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Ph.D.
Note: Faculty members working in University Departments/Engineering Colleges/Architecture Schools within Tamil Nadu and Regular employees working in the R&D centres which are recognized by this University for pursuing Ph.D./M.S.(By Research) programme can only apply under Part-time mode. Others can apply for Full-time mode. Refer the information brochure before filling the application form.
1. 2. 4. 5. 7. 9. 10. Name (in Block letters) : (As in UG/PG degree certificate) Sex: Male/ Female
If foreign national: Country ________________ Passport No.________________ Social Status: ST/SC/SCA/MBC/BC/BCM/OC 6. Community ____________________
Age & Date of Birth: ________________ 8. Marital Status: Married/ Unmarried Email ID Address : : Residential Address : _____________________________________________ _____________________________________________ _____________________________________________ District : ____________________________________ State : ___________________ Pincode: ___________
Phone : Mobile : Photograph shall be attested by a Grade A/B Officer or Head of the Institution.
Office Address : Designation : ____________________________________ Department : ____________________________________ Organization : ____________________________________ Place Dist. /State
Phone :
11.
Category applied for Full-time All eligible candidates as given in the information to the candidates
Part-time 1. Regular Faculty of University Departments, University Colleges of Engineering, Govt./Govt. Aided/Self-Financing Engineering Colleges within Tamil Nadu 2. Teaching Research Associates of this University 3. Regular employees working in Industries/ Research organizations which are recognized as research centres by this University for pursuing Ph.D./M.S. (Refer: Annexure I sec V) Please specify:
12.
Details of current employment (if applicable) Name & address of the employer: Nature of employment : Regular/Approved Probationer/ Probationer/ Consolidated pay/ Contract/ Visiting Faculty/Temporary/TRA Scale of Pay: _________________________ working since date _________________ (Certificate from the employer need to be attached) Details of employment in project (if applicable) Name of the Principle Investigator: ___________________________________________________________
13.
(copy of the project sanction order to the principle Investigator should be enclosed)
Title of the Project: ________________________________________________________________________ Funding Agency: _____________________________________ Duration of the Project : _______________ Stipend: ____________ working since date ____________ Date of Expiry of project : _____________ (copy of the project appointment order should be attached)
14.
Academic Background
Candidates with UG/PG degree other than the Universities listed in the Annexure III and degrees obtained other than Regular mode shall obtain course equivalency certificate from The Director (Academic Courses), Anna University, Chennai 600 025.
(Enclose copies of Degree Certificates and Mark sheets duly attested see Clause 8.0 of Information to Candidates) Start with the latest degree obtained: Sl. No 1. Year of Passing % of Major Class Marks / Discipline / Obtained CGPA Specialization Regular mode / Others (specify) Additional Information, if any
Degree
College
University
2.
3.
4.
5.
15. Sl. No 1. 2. 3. 4.
Professional Experience (Start from the present employment) : Period From To Total Salary P.M. Additional Information, if any
College/Organization
Designation
Nature of Job
16.
17.
18.
research with signature of the candidate & supervisor, Joint supervisor, if any should be enclosed)
19. i) Department in which the candidate proposes to register :
to the candidates)
20. Name, Designation and Address of the proposed a) Supervisor * (Recognized supervisors working in the recognized departments)
b)
Joint Supervisor (applicable only for candidates from industry / research organizations recognized as a research centre by this University and for those candidates who propose to undertake Interdisciplinary research)
21.
Demand Draft Particulars: Name of the Bank & Branch Demand Draft No. Date Amount
DECLARATION OF THE CANDIDATE: This is to certify that the particulars given above are true, correct and complete to the best of my knowledge and belief. I am aware that any wrong information or suppression of information and facts may result in punitive action in addition to cancellation of admission to Ph.D./M.S. (By Research) programme. Place Date : : Signature of the candidate
The College/Organization has no objection to forward his/her application for Ph. D./M.S. (By Research) Programme. FOR FULL TIME*: The employee will be sanctioned study leave for the entire duration of the research programme and will be relieved from duty from ________________ to ___________________ to undertake Full-time research work in the University Departments/recognized Departments of Engineering Colleges. (or) FOR PART TIME**: The employee will be permitted to undertake Part-time research in the University Departments/recognized departments of Engineering Colleges and he/she will be permitted to be present for attending course works, discussion with the supervisor, conduct experiments and participate in seminars and related discussion. Further, the required facilities at our Institute/ organization will also be provided to the employee for doing research. (Note: Choose the appropriate * / ** marks)
Place: Date: Signature of the Principal with office seal / Signature of the Head of the organization with office seal
CONSENT OF THE SUPERVISOR / JOINT SUPERVISOR (i). Recognized supervisors of this University who are working in (a) University Departments, Govt./Govt. aided Engineering Colleges (as given in Annexure I sec I to III) (b) Recognized Departments of Self-financing Engineering College (as given in Annexure I sec IV) shall only function as Supervisor. (ii). Recognized supervisors working in R&D centres (as given in Annexure I sec V) and in the non recognized departments of self-financing Engineering colleges are eligible to act only as Joint supervisor.
