Application Form for Ph.D

 

VISVESVARAYA TECHNOLOGICAL UNIVERSITY, BELGAUM BELGA UM KARN KARNATAK ATAKA A   

Paste ( do not pin ) passport size photograph in this space and get it attested by Principal  / Head of College / University last attended or a Gazetted Officer

APPLICATION FORM FOR PHD/ M.Sc. (Engg) BY RESEARCH FOR THE ACADEMIC YEAR 2013-14 Full time

Part time

Programme Applied for: Ph.D.

Research Centre applied for: VTU-RC Faculty Applied for : Engineering

Category : GM Male

SC

ST

VTU-R&D Architecture

VTU-RRC

Science

CAT-I

M.Sc.(Engg) M.Sc.(Engg)  

Computer Applications

Physically Challenged

Female

Married

Business Administration

Others Unmarried

Name: ……………………………………..……………………………….…..….Date ……………………………………..……………………………….…..….Date of Birth:..………………………………..… Father’s Name:……………………………………………………………..………………………  Name:……………………………………………………………..………………………  Academic Qualification: Programme Degree University Regular Specialization % Marks obtained obtained  /Distance with Class UG

Year of passing

PG M.Phil Others if any No. of years of experience: Industry:

Teaching:

Research:

Number of Research papers:

Patents:

Awards:

Topic of Research proposed :

……………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………… Titles of the proposed course work (enclose detail syllabus in separate sheets)* SL.No

Group

Code

Subject

1 2 3 4 5 6 7 8 * For details refer clause 14.1 & 14.3 of Ph.D. New Regulation

 Research Centre  1. VTU-RC:……………………… ………………………….Department:……………….……...Recognized: Yes

No

2. VTU-R&D:……………………………………………… Department:…………………….....Recognized: Yes

No

3. VTU-RRC: Belgaum Belgaum.. Department………………………………..………

 

Application and Processing Fee Details: D.D. for . 800/- No.:……………Drawn on Bank……..……………….date:………. ` 

 Information of the Supervisor Name: ………………………………………………………Date of Birth..……………………………………………. Affiliation : ……………………………………………… …………………………………………………Department: …Department: ……………………………………………… Designation…………………………………………………Area Designation………………………………………… ………Area of Research…………………………………………… Research…………………………………………… Academic Qualification: Programme Degree obtained UG

University

Regular  /Distance

Specialization

% Marks obtained with Class

Year of passing

PG Ph.D. Others if any No. of Publications in the preceding 5 years:  Research papers: 1. Nationa Nationall Journ Journal al

communicated: 1. National Journal

    2. International Journal Technical Reports:

Conference:

1.

Book:

    2. International Journal Patents: 

 Awards:

 No. of students Supervising: 

Sl. No.

Programme Please tick ()

Name of the Candidate/s

Ph.D.

University

Category

Specify Year of whether acting Area of registration as Supervisor Specialization or Co Supervisor

Whether Final Thesis Submitted (Y/N)

M.Sc. (Engg)

1 2 3 4 5 6 7 8 Total

Undertaking from the Supervisor I, ……………………………………………… is a permanent faculty /employee working as ……………………………….… ……………………………….………………… ……………… in the Department of …………………………………… ………………………………………. …. in the organisation ……………………………………………………………. ……………………………………………………………..…..…...and .…..…...and is

aged

less

than

62

years

as

on

the

date

of

admission

notification,

hereby

certify

Mr./Mrs……………………………….…………..… Mr./Mrs……… ……………………….…………..…….registerin ….registering g for ………………………….….. ………………………….….... .. degree under

that

the

candidate

VTU is not

my

son/daughter/immedi son/daug hter/immediate ate blood relative and the total number of candidates registered under me in VT VTU U aand nd other Universities for both Ph.D. & M.Sc. (Engg.) by Research taken

together excluding presently applied candidates is (in Words)…………… The information provided above

is true to the best of my knowledge. Date: Place: Signature : _________________________________________ ________________________________ _________

 

Fo Forwa rward rded ed b ,……………………………………………………………………………………………………………………………..…….

 Information of the Co-Supervisor( if appl applicable) icable)

Name: ……………………………………………………….Date of Birth..……………………………………………. Affiliation: ………………………………………………. .. Department: ……………………………………………… Designation…………………………………………………Area Designation………………………………………… ………Area of Research…………………………………………… Research…………………………………………… Academic Qualification: Programme Degree obtained UG

University

Regular  /Distance

Specialization

% Marks obtained with Class

Year of passing

PG Ph.D. Others if any No. of Publications in the preceding 5 years:  Research papers: 1. Nationa Nationall Journ Journal al

communicated: 1. National Journal

2. International Journal  Conference:

1.

