THE GANDHIGRAM RURAL INSTITUTE DEEMED UNIVERSITY No. APPLICATION FOR ADMISSION TO Ph.D.

. PROGRAMME (Incomplete applications will be summarily rejected)

FULL TIME REGULAR

PART TIME Teacher Internal External Non-Teacher Internal External

Mode of Remittance of Registration Fee(DD)/Challan Name & Place of Bank

Affix recent passport size photo

Amount Rs.

Date of Remittance

1. Name 2. Date of Birth & Age 3. Sex 4. Community 5. Nationality

: : : Male / Female : SC/ST/OBC/OC :

Last date for receiving the filled in application: 31st January / 31st August Please read the Regulations of the Ph.D. Programme before filling up the application form. Tick wherever necessary

6. Residential address:

7.Address for Communication:

PIN: Contact No.

PIN: Contact No.

8. Academic Qualifications:

S.No. College/ Degree Month & University Obtained Year of passing with Regn.No.

Subjects Class/ Mode % of Studied Grade/ Regular/ Marks Division Distance

9. a) Have you passed JRF/NET/SLET/GATE/CSIR/ICAR/ICSSR : b) If yes, furnish the Date & Registration Number :

Yes / No

10. Teaching / Research / Extension / Administrative Experience:

Position From

Period of Service To Name of the Institution

Nature of Duties

Teaching Research Extension Administration (if any) Total Service (in years)

11. a) Have you published any research papers?

Yes/No

b) Which of the above was/were published in refereed journal? : c) Attach reprints :

12. Award / honours / recognitions received, if any : 13. Present position 14. Salary / Emoluments 15. Declaration of the candidate : : :

I hereby declare that all the statements made above and information given in this application are true to the best of my knowledge and belief.

Place : Date :

Signature of the candidate

16. No Objection Certificate from the Employer (for part time candidates only):

We have no objection to permit Mr./Ms. ___________________________ to do his/her Ph.D. programme at Gandhigram Rural Institute (Deemed University) and to fulfill the 180 day residential requirement of research as per the G.R.I. regulations. Place: Date : Office seal Signature of the Employer `

17. State the discipline / subject in which you propose to do your Ph.D. work

18. Specify the field of your Ph.D. work

Signature of the candidate

For Office Use

Name Department / Faculty Research Supervisor / Joint Research Supervisor

: : :

Date of joining

Minimum period ends on

Maximum period ends on

Extension - I

Extension - II

Extension - III

Re-registration on

18 months over on

2 years over on

3 years over on

Synopsis submitted on

Thesis submitted on

Check list

(To be filled by the candidate and enclose the following enclosures )

Session Name Pasted a passport size photograph in the application Part-Time / Full Time FT/PT (internal) /PT(External) Community : SC/ST/OBC/OC Qualification: a) Plus Two Mark statement b) UG Degree c) PG degree certificate with consolidated mark statement d) Percentage of marks obtained in PG degree e) Whether the PG degree passed in Regular/Distance Education f) M.Phil g)UGC JRF/NET/SLET/Lecturership/GATE/CSIR/ICAR/ICSSR/ any other fellowship examinations (copy of the fellowship award certificate) Whether the NOC is obtained in the format prescribed in the application Service Certificate if any Sponsorship certificate if any Research Proposal a research proposal (not exceeding 500 words) mentioning the broad area of investigation and its justification Copy of Publication(s), if any Research Area Whether the Research is Inter-disciplinary or not Department to which application is sent Pure/Inter-disciplinary January /August Remarks if any

Yes / No

Yes / No/ awaiting for results

Yes/No Yes/No Yes/No Yes/No

Yes / No

Signature of the applicant