Application Form for Ph.D
Content
VISVESVARAYA TECHNOLOGICAL UNIVERSITY,
BELGAUM, KARNATAKA
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)
Computer Applications
Physically Challenged
Female
Married
Business Administration
Others
Unmarried
Name: ……………………………………..……………………………….…..….Date of Birth:..………………………………..…
Father’s 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. 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: ………………………………………………
Designation…………………………………………………Area of 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. National Journal
communicated: 1. National Journal
2. International Journal
Conference:
1.
Technical Reports:
2. International Journal
Book:
Patents:
Awards:
No. of students Supervising:
Sl.
No.
Programme
Please tick ()
Name of the
Candidate/s
Ph.D.
University
Category
Specify
Whether
Final Thesis
Year of whether acting
Area of
registration as Supervisor Specialization Submitted
or
(Y/N)
Co Supervisor
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
is
aged
less
than
62
years
as
on
the
date
of
admission
notification,
hereby
certify
Mr./Mrs……………………………….…………..…….registering for ………………………….….... degree under
that
the
candidate
VTU is not
my
son/daughter/immediate blood relative and the total number of candidates registered under me in VTU and 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 ,……………………………………………………………………………………………………………………………..…….
Information of the Co-Supervisor( if applicable)
Name: ……………………………………………………….Date of Birth..…………………………………………….
Affiliation: ………………………………………………. .. Department: ………………………………………………
Designation…………………………………………………Area of 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. National Journal
communicated: 1. National Journal
2. International Journal
Conference:
1.
Technical Reports:
2. International Journal
Book:
Patents:
Awards:
No. of students Supervising:
Sl.
No.
Programme
Please tick ()
Name of the
Candidate/s
Ph.D.
University
Category
Whether
Specify
Final
Year of
whether
Area of
Thesis
registration
acting as
Specialization
Submitted
Supervisor or
(Y/N)
Co Supervisor
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
is
aged
less
than
62
years
as
on
the
date
of
admission
notification
hereby
certify
Mr./Mrs……………………………….…………..…….registering for ………………………….….... degree under
that
the
candidate
VTU is not
my
son/daughter/immediate blood relative and the total number of candidates registered under me in VTU and 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 /candidate change the Research Centre, I /we will inform the same to the 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 Ph.D./ M.Sc. (Engg.) by research
at ………………………..……………………………………………………………………………………….. on part
time / full time basis. The information provided by the candidate is found correct as per our records.
Signature of the Principal/Head with 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 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 of
our Organisation, since…………………………..
Organisation:……………………………………… ……..
Seal and Signature of the
Head of the Organisation
* In case the candidate is applying under VTU-RRC, then a co-supervisor from VTU System is mandatorily to be opted.
Applicant’s Address for correspondence
…………………………………………………………………………………………………………………………….…
•
………………………………………………………………………………………………………………………….……
Phone No…………………………………….. email_id: …………………………………………………………..
Supervisor’s Address for correspondence
…………………………………………………………………………………………………………………………….…
………………………………………………………………………………………………………………………….……
Phone No…………………………………….. email_id: ………………………………………………………..…
Co-Supervisor’s Address for correspondence
…………………………………………………………………………………………………………………………….…
………………………………………………………………………………………………………………………….……
Phone No…………………………………….. 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):…………………………………………………...……………
Programme:………………………………………………………………………………………………………..
Mobile No: ……………………………………………Phone ……………………………………..…………
Enclose attested copies of the following, before sending 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
Medical Certificate for the degree of disability in
support of candidates claiming benefit
3.
UG, PG and PhD
Supervisor/Co-supervisor
4.
Category certificate of candidates belonging to SC/ST/CatI/ and any other if applicable
Test Score Card along with Admission ticket in
support of clearance of UGC/UGC-CSIR
JRF/SLET/CAT/GATE/NET or any other National Test
with valid score
5.
Synopsis of the proposed research
6.
Syllabus of the Course work chosen for the present study
In case candidate/Supervisors are possessing
degree from Foreign Universities, The Equivalence
Certificate issued by the Association of Indian
Universities( AIU)
Passport with student Visa in the case of Foreign
candidates
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:
VISVESVARAYA TECHNOLOGICAL UNIVERSITY
Application No.
“Jnana sangama”
Belgaum-590 018, Karnataka, India
APPLICATION FORM FOR UNIVERSITY LEVEL RESEARCH APTITUDE TEST (ULRAT)
Note:
1. This Form should be filled by all the candidates irrespective of their eligibility to be exempted from the ULRAT as
such an exemption is subject to a thorough scrutiny of supporting documents satisfactorily provided by the candidate
along with this Application
Test Centre Csode:
Bangalore
Belgaum
For those having
validity of VTU Tech.
Aptitude Test
None
Programme Stream Applied for:
1. Mechanical Engineering
7. 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
1 17. Statistics
Educational Qualification which makes you eligible for the Programme
Program
Degree Awarded
Specialisation
Percentage of
Marks/CGPA with
Class
Specify Regular or Distance
Education
UG
PG
M Phil
Nationality: Indian
Category:
General
Gender: Male
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…………………………………………….
………………………………………………
Specify
the status of VTU TAT: Cleared in July 2010
Cleared in Jan 2011
Write the TAT Seat No.
..…………………….....................................
National
Test qualified with valid score
Date of ULRAT:
……………………………………………………………………………………….
Programme
Are you
a facultyapplied
under for:……………………
QIP/FIP:
Yes
No
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:
Yes
No
If you possess VTU Technical Aptitude Test validity, then provide Seat No :…..…………………………….
Declaration by the 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. I have carefully studied the Regulations(Amended)
Governing the Degree of Doctor of Philosophy (Ph.D.)-2011 framed under Section 32 of VTU 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.