Technical Reports:

2. International Journal  Patents: 

Book:

 Awards:

 No. of students Supervising: Supervising:

Sl. No.

Programme Please tick ()

Name of the Candidate/s

Ph.D.

University

Category

Specify Year of whether registration acting as Supervisor or Co Supervisor S upervisor

Area of pecialization

Whether Final Thesis Submitted (Y/N)

M.Sc. (Engg)

1 2 3 4 5 6 7 8 Total

Undertaking from the Co-Supervisor I, ……………………………………………… is a permanent faculty /employee working as ……………………………….… ……………………………….………………… ……………… in the Department of …………………………………… ………………………………………. …. in the organisation ……………………………………………………………. ……………………………………………………………..…..…...and .…..…...and is

aged

less

than

62

years

as

on

the

date

of

admission

notification

hereby

certify

Mr./Mrs……………………………….…………..… Mr./Mrs……… ……………………….…………..…….registerin ….registering g for ………………………….….. ………………………….….... .. degree under

that

the

candidate

VTU is not

my

son/daughter/immedi son/daug hter/immediate ate blood relative and the total number of candidates registered under me in VT VTU U aand nd other Universities for both Ph.D. & M.Sc. (Engg.) by Research taken together excluding presently applied candidates is (in Words)……………. The information provided above is true to the best of my knowledge. Date: Place: Signature : _________________________________________ ________________________________ _________ Forwarded by ,……………………………………………………………………………………………………………………………..…….

 

Undertaking  by Supervisor  / Co-Supervisor *(in case Co-Supervisor is opted)   I / We have no objection in guiding the said candidate in the proposed area of research at the designated Research Centre. If for any reason, myself /candidat /candidatee change the Research Research Centre, I /we will inform the same to the University University without fail.

Signature of Co-Supervisor

Signature of the Supervisor 

Signature of the Head of the Institution where the research work is proposed:……………………………………….…… 

No Objection Certificate of the Organisation This is to certify that the

Organisation

has

no objection in recommending the candidature of

our

employee…………………………………………for carrying out research for his/her his/her Ph.D./ M.Sc. (Engg.) (Engg.) by research at ………………………..……………………………………………………………………………………….. on part time / full time basis. The information provided provided by the candidate is found correct as per our records records..

Signature of the Principal/Head with Seal.  Seal. 

Employment Certificate of the Supervisor

This is to certify that Dr………….……………………………………………… presently working in the capacity of…………………………………………in the Department of……………………………... is a full time employee  employee  of our Organisation, since…………………………..

Organisation:………………………………………………

Seal and Signature of the Head of the Organisation

Employment Certificate of the Co-Supervisor  (in case Co-Supervisor is opted)

This is to certify that Dr…………………………………………………………… presently working in the capacity of…………………………………………in the Department of……………………………... is a full time employee  employee  of our Organisation, since…………………………..

Organisation:……………………………………… ……..

Seal and Signature of the Head of the Organisation

*  In case the candidate is applying applying under VTU-RRC, then a co-supervisor from VTU System is mandator mandatorily ily to be opted. opted.  

 

Applicant’s Address for correspondence …………………………………………………………………………………………………………………………….…

 

•

………………………………………………………………………………………………………………………….…… Phone No…………………………………….. No…………………………………….. email_id:  email_id: ………………………………………………………….. Supervisor’s Address for correspondence …………………………………………………………………………………………………………………………….… ………………………………………………………………………………………………………………………….…… Phone No…………………………………….. No…………………………………….. email_id:  email_id: ………………………………………………………..… Co-Supervisor’s Address for corresponden correspondence ce …………………………………………………………………………………………………………………………….… ………………………………………………………………………………………………………………………….…… Phone No…………………………………….. No…………………………………….. email_id:  email_id: …………………………………………………………………

Ph.D./M.Sc.(Engg)

Name of the Applicant: …………………………………………………………………………………………… Name of the Supervisor : …………………………………………………………………………………..……... Name of the Co-Supervisor:……………………………………………………………………………………. Research Centre(VTU-RC/VTU-RRC):……………………… Centre(VTU-RC/VTU-RRC):………………………………………………… …………………………...…………… ...…………… Programme:……………………………………………………………………………………………………….. Mobile No: ……………………………………………Phone ……………………………………..…………  Enclose attested copies of the following, before sending s ending the application :  1. 

Detailed Bio-data of the Candidate, Supervisor (and CoSupervisor, if applicable) 

2. 

UG and PG degree Certificates and Marks cards of the Candidate

3. 

UG, PG and PhD Supervisor/Co-supervisor

4. 