SUPERVISOR (should furnish Anna University Ref. No. for Supervisorship recognition)
@
JOINT SUPERVISOR Applicable only for candidates from Industry/Research Organizations recognized as a research centre by Anna University and for candidates propose to undertake interdisciplinary research
Name Designation Nature of Appointment Department Regular / Contract / Temporary / Visiting Faculty
Mobile No. Date of Birth Date of Retirement Area of Specialization YES / NO Whether the supervisor fulfills the norms as per clause 7of Ph.D/M.S If Yes Please furnish Univ. Ref. No. (By Research) Regulations (R 2010) for Supervisorship recognition YES / NO If Yes Please furnish Univ. Ref. No. for Supervisorship recognition
Ph.D.
M.S.
Ph.D.
M.S.
The Supervisor while giving his/her consent should furnish list of panel members for DC/MC in the enclosed format (page 7). A supervisor shall guide only a maximum of Twelve [Ph.D./M.S. (By Research) put together] scholars as Supervisor/Joint Supervisor. Joint Supervisor is mandatory, if the supervisor is not a regular faculty member of the University Departments. A maximum of six Ph.D./M.S.(By Research) scholars only be permitted under such supervisors.
A MAXIMUM OF 4 CANDIDATES SHALL BE ALLOWED TO REGISTER WITH A SUPERVISOR IN ANY ONE SESSION.
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DETAILS OF RESEARCH SCHOLARS PURSUING RESEARCH UNDER HIS/HER GUIDANCE AS SUPERVISOR AND JOINT SUPERVISOR (Shall be furnished by the supervisor while giving his/her consent) INCOMPLETE DETAILS RESULTS REJECTION OF THE APPLICATION Details of Ph.D. / M.S (By Research) Scholars:
SL. NO NAME OF THE SCHOLAR REG. NO. Ph.D. / M.S. SUPERVISOR / JOINT SUPERVISOR RESEARCH STATUS
Name of the Joint Supervisor, if any : Sl.No. Name with full address
Phone: 2.
Name : Designation : Department : Address :
E-mail:
Phone: 3.
Name : Designation : Department : Address :
E-mail:
Phone: E-mail: Members from other Institutions (preferably within Tamil Nadu) Name : 1.
Designation : Department : Address :
Phone: 2.
Name : Designation : Department : Address :
E-mail:
Phone: 3.
Name : Designation : Department : Address :
E-mail:
Phone:
E-mail:
* For M.S (By Research) scholars, only three members need to be given.
(If applicable)
Programme
Ph.D.
M.S.
DATA SHEET FOR Ph.D./M.S. (By Research) ADMISSION (TO BE FILLED BY THE CANDIDATE ALL LETTERS SHOULD BE IN CAPITAL LETTERS) 1.NAME (As in UG/PG Degree with initials at the end) 2. Date of Birth 5. Community: 6. Social Status 7. Communication Address with Email ID Mobile Number: 8. B.E./B.Tech./ B.Sc.(Engg.)/B.Sc./ Others Major: Year of Passing University 9. M.E./M.Tech./ M.Sc.(Engg.)/M.S.(By Research)/M.Sc./ /M.Phil./M.A./M.B.A./M.C.A./ Others Major: Year of Passing University 10. Employed Yes No (If Yes, write Office address with designation; If No, write Residential address) Percentage of Marks/CGPA Mode of Study R O Percentage of Marks/CGPA Mode of Study R O ST Married SC 3. Sex SCA Unmarried M MBC F 4. Nationality BC BCM Indian OC Foreign
Full time
15. Area of Research (Topic) R Regular O Others (please specify) SIGNATURE OF THE CANDIDATE