ph.d.m.s (by research) application july 2011

8/13/2019 Ph.D.M.S (by Research) Application July 2011

1/5

Page 1of 5

ANNA UNIVERSITY OF TECHNOLOGY MADURAIAlagar Ko il Road, Madurai 625 002

APPLICATION FOR ADMISSION TO RESEARCH PROGRAMME JULY 2011(Tick whichever is applicable)

1. Name (in Block letters withInitials at the end) :

2. Sex : Male/Female

3. Nationality : Indian/Foreign

4. If foreign national : Country____________ Passport No___________

5. Social Status : ST/SC/ MBC/BC/OC

6. Community :

7. Age & Date of Birth :

8. Marital Status : Married/Unmarried

9. Email Address :

10. Address:

Office Address:

Designation : _________________________

Organization: _________________________

Place : _________________________

Taluk/Dt./State:________________________

Pincode : _______________________

Phone : ______________________

Fax : ______________________

Mobile :_______________________

Email:________________________

Residential Address:

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

Pin code: _____________________________

Phone : ___________________________

Fax : ________________________________

Mobile : ____________________________

Email: ___________________________

11. Category applied for: (Tick appropriate box, after referring Instructions)

FULL TIME PART TIME

12. Details of Current employment (if Applicable)

Name & Address of the employer :

Ph.D. M.S. (By Research)

Affix recently

taken passport

size photo

Appln. No:

For office use only


2/5


3/5

Page 3of 5

18. Tentative research topic :

(One page write-up of proposed research with signature ofCandidate & Supervisor should be enclosed)

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

ii) Department in which the candidate proposes to register :

iii) Faculty : CIVIL / MECH / ELECTRICAL / I & C /TECH / S & H / MANAGEMENT

20. Name, Designation and Address of the proposed

a) Supervisor :

b) Joint Supervisor (applicable only for candidates from :

industry / research Organizations recognized as aresearch centre by this University)

(* Refer:http://www.autmdu.ac.in/researchfor Approved Supervisors list.)

21. D.D Particulars:(Rs.600/- for General Candidates(Rs.300/- for SC/ST Candidates) drawn in favour ofThe Director, Centre for Research, Anna University of Technology Madurai, payable at Madurai.)

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

22. Awards, Medals, Prizes and Honors conferred if any :

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 candidature for Ph. D. / M.S. (By Research)

programme admission.

Place:

Date : Signature of Candidate


4/5

Page 4of 5

CONSENT OF THE SUPERVISOR / JOINT SUPERVISOR

(Recognized supervisors working in the recognized departments shall only function as supervisor)SUPERVISOR

*

(should furnish theUniversity Ref. No. for

Supervisorship

Recognition)

JOINT SUPERVISOR(Applicable only for candidates fromIndustry / Research Organisations

Recognized by this University)

Name

Designation

Nature of Appoi ntment

Department

College / OrganizationAddress

Date of Birth

Area of Research

Whether the supervisorfulfi ls the norms as perPh.D. / M.S (by research)Regulations

YES / NOIf Yes Please furnishUniversity Ref. No.

YES / NOIf Yes Please furnish University Ref. No.

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

As on Date

As Supervisor

As Joint Supervisor

Total

Signature

* The supervisor while giving his / her consent should furnish the list of panel members for DC / MC in theenclosed format (page 5). A Supervisor shall not normally guide more than ten research scholars(including MS by Research Scholars) for Ph. D. at any time. Additional candidates, if any underextraordinary circumstances, shall be decided on the merit of the cases, subject to the approval ofResearch Board.

Joint Supervisor is mandatory if the supervisor is not regular faculty member of this university. A

maximum of ten research scholars only be permitted under such supervisors.

If the supervisor wants to guide in areas other than his / her area of research, these areas shall beaccepted based on two publications in reputed journals or the staff member shall have handled PG levelclasses in the above areas, during last three years preceding the date of application.


5/5

Page 5of 5

CENTRE FOR RESEARCHANNA UNIVERSITY OF TECHNOLOGY MADURAI, MADURAI 625 002

LIST OF PANEL MEMBERS FOR DC / MC[To be sent in a sealed cover]

(Tick whichever is applicable)

Name of the Candidate :

Research Topic of the Candidate :(Abstract of topic duly signed by theSupervisor should be enclosed)Name of the Supervisor :

Supervisor Recognition Ref. No. :

Sl.

No.Name with full address Area of Research in Ph.D.

From Academic Institutions:1. Name :

Designation :Department :

Address :

Mobile : Email:

2. Name :Designation :Department :

Address :

Mobile : Email:3. Name :


Address :

Mobile : Email:

From Industry/R&D organizations:

1. Name :Designation :Department :

Address :

Mobile : Email:2. Name :


Address :

Mobile : Email:

3. Name :Designation :

Department :Address :

Mobile : Email:

SIGNATURE OF THE HOD* SIGNATURE OF THE SUPERVISOR(NAME WITH ADDRESS) (NAME WITH SEAL)

*HOD of the Supervisor

Ph.D. M.S. (By Research)

ph.d.m.s (by research) application july 2011

Documents