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Office Reference No.

ANNA UNIVERSITY CHENNAI : CHENNAI - 600 025


APPLICATION FOR ADMISSION TO RESEARCH PROGRAMMES - JULY 2010

Strike out whichever is not applicable Ph. D. M.S. (By Research)
Note: The candidates working in Affiliated Engineering Colleges situated in the districts of Chennai,
Kancheepuram, Thiruvallur, Vellore, Thiruvannamalai and Villupuram are only eligible to apply under
Part-time category. For further details please refer Annexure IV in the information brochure.

Photograph shall be attested
by a Grade A/B Officer or by
Head of the Institution.


(Affix Passport
size Photo
recently taken)

1. Name (in Block letters) :
(As in UG/PG degree certificate)

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 ID :

10. Address :
Office Address :
Designation : ____________________________________
Department : ____________________________________
Organization : ____________________________________
Place : ____________________________________
Dist. /State : ___________________ Pincode:__________
Phone : Mobile :
Residential Address :
_____________________________________________
_____________________________________________
_____________________________________________
District : ____________________________________
State : ___________________ Pincode: ___________
Phone : Mobile :

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

Full-time Part-time
All eligible
candidates as
given in the
information to
the candidates
1. Regular Faculty of University Departments, University College of Engineering,
Govt. Engineering Colleges/ Self-Financing Engineering Colleges affiliated to
this University and Teaching Research Associates

2. Industry/ Research organizations Recognized as a Research Centre by this
University
(Refer: Annexure I sec III and Annexure IV)

Please specify:

12. Details of current employment (if applicable)

Name & address of the employer:

Nature of employment : Regular/Approved Probationer/ Probationer/ Consolidated pay/ Contract/
Visiting Faculty/Temporary/TRA

Scale of Pay: _________________________ working since date _________________

(Certificate from employer to be attached)


13. Details of employment in project (if applicable)
Name of the Principle Investigator: ________________________________________________________________
(copy of the project sanction order to the principle Investigator should be enclosed)
Title of the Project: ______________________________________________________________________________

Funding Agency: _____________________________________Duration of the Project_______________________

Stipend: ____________________ working since date ______________ Date of Expiry of project _____________
1
(Copy of the project appointment order should be attached)
2

14. Academic Background :
Candidates with UG/PG degree other than the Universities listed in the annexure III or the
degrees obtained other than Regular mode shall obtain course equivalency certificate from
the Director (Academic Courses), Anna University Chennai.
(Enclose copies of Degree Certificates and Mark sheets duly attested see Clause 8.0 of Information to Candidates)
Start with the latest degree obtained:

Sl.
No
Degree
Year
of
Passing
College University
Major
Discipline /
Specialization
Class
Obtained
% of
Marks /
CGPA
Regular
Course /
Others
(specify)
1.



2.



3.



4.




15. Professional Experience (Start from the present employment) :
Sl.
No
Organization
Period
From To
Designation
Total
Salary P.M.
Nature of Job
1.

2.

3.


16. Details of Publications if any in referred journal :
(Xerox copy shall be enclosed)


17. Major Area for Ph.D. / M.S (By Research) Degree Programme :


18. Tentative research topic (One page write-up of proposed :
research with signature of the candidate & supervisor
should be enclosed)


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

ii) College in which the candidate proposes to register :

iii) Faculty (See Annexure - I & II of information : CIVIL/MECH/ELECTRICAL/I&C/
to the candidates) TECH/ARCH/S&H/MANGT. SCIENCE

2

0. Name, Designation and Address of the proposed
a) Supervisor * (Recognized supervisors working in the :
recognized departments of this University)


b) Joint Supervisor (applicable only for candidates from industry / research :
organizations recognized as a research centre by this University and for
candidates undertake interdisciplinary research)

* Refer: http://www.annauniv.edu/research/super.htm for Recognized Supervisors list.



21. Demand Draft Particulars:

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






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 the candidate


CERTIFICATE FROM THE ORGANISATION WHERE THE CANDIDATE IS EMPLOYED

Certified that Mr./Ms./Mrs._________________________________________________ is employed as
(Designation)_________________________________________________________ in the (Department/Division
Name)_____________________________________________________________________of (Institution Name)
_____________________________________________________________________________________________

The organisation has no objection in forwarding his/her application for Ph. D./M.S. (By Research)
Programme.

FOR FULL TIME* :

The candidate will be sanctioned leave for the entire duration of the research programme and will be
relieved from duty from ________________ to ___________________ to undertake Full-time research work in
the University Departments/recognized Departments of Colleges affiliated to Anna University Chennai.
(or)
FOR PART TIME** :
The candidate will be permitted to undertake Part-time study in the University/College and will be
permitted to be present for discussion with the supervisor, attending course works, conduct experiments and
participation in seminars and related discussion. Further, the required facilities at our Institute/organization
will also be provided to the candidate for doing research.
(Note: Choose the appropriate * / ** marks)


Place :

Date : Signature of the Head of organization with office seal







3
4

CONSENT OF THE SUPERVISOR / JOINT SUPERVISOR
(Recognized supervisors working in the recognized departments of this University
as given in Annexure I shall only function as Supervisor)




