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Annexure I Admission - Registration Form PHD

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Government of Maharashtra

Higher and Technical Education Department


Government College of Engineering, Chandrapur
Ballarpur Bypass Road, Babupeth, Chandrapur-442 403
Phone No. (Principal) : 07172-227334 Website : www.gcoec.ac.in
(Auto EPBAX) : 07172-227664,227028,227702 E-mail (Principal) : principal.gcoechandrapur@dtemaharashtra.gov.in
(Office) : office.gcoechandrapur@dtemaharashtra.gov.in

Application fee: Rs. 500/- (attach proof of payment)

ANNEXURE- I

APPLICATION FOR CENTRE OF HIGHER LEARNING AND RESEARCH

To
Head Passport‐
Centre of Higher Learning and Research, size photo
Govt. College of Engineering Chandrapur

Sir,

I wish to get registration as a research student for the Degree of Doctor of Philosophy (Ph.D) in
the faculty ________________ Engineering, and wish to get registration in the ___________________
Engineering Laboratory as working place for my research.

1. Name of Candidate: ------------------------------------------------------------------------------------------------

2. Permanent Address: --------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------

3. Address for correspondence: --------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------

Email: -------------------------------------- Mobile No. ----------------------------------------------------

4. Qualification: ME/MTech ( Specialization ) Date of Birth: ---------------------------


-------------

5. Faculty for Doctoral program: ---------------------------------------------------------------

6. Name of Supervisor: ------------------------------------------------------------------------------------------------

Email: ------------------------------------------------- Mobile No. : ----------------------------------------

7. Name of Co-Supervisor if any : -----------------------------------------------------------------------------------


Email: -------------------------------------- Mobile No. ----------------------------------------------------

8. Topic of Research: --------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------

9. NOC from Employer/Higher Authority not less than Head of the Institutions: --------------------------
---------------------------------------

10. Ph.D. qualifying Entrance Test: GATE/PET/SET/JRF


(a) Roll No./Seat No.-------------------------------
(b) Date & Year of passing:------------------------------------
(c) Percentage/Marks Obtained: -----------------------------
11. List of documents enclosed:

(1) Attested true copies of the mark list / Degree certificate must be attached.
(2) Candidate who has passed the qualifying examination from any University other than Gondwana
University, Gadchiroli should submit an original Eligibility Certificate from Gondwana University
Gadchiroli.
(3) If the candidate belongs to the Backward Community, copy of caste certificate also should be
enclosed.
(4) Incomplete application will not be accepted under any circumstances.
*Direction No. 162 of 2013, para 5) b) clauses i to ix

Place :
Date :

(Signature of the Candidate) (Signature of the Guide/Co-Guide)


UNDERTAKING OF THE CANDIDATE

I Mr./Ms. -------------------------------------, promise to abide by the discipline of the institute and


following rules and regulations,

1. I will pay the Lab retention and term fees regularly before 15th January of every year.
2. I aware that Lab retention and term fees may change as per the policies of the institute which will be
applicable for me.
3. I will submit my progress report duly signed by the supervisor after every six months ( 1 -15 January
and 1-15 July)
4. My registration will be liable for cancellation for any misconduct or violate the rules and regulations
of the institute.

Place: Signature: --------------------------------------

Date: Name : ------------------------------------------


COMMENTS OF THE EXPERT COMMITTEE

Mr./Ms. ------------------------------ has presented his proposed work and the comments are as follows,
Name of Expert Comment Signature

1. ----------------------------- Approved / Reject ---------------------


2. ----------------------------- Approved / Reject ---------------------
3. ----------------------------- Approved / Reject ---------------------

ENDORSEMENT OF THE HEAD OF THE DEPARTMENT

To
Principal
Govt. College of Engineering Chandrapur

Sir,
In considering the Topic of Research, Necessary facilities which are available in this department,
____________________________________Research Laboratory may be allotted to Mr./Ms. ------------
------------------ as working place for his/her research work under Gondwana University, Gadchiroli
1. Total number of seats sanctioned in the Laboratory : -----------
2. Total number of candidates presently working : -----------

Date: Signature:---------------------------

Office Seal:

ENDORSEMENT OF THE HEAD CHLR GCOE CHANDRAPUR

Research Laboratory of _______________________________ Department is allotted to


Mr./Ms. -------------------------------- as working place for his /her research work under Gondwana
University, Gadchiroli

Date: Signature:

Seal:

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