AMRITA

AMRITA

VISHWA VIDYAPEETHAM

U N I V E R S I T YEstablished u/s 3 of UGC Act, 1956

Amritanagar P.O., Coimbatore 641 112, Tamil Nadu, INDIA

(All columns to be filled only in CAPITAL LETTERS)

1. Name of the candidate as given in the Academic record (leave blank space between name and initials)

2. Gender: Male / Female/ Transgender3. Contact Details:

(a) Address for communication:

PIN Code:

Phone No.

(STD Code)

E-mail ID:

(b) Permanent address:

PIN Code:

4. Admission Details: (a) Department in which the candidate proposes to register for Ph.D: (b) Area of Research: ______________________________________________________________________

(c) Tentative Title of proposed Research: (Please enclose a one page write-up about your proposal)

(d) Preferred Campus: Amritapuri / Bangalore / Coimbatore

(e) Category of Admission: Full time/ Part-time (f) Name of the proposed Thesis Advisor (within Amrita), if any:

5. Academic record

S.No.Degree obtained Area of specialization University Year of PassingPercentage of marks / CGPA (on a 10 point scale)

1

2

3

4

Note: If any degree (UG or PG) was obtained through correspondence course / distance education mode, please specify.

6. Publications, if any (please enclose copies):

7. Additional examinations passed if any (like GATE/ GRE/ CAT/ UGC- JRF/ Lectureship/ CSIR/ DAE). 8. Professional experience (Teaching / Research / Industrial), if any:

S.No.PeriodOrganization Designation & Nature of work

FromTo

9. Please enclose 3 letters of reference from persons you know professionally. List the Name, Designation and Address of your referees.

Name DesignationAddress

10. Personal details:Age & Date of Birth: Religion: Caste:

Community: (SC, ST, MBC, BC, OBC,OC)

Marital Status:

State:

Mother Tongue:

Nationality:

11. List of documents to be enclosed. (Please enclose only the attested copies)

1. SSLC or Equivalent Certificate.

2. Plus two Certificate.

3. Degree/ Provisional Certificate.

4. Statement of marks for all the Semester/Years.

5. Certificate/Mark sheet of additional examinations in respect of serial no. 7.6. Transfer Certificate and Conduct Certificate from the Institution last attended.

7. One page write-up about the proposed area of research.8. Reference Letters Original (see item no. 9)

9. Copies of Research Paper Publications, if any.10. NOC from the present employer12.

DECLARATION

I,

Son / Daughter of

hereby declare that the particulars given by me in the application are true. I shall produce the original certificates at the time of admission or on demand. If, in future, any information is found to have been furnished falsely or incorrectly or any information suppressed to secure admission, I shall withdraw from the programme without any claim or consideration

Place:

Date: Signature of the Applicant

The completed application together with the necessary enclosures should be submitted to any one of the following campuses

AmritapuriBangaloreCoimbatore

The Chair, PGP

Amrita Vishwa Vidyapeetham

Amritapuri, Clappana P.O.,

Kollam 690 525.

Phone: +91 476 2801280

The Chair PGP Amrita Vishwa Vidyapeetham

Kasavanahalli, (off Sarjapur Road), Carmelaram P.O., Bengaluru-560035

Phone: +91 80 25183700 The Chair PGP Amrita Vishwa Vidyapeetham

Amrita Nagar P.O., Coimbatore 641112

Phone: +91 422- 2685118

along with a demand draft of Rs.600/- in favour of Amrita Vishwa Vidyapeetham Amrita School of Engineering payable at (Amritapuri/Bangalore/Coimbatore)Bank Draft No. Dated: . for Rs. Drawn on (Bank and Branch):

Affix latest Passport size Colour Photograph

APPLICATION FORM FOR ADMISSION TO Ph.D. PROGRAMME IN ENGINEERING

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