SUPERVISOR
@

(should furnish the University
Ref. No. for Supervisorship
recognition)
JOINT SUPERVISOR
Applicable only for candidates from
Industry/Research Organizations
recognized as a research centre by this
University and for candidates undertake
interdisciplinary research
Name




Designation




Nature of Appointment
Regular / Contract / Temporary /
Visiting Faculty

Department




College / Organization Address






Date of Birth



Area of Specialization




Whether the supervisor fulfills the
norms as per clause 7.4/7.5*** of
Ph.D/M.S (By Research)
Regulation
YES / NO
If Yes Please furnish Univ. Ref. No.
for Supervisorship recognition


YES / NO
If Yes Please furnish Univ. Ref. No.
for Supervisorship recognition
No. of Research Scholars working
as on Date
As Supervisor
Ph.D. M.S. Ph.D. M.S.
As Joint Supervisor



Signature




@

The supervisor while giving his/her consent should furnish list of panel members for DC/MC in the
enclosed format (page 6). A supervisor shall normally guide not more than nine research scholars
(Ph.D./M.S. put together) at any time. However, a supervisor shall guide three more Ph.D./M.S.
scholars as Joint Supervisor.

Joint Supervisor is mandatory, if the supervisor is not a regular faculty member of the University
Departments. A maximum of six Ph.D./M.S.(By Research) scholars only be permitted under such
supervisors.


*** 7.4 : If the supervisor intends to guide in areas other than his/her Ph.D. degree, these areas shall be
accepted based on two publications in referred journals in the above areas or the staff member shall have
handled PG level classes in the above areas, in the last three years preceding the date of application.

*** 7.5: If the supervisor intends to guide in areas other than his / her area of research, these areas shall be
accepted based on two publications in reputed journals / conference proceedings or the staff member shall
have handled PG level classes in the above areas, in the last three years preceding the date of application.
5

DETAILS OF RESEARCH SCHOLARS PURSUING RESEARCH UNDER HIS/HER GUIDANCE
EITHER AS SUPERVISOR OR JOINT SUPERVISOR
(Shall be furnished by the supervisor while giving his/her consent)

INCOMPLETE DETAILS RESULTS REJECTION OF THE APPLICATION

Details of Ph.D. / M.S (By Research) Scholars:

SL.
NO
NAME OF THE SCHOLAR REG. NO.
Ph.D. /
M.S.
SUPERVISOR
/ JOINT
SUPERVISOR
RESEARCH
STATUS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.



Signature of the Supervisor

ANNA UNIVERSITY CHENNAI
CENTRE FOR RESEARCH

6
LIST OF DC/MC* PANEL MEMBERS Course Ph.D. M.S.*
Name of the Candidate :

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

Supervisorship recognition Ref. No. :

Sl.No. Name with full address Area of Research in Ph.D.
Within Anna University Chennai (including affiliated Engineering colleges):
1.
Name :
Designation :
Department :
Address :


Phone: E-mail:





2.


Name :
Designation :
Department :
Address :


Phone: E-mail:

3.
Name :
Designation :
Department :
Address :


Phone: E-mail:

Out side Anna University Chennai :
1.
Name :
Designation :
Department :
Address :


Phone: E-mail:

2.
Name :
Designation :
Department :
Address :


Phone: E-mail:

3.
Name :
Designation :
Department :
Address :


Phone: E-mail:

* For M.S (By Research) scholars, only three panel members need to be given.







SIGNATURE OF THE HOD* SIGNATURE OF THE JOINT SUPERVISOR SIGNATURE OF THE SUPERVISOR
(NAME WITH ADDRESS SEAL) (NAME WITH ADDRESS SEAL) (NAME WITH ADDRESS SEAL)
*HOD of the Supervisor (If applicable)
7
Course Ph.D. M.S. Office Ref. No.

DATA SHEET FOR Ph.D./M.S. (By Research) ADMISSION
(TO BE FILLED BY CANDIDATE ALL LETTERS SHOULD BE IN CAPITAL LETTERS)

1.NAME
(As in UG/PG Degree with
initials at the end)


2. Date of Birth 3. Sex M F 4. Nationality Indian Foreign

5. Community:
ST SC MBC BC OC


6. Social Status Married Unmarried




7. Communication
Address with
Email ID and
Mobile Number


8. B.Tech./B.E./B.Sc.(Engg.)/AMIE. / Others
Major:

Year of Passing Percentage of Marks/CGPA Mode of Study R O

University

9. M.Tech./M.E./M.Sc.(Engg.)/M.Sc./M.S.(By Research)/M.A./M.B.A./M.C.A./ Others
Major:

Year of Passing Percentage of Marks/CGPA Mode of Study R O

University

10. Employed Yes No (If Yes, provide Office address with designation; If No, provide Residential address)




11. Category
Applied for
Full -
time
If Part
- time



College Organisation Staff TRA Contract Project

12. Proposed Department for Research
and Institution address



13. Supervisor Name, Designation & Address



14. J oint Supervisor Name, Designation & Address
(If applicable)




15. Area of Research (Topic)


R Regular O Others (please specify)

SIGNATURE OF THE CANDIDATE