APPLICATION NO.

(To be filled by the office)

REGISTRATION NO.
(To be filled by the office)

ACHARYA NAGARJUNA UNIVERSITY :: NAGARJUNANAGAR - 522 510

DIRECTORATE OF ADMISSIONS APPLICATION FOR ADMISSION INTO M.Phil. / Ph.D. (PART-TIME / FULL-TIME)
Affix recent Photograph & sign across photograph

Research Programme of ANURCET - 2013

(To be filled by the candidate)
Note: Admission into M.Phil / Ph.D. degrees are made in accordance with the Revised U.G.C. Guidelines (2009) Read the Brochure before filling the Application Strike off whichever is not applicable and Put a mark wherever necessary

DD No.
Details of D.D 1.

Date

Bank

Amount

2.

a)

Name of the Course

Course Code :

In case of Ambedkar Studies only Subject selected for Entrance Test :

b)

Name of Research Programme (Put a M.Phil Ph.D.

mark)

: Full-time Part-time Surname

* No. M.Phil Programme for M.Tech Engineering Candidate Name of the Candidate 1. 2. 3. 4. 5. 6. Name of the Applicant (in Capital Letters) : as entered in the qualifying examination Name of the Father/Mother (Guardian if parents are not alive) Sex (Put a Date of Birth Residential status (Put a mark) mark) mark) : : : : Local : mark) NCC OH IN RDP State C/GII B/GI IN SPORTS N IU 1 2 ST SC Non - local BC-A BC-B Others (specify) BC-C BC-D Male Female

Reservation Category (Put a

BC-E

Special Reservation category (Put a PH VH HI

CAP 3 4

Note: VH: Visually Handicapped, HI: Hearing Impaired, OH: Orthopedically Handicapped, IN: International, N: National,
RDP: Republic Day Parade, IU: Inter University. CAP: 1,2,3,4 indicate priorities as given in the certificate issued by district sainik Welfare Officer

7.

Particulars of P.G. / M.Phil. Degrees acquired by the Applicant Degree Awared / Year of Passing P.G. / M.Tech M.Phil (if applicable) Subject Studied / Specialization Percentage of Marks Class Awared University

8. 9.

Specific Area of Research : Are you applying for Part-Time Research? If yes, furnish the following information
Sl. No. Name of the Organisation / Institution Designation Service After Completion of P.G. From To Total Service Year Month

10.

* Enclose Service Certificate and No Objection Certificate issued by Competent Authority. Address for Communication in Block Letters Permanent Address in Block Letters

Pin Code ...................... Ph.No.............................

Mobile No. __________________________

Pin Code ...................... Ph.No.............................

Email Id: ________________________________

DECLARATION BY THE CANDIDATE

I hereby solemnly and sincerely affirm that the statements made and information furnished by me in the application form and also in the enclosures herein submitted by me are true and correct. I have not suppressed any information, should it however be found that any information furnished is fraudulent, incorrect or untrue in material particulars, I realize that I am liable to criminal prosecution and also I agree to forego my admission at the University College / Research Centres. Place : Date : Signature of the Applicant
SERVICE CERTIFICATE PROFORMA (FOR CANDIDATES UNDER PART-TIME RESEARCH)

This is to certify that ....................................................................... is a teacher / employee of this College/ Institution. He / She is working as ...................................................... from .............................................. He / She has a total service of ......................................................... years .................................. months. The candidate is hereby accorded permission for Part-time research and the application is recommended for admission into M.Phil/Ph.D.

Place : Date :

Signature of the Principal / Employer