UNIVERSITY

(Karunya Institute of Technology and Sciences)

(Declared as Deemed to be University under section-3 of the UGC Act, 1956)

Appln. No.

Karunya Nagar Post, Coimbatore 641 114, India

APPLICATION FOR Ph.D/M.Phil ADMISSION: Odd Semester - 2011-12

Paste recent passport size photograph

FULL TIME / PART TIME

1. Name 2. Father / Husband Name 3. Address: House No. Street Location City & Pincode Phone Email 4. Personal details: a) Date of Birth: ____ /____ /____ d) Community: OC / BC / MBC / SC / ST g) Denomination: ___________________ 5. Academic Record:
EXAMINATION NAME OF INSTITUTION UNIVERSITY/ BOARD MONTH & YEAR OF PASSING CLASS / GRADE % OF MARK

For Communication

Permanent

b) Blood Group ____________ e) Caste __________________ h) Nationality _____________

c) Marital Status: Single / Married f) Religion: ___________________ i) Mother Tongue_______________

Masters Degree Bachelors Degree HSC or equivalent SSLC or equivalent Any other (Minimum eligible marks is 55%) Page 1

6. Achievements (use extra sheets if necessary)

6.1 Academic awards

6.2 Extra Curricular

7. Employment Details: Name & address of Employer Designation Period & Nature of service

8. Details of Research Work 8.1 Area of Research 8.2 Proposed Title 8.2 To be attached Preliminary Literature survey and abstract

DD No. 9. Application fee Date : Declaration:

Bank: Amount :

I hereby solemnly and sincerely affirm that I shall abide by the rules and code of conduct of the University. If I contravene any of the rules and regulations of the University I am aware that I am liable to any disciplinary action that the University Management may consider necessary and appropriate. Moreover, I hereby solemnly and sincerely affirm that the details, statements, date of birth and the information furnished by me in the application and enclosures submitted by me are true. Should it, however, be found that any information furnished therein is untrue in material particulars on verification at a later date. I accept that I am liable for criminal prosecution and also agree to forego my seat in this University or removal of my name from the rolls of the University at whatever stage of study I may be, at the time of detection of such wrong particulars. Place: Date: Signature of the Candidate

Note : 1) In case the candidate is proposing to do the programme as part time external candidate the Annexure is to be down loaded and filled 2) Enclose attested copies of academic / employment / extra curricular / co-curricular, etc. certificates for proof. (Important: Submit this application to Admissions Officer, Karunya University, Karunya Nagar (PO), Coimbatore 641 114. Application fee: Rs.300 demand draft drawn in favour of Registrar, Karunya University payable at Coimbatore has to be sent along with filled in application.) Page 2

ANNEXURE For Part-Time (External) students only .............

10. No-Objection Certificate from the employer

This is to certify that Mr. / Mrs. / Miss. is working in our organization as from . to till date. He / She is willing to register for Ph.D / M.Phil. (Part-time -External) programme at Karunya University. objection in doing research by him / her at Karunya University. for his / her research work. Name & Designation of the forwarding authority: Our organization has no

We will extend all the facilities at our organization

Signature :

Seal :

11. No-Objection Certificate from the place of Research ( if planning to do research work in establishment other than the place of employment)

This is to certify that Mr. / Mrs / Miss. who has registered for Ph.D / M.Phil. (Part-time -External) programme at Karunya University; is planning to do research work in our establishment. Our organization will extend all the facilities at our organization for his / her research work. Name & Designation of the competent authority:

Signature :

Seal :

12. Declaration by the Co-Guide / Research Coordinator at the place of research

I am willing to supervise / coordinate the research work of Mr. /Mrs. /Miss as external research co-guide / coordinator. I am already an approved guide / research coordinator [or] I am not an approved guide / research coordinator, kindly find enclosed my bio-data for approval please

Signature Name, Designation and address:

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