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APPLICATION FORM FOR ADMISSION FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY (Ph.D.)
(Applicable from January, 2019 onwards)
(To be filled in by the candidate)
Full Time |
External |
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Part Time |
Internal |
Session |
January |
July |
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Year |
Science | Commerce | Management | Humanities |
Engineering | Pharmacy | Interdisciplinary |
Permanent Residential Address |
Correspondence Address |
(i) | Gender | M | F | T | ||||||
(ii) | Date of Birth (dd/mm/yyyy) | Age Yrs. | ||||||||
(iii) | Nationality | Indian | Foreign | |||||||
(iv) | Category (GE/SC/ST/OBC/BC) | |||||||||
(v) | E-mail Id | |||||||||
(vi) | Contact Number | Mob. No. | ||||||||
Landline No. |
Sr. No. | Name of Examination | Year | School/College Board/University | Percent./Grade | Div./Class | Subject/Specialization |
I. |
Secondary | |||||
Ii. |
Senior Secondary | |||||
iii. |
U.G.(B.Sc./B.Com/ BE/B.Tech/ B.Pharm/etc) | |||||
iv. |
P.G.(M.Sc./ M.Tech./ M.Pharm/etc) | |||||
v. |
M.Phil | |||||
vi. |
Any Other |
Sr. No. | Name of Examination | Year | JRF/LS | Rank | Subject |
I. |
Secondary | ||||
Ii. |
Senior Secondary |
Sr. No. | Name of Organization and its addresses | Designation | Duration (From - To) | Total Exp. in Yrs - Months |
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Sr. No. | Name of Organization | Designation(JRF/SRF/RA/others) | Duration (From - To) | Total Exp. in Yrs - Months |
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Total Experience: Teaching: ___ Research: ___ Industry: ___
Sr. No. | Publication Type | National/International | Number | Enclosure No. |
I. |
Research Paper | |||
Ii. |
Review Article | |||
iii. |
Book |
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iv. |
Popular Article |
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v. |
Patent * Filed*Approved |
Sr. No. | Award/Medal/Honours | National/International | Remark |
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Have you ever been registered/completed for Ph.D./M.Phil programme to this or any other University?
If Yes, Please provide following details.
Name of the University: ____________________________________________
Year of Registration:_________ Registration No.:_______________________
Course work completed (Yes/No): _____________________________________
Reason for discontinuation: __________________________________________
Details of Online Payment of Fees – Rs. 2500/-
Fees Payment URL: http://seminar.atmiya.edu.in/
Date |
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Transaction ID |
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Order No. |
*Please attach copy of the Email received after the successful payment of the application fees
Declaration
I, _________________ hereby declare that the information given in the application form is correct to the best of my knowledge and belief. I shall abide by the rules and regulations of the Ph.D. Programme and adhere to the code of conduct for the research scholar of Atmiya University. If my actions are found to be in violation of the rules and regulations of Atmiya University, my registration as research fellow is liable to be terminated.
Date: Place: |
(Name and Signature of the applicant) |