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    Phdapplication Form 2015-16

    Uploaded by

    Byomkesh Bakshi

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Phdapplication Form 2015-16

    Uploaded by

    Byomkesh Bakshi
    19 views5 pages

    Original Title

    PHDAPPLICATION_FORM_2015-16

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    19 views5 pages

    Phdapplication Form 2015-16

    Uploaded by

    Byomkesh Bakshi

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 5

    ANNEXURE-A

    NATIONAL INSTITUTE OF TECHNOLOGY, KURUKSHETRA


    (Institution of National Importance)
    Sr.No…………………

    APPLICATION FOR ADMISSION TO


    THE DOCTORATE IN PHILOSOPHY (Ph.D.) PROGRAMME
    IN ACADEMIC SESSION 2015-16(EVEN SEMESTER)

    To
    The Director, Space for
    National Institute of Technology, Kurukshetra
    Room No. -210, Academic Section, Golden Jubilee Administrative
    Building, Kurukshetra-136119 Photo
    Sir /Madam,

    I hereby apply for admission to the Ph.D. programme as a research scholar (full-time/part-time) in the
    Department of ……………………………………………………, National Institute of Technology,
    Kurukshetra; and submit the following particulars in support of my application. I have read the Ordinances &
    Regulations for this programme and undertake to abide by them, and also to abide by the amendments made
    from time to time. I am not pursuing any Degree/Diploma programme at any of the Institutes/ Universities,
    and also will not pursue such a programme during the period of my Ph. D programme at this Institute. I
    hereby declare that all the statements made in this application are true, complete and correct to the best of my
    knowledge and belief. If at any stage, any information furnished by me in this application is found false or
    incorrect, the Institute may take any action against me and I will not have any claim whatsoever.

    Place____________ Yours faithfully

    Signature

    Dated____________ Name ( )

    (Particulars to be filled in neatly by the Candidate)

    1. Name (in block letters) Mr./ Ms ……..…………………………………………………………


    (As given in qualifying examination certificate)

    2. Father’s Name …………………………………………………………………………………

    3. Mother’s Name …………………………………………………………………………………

    4. Date of Birth (as given in Matriculation Certificate) ………………………………………………

    5. Registration No. (if already registered with this Institute) ………………………………………

    6. Permanent Address ……………………………………………………………………………….

    ……………………………………………………………………………….

    7. Address for correspondence ……..……………………………………………………………….

    ……………………………………………………………………………….
    1
    8. Contact Telephone/ Mobile No. ……... ……………………………………………………….

    9. Category to which you belong (state one of these- General / SC / ST / PH) ……………………

    10. Academic Qualifications-

    Examination Passed Discipline/ Full- Name of the Year Max. Marks/ %age of
    Specialization time/ University/ Marks Grade Marks
    Part- Institute Obtained
    time
    Bachelor’s Degree

    Master’s Degree

    National
    Test/GATE/NET etc.
    Any other Exam

    11. Master’s programme Dissertation/ Project Title ……………………………………………………….

    ……………………………………………………………………………………………………….

    12. Have you ever been disqualified from appearing in examinations, or


    punished during your educational career?

    (state Yes/No)…………………………………………………………………………………….

    If yes, Class/Examination………………………………Session/Year……………………………

    Name of the University…………………………………Punishment awarded…………………...

    13. Did you apply earlier also for Ph.D. programme to this, or to any other Institute/ University? If yes, give
    full details.

    14. Proposed area of research……………………………………..…………………………………...

    ………………………………………………………………………………………………………

    15. To be registered as a Full-time, or a Part-time scholar? ………………………………………

    If part-time; are adequate computing, laboratory, and library facilities in the proposed area of

    research available to you in your parent Institute/Org?

    16. If full-time; source of scholarship/ financial support, if any …………………………………

    ……………………………………………………………………………………………………….
    2
    17. Proposed supervisor(s) & his affiliation

    ……………………………………………………………………………………………………….

    18. Details of previous research experience, if any …………………………………………………

    …………………………………………………………………………………………………..

