Detailed Bio-data

2 SSLC/X marks card

3 PUC/XII marks card

4 Diploma Certificate (if applicable)

5 UG degree Certificate

6 PG degree Certificate (if applicable)

7Test Score Card along with Admission ticket in support of clearance of GATE with valid score (if available)