Académique Documents
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Ph.D
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Full Time Internal (Refer Instructions Full Time External to the candidates) Part Time Internal Part Time External
1. 2. 3. 4. 5. 6. 7. 8. 9.
Father / Guardian Name Designation & Department Gender Age (Attach Proof) Date of Birth Marital Status Nationality Religion
10. Community (Attach Proof) 11. Name of the Caste 12. Office Address ( Ref. Annexure 2) College Code College Name College Address & Phone no
: : :
17. Academic Qualification (UG, PG & Others) Name of the Institution Degree
University
Year of Completion
Specialization
Marks
Class / Rank
19. Tentative Research Title 20. Abstract of the Proposed Research topic ( to be Enclosed)
21. Whether he / she has been awarded fellowship like UGC,CSIR,etc. If so, give details : 22. Awards, Medals, Prizes and Honours achieved in his / her career :
23.
Any other particulars he/she would like to present for the consideration of the authorities.
24. Whether he /she has already registered or discontinued the Ph.D. /M.Sc. (Engineering) M.Tech (By Research) Programme etc. in any other institution. If so, give details 25. Whether he /she any publications/ articles to his /her credit. If so, give details (Attached a Separate Sheet,if necessary)
26.
Name & Address of the Institution, where the proposed research supervisor is located ( Attach Proof) Supervisor ID Number * Name of the Supervisor Office Address E-mail id Number of the Candidates currently registered under him /her with this / any other University. If with other universities, mention the name of the Universities
27.
: Application Fees/SBI Power Jyothi Challan details(Attach University copy - Original ) Branch Name Branch Code Amount Date Journal No
28. ATTACHMENTS (TICK APPROPRIATE) SSLC +2 / Diploma UG Degree Certificate PG Degree Certificate M.Phil. Degree Certificate NOC from Head of the Institution Where employed Service Certificate Acceptance of the Research Supervisor Community Certificate Challan Enclose attested Xerox copy Declaration
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The above particulars given by me are correct to the best of my knowledge .. Place: Signature of the Applicant Date : --------------------------------------------------------------------------------------------------------------------------------------------------------------(Office use only) Verified by Staff (Name) Eligible / Not Eligible Signature
Mandatory field
ANNA UNIVERSITY OF TECHNOLOGY,COIMBATORE Coimbatore -641 047. To be filled in by the Supervisor concerned Particulars required with regards to the candidates of Ph.D., / M.Tech.(By Research) Degree currently registered under the Supervision of ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Name of the Candidates ----------------------------------------------------------------------------------------------------(Note : Candidates who have been permitted recently to register Ph.D. degree should also be indicated)
Whether Stipendiary or Non Stipendiary if Stipendiary, mention the Source
Sl.No
When Registered
1 2 3 4 5 6 7 8 9 10 11 12
Note : The number of candidates registered under your guidance should not exceed twelve. Whether the Supervisor is recognized if so, state the No. and date of this University communication through which he /she is recognized as a Supervisor for Ph.D. / M.Tech.(By Research) Programme.
Signature
Contact No.
Seal