    19. Details of publications, if any (attach copies) …………………………………………………..

    20. If employed,
    (a) Regular/Temporary ……………………………………………………………
    (b) Name of the employer………………………………………………………...
    (c) Nature of work (Teaching/other)………………………………………….…..
    (d) Total experience…………years…………months

    21. Remarks, if any………………………………………………………………………………

    Date:
    Signature of the applicant

    Note: The applicant is required to submit one attested photocopy of each of the following (as applicable)
    Certificates/ Degrees with the application form.

    1. Matriculation Certificate.
    2. Bachelor’s Degree Certificate and Marks Sheet.
    3. Master’s Degree Certificate and Marks Sheet.
    4. GATE/ NET Score Card.
    5. Scheduled Caste/ Scheduled Tribe / Physically Handicapped Certificate.
    6. Migration certificate (in the case of a student coming from other University/ Institute).
    7. If employed, No-Objection-cum-Service Certificate from the employer.
    8. Nature of employment, research experience, publications and other related details.
    9. If seeking admission to Ph.D. programme on the basis of study leave, please show a
    proof at the time of interview that you will be granted study leave for a minimum period
    of 02 years.
    10. The eligibility shall be determined on the basis of the documents received by the last day of
    receiving the applications.

    INCOMPLETE APPLICATION IS LIABLE TO BE REJECTED SUMMARILY.

    Note 1 - If applying on the form downloaded from the website, please attach a DD of Rs. 200/- in the
    name of the Director, NIT, Kurukshetra.

    Note 2 - The applications for Ph.D. can be submitted once from 1st November to 30th November w.e.f
    2015-16 onwards , the last date for submission of the application may change due to
    administrative reasons. Please visit nitkkr.ac.in regularly for latest update in this regard..
    3
    NO OBJECTION-CUM-SERVICE CERTIFICATE

    (CERTIFICATE TO BE SIGNED BY THE COMPETENT AUTHORITY/ HEAD OF THE


    INSTITUTE, IF COMPETENT)

    I hereby certify that the application of Mr./ Ms…………………………………………for admission to


    the Ph.D. programme as a full-time/ part-time scholar at the National Institute of Technology, Kurukshetra, is
    being made with my consent and permission. He/ She has been serving in this Institute/ Department as
    (designation) ……………………since…………………on…….................... basis. I also certify that the post
    on which he/she is working here is a teaching/non-teaching post.
    Mr./ Ms……………………………………………shall be relieved for the period required to be spent at NIT
    Kurukshetra to complete his/ her Ph.D. requirements.
    *Further certified that his/ her official duties permit him/ her to devote sufficient time for research; and that
    the facilities for pursuing research in his proposed field of research are available at this Institute/ organization.

    *For part-time applicants only

    Place………….. Signature of the competent authority/ Head of the


    Institute, if competent

    Dated…………. Name ………………………………………………

    Seal

    Note - Minimum two years continuous service in sponsoring institute/org. is essential.

    4
    PROPOSED SUPERVISOR’S CONSENT

    I have read the Ph.D. Ordinances and Regulations of the Institute, and have examined this
    application. The applicant is eligible for Registration for Ph.D.
    I hereby give my consent for supervising the Ph.D. work of the applicant

    Mr./ Ms. ___________________________________________

    in the proposed research area _________________________________________________________

    for which he/she is applying in the Deptt of _____________________________________________


    at NIT, Kurukshetra.
    Signature __________________________________

    Name ___________________________________ Designation __________________________

    Dept of ___________________________________

    FOR OFFICE USE

    I. Certificates

    1. Whether Qualification / Migration/ Caste Certificate etc.


    checked (point out deficiency, if any)? ______________________
    2. For employed applicants- whether no objection-cum-service/
    study leave certificate attached? ______________________

    3. Classification/ Category under which to be registered ______________________

    4. Whether consent of Supervisor given? (Yes/ No) ______________________

    5. Whether the present case is within the prescribed


    ceiling for the Supervisor (Yes/ No) ______________________

    6. DRC approval? –Yes/ No; and the date of approval ______________________

    Initial of DA/Supdt.

    II. Registration

    Category of scholar (for the purpose of fee payment) ________________________________

    Details of first fee paid (Rs.) _____________________ Allotted Regn No._____________

    III. Scholarship Eligible/ Ineligible Scholarship amount per month- Rs.

    Signature of DA/ Supdt. Deputy Registrar (Academic) Dean (Acad.)


    5

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