Category certificate of candidates belonging to SC/ST/CatI/ and any other if applicable  applicable 

5. 

Synopsis of the proposed research

6. 

Syllabus of the Course work chosen for the present study

7. 

Degree

Certificates

of

the

Demand Draft of .800 drawn in favour of The Finance Officer, VTU, Belgaum towards Application and Processing fee   `

9.

 Any other additional Certificates supporting your claim for benefits like:

 

Medical Certificate for the degree of disability in support of candidates claiming benefit

 

Test Score Card along with Admission ticket in support of clearance of UGC/UGC-CSIR  JRF/SLET/CAT/GATE/NET  JRF/SLET/CAT/GAT E/NET or any any other National Test with valid score





 

In case candidate/Supervisors are possessing degree from Foreign Universities, The Equivalence Certificate issued by the Associa Association tion of India Indian n Universities( AIU)

 

Passport with student Visa in the case of Foreign candidates





 

  VISVESVARAYA TECHNOLOGICAL UNIVERSITY

󰁁󰁰󰁰󰁬󰁩󰁣󰁡󰁴󰁩󰁯󰁮 󰁎󰁯󰀮

“Jnana sangama” Belgaum-590 018, Karnataka, India

 APPLICATION FORM FOR UNIVERSITY  UNIVERSITY  LEVEL  LEVEL RESEARCH APTITUDE TEST (ULRAT) Note: 1. This Form should be filled by all the candidates irrespective of their eligibility to be exempted from from the ULRAT as such an exemption is subject to a thorough thorough scrutiny of supporting docum documents ents satisfactorily provided by the candidate along with this Application

Test Centre Csode:  Csode: 

Bangalore

Belgaum

󰁆󰁯󰁲 󰁴󰁨󰁯󰁳󰁥 󰁨󰁡󰁶󰁩󰁮󰁧 󰁶󰁡󰁬󰁩󰁤󰁩󰁴󰁹 󰁯󰁦 󰁖󰁔󰁕 󰁔󰁥󰁣󰁨󰀮 󰁁󰁰󰁴󰁩󰁴󰁵󰁤󰁥 󰁔󰁥󰁳󰁴

None

 Programme Stream Stream Applied for:  for:  1. Mechanical Engineering

7. Bio-Technology Bio-Technology

13. Maths

2. Computer Science Engineering

8. Polymer Science

14. Physics.

3. Electrical Engineering

9. Silk Technology

15. Chemistry

4. Civil Engineering

10. Textile

16. Business Administration

5. Environmental Engineering

11. Chemical

17. Computer Applications

6 . Architecture. 12. Geology Educational Qualification Qualification which makes you eligible for the Programme Program

Degree Awarded

Specialisation

Percentage of Marks/CGPA with Class

1 17. Statistics Statistics   Specify Regular or Distance Education

UG PG M Phil Nationality:   Indian Nationality: Category:  Category: 

General

Gender:: Male Gender

Others (NRI/FN/PIO): SC

ST

Whether Physically challenged

Cat-1 Yes

To be filled by candidates

OBC No

Seat No.:

Female

Any Other………………………………. : If Yes, Nature of disability:……….……………...

For Office Use only 

Name:……………………………………………… Address……………………………………………. ……………………………………………… Cleared in Jan 2011 Specify the status of VTU TAT: TAT: Cleared in July 2010 Write the TAT Seat No. ..……………………..................................... National Test qualified with valid score Date of ULRAT: ………………………………………………………………………………………. Programme Yes No Are you a facultyapplied under for:…………………… QIP/FIP: QIP/FIP: Test Centre: Address for correspondence: Reporting Time: ……………………………………………..

Cleared

Paste ( do not pin ) passport size photograph in this space and get it attested by Principal  / Head of College / University last attended or a in July 2011 Gazetted Officer

Candidate’s Signature

 

Whether any National Test Qualified: Qualified:

Yes

No

If you possess VTU Technical Aptitude Test validity validity,, then provide Seat No :…..…………………………….  Declaration by the Candidate Candidate

I

……………………………………………………………hereby acknowledge that all the information given

by me are true to the best of my knowledge. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the University at any time and I shall not be entitled for refund of any fee paid by me to the University. University. I have carefully studied the Reg Regulations(Amended) ulations(Amended) Governing the Degree of Doctor Doctor of Philosophy (Ph.D.)-2011 framed under Section 32 of V VTU TU Act 1994.

Date:

Signature of the Candidate

Visit www.vtu.ac.in for details regarding Regulations, Guidelines , Recognised Research Centres, Course Work, Fee Structure and Syllabus for

ULRAT.