DAVANGERE UNIVERSITY Recent

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Shivagangotri, Davangere-577 007. with

Ph.D./ M.Phil. Admissions 2019-20 Attestation

Application No: Form-A

APPLICATION FOR Ph.D./ M.Phil. PROGRAMME

Application for Admission to PhD./ M.Phil. Programme: (Full Time/ Part Time)
Admission is sought in the Department of ………………………………………………

Ms./Mr.
Name of the Candidate
1 :
(IN BLOCK LETTERS)

2 Course applied for : Ph.D. : M.Phil. :

3 Subject :
Date and Place of Birth
4 :
(As Per SSLC Marks Cards)
5 Name of Father/Guardian :

6 Name of the Mother :

7

(a) Permanent Address :

(b) Address for Communication :

(c) Phone No: Land Line/Mobile :

(d) E-Mail :
8 Qualification(s) with % of Marks :
(Enclose certified copy of Marks
Card)
 9 Nationality :

10 Category : GM/SC/ST/Cat-I/IIA/IIB/IIIA/IIIB/ Others

11 Occupation of :

i) Father /Guardian :

12
ii) Mother :

Monthly Income of
13 :
Parent/Guardian
Physically Challenged : Yes/No
(if yes, State the Nature with
percentage of disabilities along with
14 an attested copy of medical
certificate issued not below the rank
of District surgeon)

: Yes/No
15 Are you a sponsored candidate?

16. Details of Academic Record (from degree level):

Name of the Month and
Qualifying University Average % of No. of
Specialization College/ year of
Degree Marks/Grade* Attempts
Institution Passing

* Average % must be based on Marks/Grade obtained in all the

Semester examinations

17. Qualifying Examination passed: UGC-JRF/UGC-CSIR-JRF/GATE

(If yes, attach the related certificate) and year of appearance

18. Professional Experience (Research/Industrial) if any, after the

Qualifying Degree

SI. Name of the Designation and Period

No. Organization Nature of Work
From To
19. If employed
a) Regular/Temporary ________________________
b) Name of the Employer ________________________
c) Nature of Work ________________________
(Teaching/Industry/Other)
d) Total Experience ________________________

20. Details of Papers Published in refereed Journals/Proceedings of

Seminars/ Conferences (Please add Separate sheet, if needed)

21. Any other relevant information

Declaration by the Applicant

I ……………………………………………….. (Name in full) Daughter/Son

of ……………………………. hereby solemnly declare that the
information furnished and the statements given in the application
and enclosures are complete and correct. I further declare that if I
am found otherwise, I shall be liable to forfeit of my admission and/or
any kind of disciplinary action besides prosecution.

Place:
Date:
SIGNATURE OF THE CANDIDATE
 SPONSORSHIP CERTIFICATE
(From the Present Employer)
Certified that Mr./Ms./Mrs. ......................................... is a
Permanent employee of ................................ and is working as
............................... (Full Time/Part Time) All facilities will be extended
to him/her during the course of study, by the Government/ Management/
Institution. This Organization/Department/Institute has NO OBJECTION
for him/her to register the Ph.D. programme. He/ She has a teaching
experience in this Organization/College for a period of
………………………………………………….. y e a r s m o n t h s a n d D a y s
a s o n … … … … … … … … as detailed below.

Sl. Period of Duration of Service

No. Designation ServiceTo
From Years Months Days

Total

Station: IGNATURE OF THE SPONSORING AUTHORITY

Date & Office Seal: NAME & DESIGNATION

 This certificate will not be considered if the Office Seal of the issuing
authority is not affixed.
 The application of the Candidates who have not furnished the sponsorship
certificate in the above format will be rejected without notice.
 If the above certificate is false or contains false information, criminal/legal
action will be initiated against the Candidate and the concerned authority.
 Instructions to Candidates
(for Admission to Ph.D. and M.Phil. Programme)
1. Courses Offered: Ph.D. & M.Phil.
Sl.No. Name of the Faculty Department
1 Arts
2 Commerce &
Management
3 Science and
Technology
4 Education
2. Qualifying Examination and Eligibility – Criteria.
Relevant PG Programmes with good academic performance recent
with 55% (in case of SC/ST/Cat-I -50%) or equivalent grade.
3. Other State Candidates:
Candidates from other states/other Universities are
eligible with Migration Certificate issued by competent
authority.
4. Filling up the application form
a) If a candidate wishes to apply for more than one course
he/she should use separate application form for each
course with separate fees.
b) All columns in the application form are to be filled in
Programme Fees SC/ST Fee payment
(for GM/ others) /Cat-I
Ph.D. Fees to be paid to the Account No:
1,200/- 600/-
64050447113 of the State Bank of
M.Phil. India (Main), Davangere/ Davangere
600/- 300/- University, Shivagangotri, Davangere.

5. Attested copies of the following testimonial should be

enclosed with the application form.
1 SSLC Marks Card.
2 PUC Marks Card.
3 Degree Marks Cards (All Semester/Year)
4 Transfer Certificate.
5 Reservation Certificate for SC/ST/OBC.
6 Other Co- Curricular activities.
7 Seminar, Short Term training, Industry Certificate.
8 Medical Fitness.
9 Publications, Journals if any.
10 Application Fee Challan/DD (Copy)
11 Duly filled in application of all the attested certificates/enclosures to
be submitted to the concerned department chairperson on or before
30-09-2019 before 4.00 p.m.
12 Intimation relating to Entrance test will be communicated separately
by the respective department to the concerned candidate.