application form for phd
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Cost of Application : Rs.1000/-
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Application No.
Ph.D. REGISTRATION FORM
Registration No.(To be allotted by the University)
1. Name of the Applicant
Bank Name:
5. Date of Birth 6. Blood Group
Male Female
8. Religion
9. Social Status SC/ST/MBC/BC/OBC/OC/PWD
2. Gender
3. Official Address for Correspondence (Do not repeat the Name)
4. Residential Address (Do not repeat the Name)
7. Nationality
Fill up the details in English in BLOCK LETTERS
Put mark wherever applicable
For Eligibility Criteria, please visit our website
Website: www.ametuniv.ac.in
(Under Sec. 3 of UGC Act 1956)
PIN Code
PIN Code
State
Country
Country
State
1
10. Mobile No.of the Candidate:
11. Email ID .................................................................................................................
Email : [email protected]
DD No :
Date :
Branch :
Demand Draft in favour of The Registrar, AMET University, Chennai
Category(Please Tick) a. Full Time b. Part-Time (Internal) c. Part-Time (External)
D D M M Y Y Y Y
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PIN Code State
Sl.No. OrganizationPeriod
From To
Salary
Per MonthDesignation Nature of Job
14. Academic Background (Start with the latest Degree / Diploma obtained)
(Enclose copies of Degree/Diploma Certificates duly self attested)-Attach Separate Sheet if necessary
13. Salary received per month
Sl. No.Degree/
Diploma
Year of
Passing
University/
Institution
Major
Discipline
Percentage
of marks and
Class
obtained
Full-Time (or)
Part-Time(or)
Distance
Education
1.
1.
2.
2.
3.
3.
4.
4.
15. Professional Experience (Start from the present employment)-Attach Separate Sheet if necessary
16. Awards/Medals/Prizes and Honours conferred if any :
17. Major Area of Ph.D. Research
19. School & Department in which the candidate proposes to register
18. Tentative Topic on which the research is proposed to be conducted
2
12. Are you employed?
If yes, specify the Name and Address of the Employer
Yes No
Country
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3Part-time Candidates (External) shall have a Supervisor/Guide recognized by AMET University
preferably or from other organizations and in addition, shall have a Research Coordinator at the
organization in which they are working(optional).
20. DECLARATION OF THE CANDIDATE
21. PART-TIME (External) REGISTRATION ONLY
CERTIFICATE FROM THE HEAD OF THE ORGANIZATION
This is to certify that the particulars given above, are true, correct and complete to the best of my
knowledge and belief.
Place:
Date: Signature of the candidate
i) The candidate will be permitted to be available at AMET University for fulfilling the residential
requirements, as per University Regulations.
ii) The required facilities at our University will be provided to the candidate for doing research.
iii) The candidate will be permitted to be available at AMET University, whenever required by the
Supervisor to have discussions with him, to attend to the prescribed course works, to conduct
experiments and to participate in Seminars/Conferences/Workshops/Symposias/Short Term
Courses etc...
Name of the Research Coordinator (Optional) :
Designation :
Signature of the Signature of the Head
Research Coordinator of the Organization
Place :
Date :
Seal of the Organization :
22. CONSENT OF THE SUPERVISOR / GUIDE
(i)SUPERVISOR / GUIDE
a. Name (in BLOCK LETTERS)
(i) Official Address (Do not repeat the Name)
b. Address for Communication
PIN Code State
Country
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4(ii) Residential Address (Do not repeat the Name)
(iii) Contact Phone Number
a) Office (with STD Code)
b) Residence (with STD Code)
c) Mobile
PIN Code State
(iv) Email ID ................................................................
c) Whether the Supervisor / Guide has been recognized by
AMET University to guide research scholars :
If yes, University Reference No.
d) No. of Ph.D Scholars Supervising
* This list is to be provided only after getting the consent from the members mentioned above. If Area of Research,
Designation & Address are not provided, properly then University will fix the DC Members.
e) Panel of Names suggested for the Doctoral Committee (DC) Members* :(Attach Separate Sheet if
necessary) (At least six names, excluding Supervisor, Research Coordinator must be given by the
Supervisor / Guide out of six, three from academic institution and three from industry)
(i) As a Supervisor / Guide in AMET University :
(ii) As a Supervisor / Guide in other Universities :
(v) Website address if any .......................................................
Sl.
No.Name Designation
Official Address
with Pin Code
E-Mail & Mobile
number
Area of Specialization
Country
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CERTIFIED that the details furnished above have been verified and found to be correct and I am
willing to supervise the candidates research work.
Place :
Date : Signature of the Supervisor
(ii) JOINT - SUPERVISOR (Optional)
23. CONSENT OF THE AMET UNIVERSITY SCHOOL / HEAD OF THE DEPARTMENT
24. RECOMMENDATION OF THE DIRECTOR-RESEARCH :
25. FORWARDED BY
26. APPROVAL OF THE VICE-CHANCELLOR
a. Name (in BLOCK LETTERS)
b. No. of Ph.D Scholars Supervising
CERTIFIED that I am willing to Supervise the candidates research work.
(i) As a Supervisor in AMET University :
(ii) As a Joint-Supervisor in AMET University :
(iii) As a Supervisor/Joint Supervisor in other Universities :
c) Whether the Joint-Supervisor has been recognized by
the AMET University to guide. :
If yes, University Reference No.
Place :
Date : Signature of the Joint-Supervisor
Consent of the AMET University School / Head of the Department in which the candidate works: Yes / No(For Part-Time (Internal) candidates only)
Place : Signature :Date :
Name :
School / Department : Seal
Admitted / Not Admitted for Provisional registration in the Ph.D Programme Full-Time / Part-Time
(Internal) / Part-Time(External).
DIRECTOR - RESEARCH
REGISTRAR
VICE-CHANCELLOR
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NOTE:
1. Duration of the Ph.D. programme is Three years.
2. Monthly Fellowship / Stipend of Rs.8000/- will be given to the selected candidates for the
Full Time Ph.D programme with fellowship category candidates.
3. Completed Ph.D Registration form with enclosures and demand draft should be sent to
The Director - Research
AMET University,
135, East Coast Road,
Kanathur - 603 112
Chennai, India
Tel : 044 - 27472155 / 157 Fax : 044 - 27472804
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