APPLICATION-A

KARNATAK UNIVERSITY, DHARWAD

A Grade
NAAC Accredited-2008

APPLICATION FOR REGISTRATION FOR PH.D. PROGRAMME IN .

To,

Photo

The Registrar
Karnatak University
Dharwad-580 003
Sir,
I am herewith submitting the duly filled application for the Doctoral Programme of the Karnatak
University as a Full-time/Part-time candidate in the Department of Studies in ___________________.

My name has not been registered as a student for any other Degree in this University or any other
University.
I hereby solemnly and sincerely affirm that the statement made and information furnished by me in this
application and the enclosures submitted by me herein are true.

Date :

Yours faithfully,

Place :
Signature of the Applicant

1
Ph.D. Application 2014-15

KARNATAK UNIVERSITY, DHARWAD

Name in full in block letters

Shri/Smt. ________________________________________

(as per the Masters degree marks card) ________________________________________________

zyAi t g
./w__________________________________________
(vPvg z CAPnAi zAv) _____________________________________________
Residential Address :

_________________________________________________
_________________________________________________

Permanent Address :

_________________________________________________
_________________________________________________
________________________________________________

Cell. No.________________________ E-Mail___________________________________________

Nationality: ____________________________________ Category ___________________________

03. (a) Category: SC

ST

(b) Male

Others

Female

(enclose caste certificate if belongs to SC/ST/OBC)

(c) Marital Status: S

04. Details of Post-Graduate Degree Examination passed:

University

P.G. Degree
and Subject

Year of
Passing

Marks

Specialization

Maximum Obtained Percentage

05. Whether cleared Gate/Gre/UGC/UGC-CSIR NET for JRF?

es

No

06. If sponsored, whether the candidate is a permanent employee of educational and

/research institution or public/private sector organization/FIP/QIP/Project Fellow?
es

No

07. Whether the candidate is foreign citizen?

es

No

[if your reply to any of the above four items (i.e., items 04 to 07) is yes, enclose the relevant certificate)

08. Medium

: Kannada/English(Specify if any other )

09. Proposed area of research

2
Ph.D. Application 2014-15

DECLARATION
1. I shall submit the progress reports regularly as per the rules of the University.
2. I shall pay the registration fee/term fee/fee for extended terms within the stipulated date.
3. I also understand that, if I fail to submit the progress reports /payment of fees within the
stipulated period my registration for Ph.D. Degree stands cancelled automatically.
4. I shall seek extension of terms wherever needed before the expiry of the period. I understand
that post facto extension of terms may not be granted except in special circumstances such as
accidents and hospitalization (unforeseen reasons). In such cases also, intimation shall be given
within one month after accident/hospitalization.
5. I shall abide by all the relevant rules pertaining to the Doctoral Degree programme of the
University.
6. I Certify that Proposed research Topic is a fresh Proposal

Signature with seal of the Head of the

Institution/College/etc.
(for in-service candidates)

SIGNATURE OF THE CANDIDATE

3
Ph.D. Application 2014-15

Certificate by the Guide/Co-guide(if any)

I am willing to work as the co-guide for Sri/Smt. _____________________in his/her Ph.D.
programme. I find that the research topic is new and its contents are not published
anywhere.

Date:
Place :

(Signature of the co-guide)

Name & designation

I am a recognized guide for Ph.D. programme in the field of ____________as per ______
Universitys Order No. ________________ dated : _____________ I undertake the
responsibility of guiding Sri/Smt. ________________ for the Ph.D. Programme in the
proposed field of research. I find that the research topic proposed by the above candidate is
new and the contents are not published anywhere.

Certified that the above particulars and also details furnished by the candidate are correct
and true.

(Signature of guide with seal)

Name & designation
FOR USE IN THE DEPARTMENT OFFICE
Is the application approved by the Doctoral Committee

Yes/No

Resolution No:

Date:

Signature of the Chairperson of the Department. K.U.D. (with Seal)

Signature of the Chairperson, Doctoral Committee. (with Seal)

4
Ph.D. Application 2014-15