VISVESVARAYA TECHNOLOGICAL UNIVERSITY, BELGAUM BELGA UM KARN KARNATAK ATAKA A
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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
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 …………………………………………………………………………………………………………………………….…
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
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