BELGAUM, KARNATAKA
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)
Computer Applications
Physically Challenged
Female
Married
Business Administration
Others
Unmarried
Name: ……………………………………..……………………………….…..….Date of Birth:..………………………………..…
Father’s 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. 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: ………………………………………………
Designation…………………………………………………Area of 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. National Journal
communicated: 1. National Journal
2. International Journal
Conference:
1.
Technical Reports:
2. International Journal
Book:
Patents:
Awards:
No. of students Supervising:
Sl.
No.
Programme
Please tick ()
Name of the
Candidate/s
Ph.D.
University
Category
Specify
Whether
Final Thesis
Year of whether acting
Area of
registration as Supervisor Specialization Submitted
or
(Y/N)
Co Supervisor
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
is
aged
less
than
62
years
as
on
the
date
of
admission
notification,
hereby
certify
Mr./Mrs……………………………….…………..…….registering for ………………………….….... degree under
that
the
candidate
VTU is not
my
son/daughter/immediate blood relative and the total number of candidates registered under me in VTU and 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 ,……………………………………………………………………………………………………………………………..…….
Information of the Co-Supervisor( if applicable)
Name: ……………………………………………………….Date of Birth..…………………………………………….
Affiliation: ………………………………………………. .. Department: ………………………………………………
Designation…………………………………………………Area of 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. National Journal
communicated: 1. National Journal
2. International Journal
Conference:
1.
Technical Reports:
2. International Journal
Book:
Patents:
Awards:
No. of students Supervising:
Sl.
No.
Programme
Please tick ()
Name of the
Candidate/s
Ph.D.
University
Category
Whether
Specify
Final
Year of
whether
Area of
Thesis
registration
acting as
Specialization
Submitted
Supervisor or
(Y/N)
Co Supervisor
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
is
aged
less
than
62
years
as
on
the
date
of
admission
notification
hereby
certify
Mr./Mrs……………………………….…………..…….registering for ………………………….….... degree under
that
the
candidate
VTU is not
my
son/daughter/immediate blood relative and the total number of candidates registered under me in VTU and 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 /candidate change the Research Centre, I /we will inform the same to the 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 Ph.D./ M.Sc. (Engg.) by research
at ………………………..……………………………………………………………………………………….. on part
time / full time basis. The information provided by the candidate is found correct as per our records.
Signature of the Principal/Head with 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 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 of
our Organisation, since…………………………..
Organisation:……………………………………… ……..
Seal and Signature of the
Head of the Organisation
* In case the candidate is applying under VTU-RRC, then a co-supervisor from VTU System is mandatorily to be opted.
Applicant’s Address for correspondence
…………………………………………………………………………………………………………………………….…
•
………………………………………………………………………………………………………………………….……
Phone No…………………………………….. email_id: …………………………………………………………..
Supervisor’s Address for correspondence
…………………………………………………………………………………………………………………………….…
………………………………………………………………………………………………………………………….……
Phone No…………………………………….. email_id: ………………………………………………………..…
Co-Supervisor’s Address for correspondence
…………………………………………………………………………………………………………………………….…
………………………………………………………………………………………………………………………….……
Phone No…………………………………….. 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):…………………………………………………...……………
Programme:………………………………………………………………………………………………………..
Mobile No: ……………………………………………Phone ……………………………………..…………
Enclose attested copies of the following, before sending 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
Medical Certificate for the degree of disability in
support of candidates claiming benefit
3.
UG, PG and PhD
Supervisor/Co-supervisor
4.
Category certificate of candidates belonging to SC/ST/CatI/ and any other if applicable
Test Score Card along with Admission ticket in
support of clearance of UGC/UGC-CSIR
JRF/SLET/CAT/GATE/NET or any other National Test
with valid score
5.
Synopsis of the proposed research
6.
Syllabus of the Course work chosen for the present study
In case candidate/Supervisors are possessing
degree from Foreign Universities, The Equivalence
Certificate issued by the Association of Indian
Universities( AIU)
Passport with student Visa in the case of Foreign
candidates
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:
VISVESVARAYA TECHNOLOGICAL UNIVERSITY
Application No.
“Jnana sangama”
Belgaum-590 018, Karnataka, India
APPLICATION FORM FOR UNIVERSITY LEVEL RESEARCH APTITUDE TEST (ULRAT)
Note:
1. This Form should be filled by all the candidates irrespective of their eligibility to be exempted from the ULRAT as
such an exemption is subject to a thorough scrutiny of supporting documents satisfactorily provided by the candidate
along with this Application
Test Centre Csode:
Bangalore
Belgaum
For those having
validity of VTU Tech.
Aptitude Test
None
Programme Stream Applied for:
1. Mechanical Engineering
7. 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
1 17. Statistics
Educational Qualification which makes you eligible for the Programme
Program
Degree Awarded
Specialisation
Percentage of
Marks/CGPA with
Class
Specify Regular or Distance
Education
UG
PG
M Phil
Nationality: Indian
Category:
General
Gender: Male
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…………………………………………….
………………………………………………
Specify
the status of VTU TAT: Cleared in July 2010
Cleared in Jan 2011
Write the TAT Seat No.
..…………………….....................................
National
Test qualified with valid score
Date of ULRAT:
……………………………………………………………………………………….
Programme
Are you
a facultyapplied
under for:……………………
QIP/FIP:
Yes
No
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:
Yes
No
If you possess VTU Technical Aptitude Test validity, then provide Seat No :…..…………………………….
Declaration by the 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. I have carefully studied the Regulations(Amended)
Governing the Degree of Doctor of Philosophy (Ph.D.)-2011 framed under Section 32 of VTU 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.
