rpapplication

8/7/2019 rpApplication

http://slidepdf.com/reader/full/rpapplication 1/6

K L University Vaddeswaram, Green Fields, Guntur District

Ph: 08645246948, htt :// www.kluniversit .in

Application Form for Admission into Ph.D. Program(Read important points available at the end of this application and also

Appendix-A which details all rules and regulations)

Tick the Appropriate from following options

Applicant Category: Regular□Long standing □ Re-Registration□

Industrial□ Research Organization □

Mode of registration: Full Time□ / Part Time□

Application Fee

DD/Pay Order

Num/ Cash

receipt Num

Bank Name Branch Name Amount

Paid

1. Name of the candidate :

First Name-Middle Name-Last Name

2. Date of Birth(DD/MM/YY) : □□ /□□ /□□

3. Gender : Male/Female: □□□□□□

4. Father’s / Husband’s Name :

5. Nationality : □□□□□□□□□□□□

6. Address for communication

D.No :

Flat No:

Name of the Apartment:

Name of the Street:

Name of the City :

District:

Passport Size Photo





State:

Pin Code:

Email ID:

Phone (with STD/ISDcodes)/ Mobile No’s:

7. Educational details (Up-to latest degree obtained) :

Srl

No

Qualification Specialization/

Major

Name of the

University

Year of

Passing

Percentage /

CGPA

1 Xth class

2 XIIth Class

3 UG-1

4 UG-2

5 PG-1

6 PG-2

8. Details of Teaching/Industrial Experience :

S.No.

Designation Name of theOrganization

Period Total DurationIn MonthsFrom

MM/YY

To

MM/YY

1

2

3

4

Total Experience

9. Research Discipline /(s) in which Registration is desired

Dicipline-1(Code)□□□□□□

Dicipline-2 (Code)□□□□□□ in case of Inter-discipline

Refer to Annexure-A for the Code Numbers





10. Details of Honor(s) / Ranks if any:

S.No. Type of Rank RankObtained

Institution Awarded YearObtained

1

2

3

4

5

11.

Details of Internships in Industry / Academia if any:

S.No. Name of the Industry /Institution

Duration of internship Total durationMonthsFrom

MM/YYTo

MM/YY

1

2

3

4

12. Details of Membership(s) in Professional Bodies if any :

S.No. Name of the Body Type of Membership(AM/LM/Fellow etc)

Nature of Membership

(Annual / Five Years / Life Time)

13. Details of Research Publications in the proposed research area:

Number of Publications:

International Journals □□□ National Journals: □□□

International Conferences □□□ National Conferences □□□





Details of Publications:

Journals:

S.No. Title of the paper Name of the Journal Vol No.& IssueNo.

Month & Year of Publication

1

2

3

4

5

Conferences:

S.No. Title of the paper Name of theConference

Name of theOrganizing Body

Month& Year

1

2

3

4

5

14. Details of Research Projects carried / Associated with (if any):

S.No. Title of the Project Funding Body Nature of Association

1

2

3

4

5





15. Proposed Area of Research

16. Title of the Research

17. Proposed Plan of Research work with its scope (Please attach a write-up with

phase wise plan: The research plan must be submitted as per Annexure-C

18. Status of the research work if being carried already: Should be submitted as

per Annexure-D

Signature of the Candidate





Instructions to the Candidates

Important Points to Note before filling the Application Form:

1. The candidate opting for full time Program must give their Research

director/ co-director choice from the Existing faculty on rolls of K L E FUniversity. The research area of the applicant must be same as the focus

area of the Research director.

2. Please attach No objection Certificate from the Present Employer in case

of Part time program (Annexure-E). No objection Certificate is not

required in case of K L University candidate

3. Please attach a cancellation letter addressed to the university at which the

registration is made if Re-Registration is sought (Annexure-AI)

4. Please attach the attested copies of all your certificates starting from SSC.

5. Enclose the DD of Rs.500/- towards application fee.

6. Enclose the Proofs for Teaching Experience for Part time program.

7. In case of part-time program attach a Letter from Head of Institution

expressing the willingness to extend the infrastructural and lab facilities

for undertaking the Ph.D program.

8. Mention your name and phone number on the back side of the DD.

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