Category under the registration is sought (Please tick appropriate)

Full Time

 

External

 

Part Time

 

Internal

 

Session applied for (Please tick appropriate and Write year against the year column)

Session

January

 

July

 

Year

       

 

(a) Discipline of subject in which admission is sought (Please tick appropriate)

Science Commerce Management Humanities
Engineering Pharmacy Interdisciplinary

Name of the Applicant (in block letters and as per certificate of secondary education ):

                                     
                                     

Father’s/Husband’s name (in block letters):

                                     
                                     

Address to which communication to be sent with pin code:

Permanent Residential Address

Correspondence Address

   

 

Personal details

(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.

 

Educational Qualifications (Enclose attested copies):
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          
Whether cleared CSIR-NET/UGC-NET/GATE or Any Other Equivalent State Level examination? If yes, give the detail:
Sr. No. Name of Examination Year JRF/LS Rank Subject

I.

Secondary        

Ii.

Senior Secondary        
Professional/Teaching Experience, if any (Enclose attested copies):
Sr. No. Name of Organization and its addresses Designation Duration (From – To) Total Exp. in Yrs – Months

 

       

 

       

 

       

 

       
RESEARCH EXPERIENCE, if any (enclose attested copies):
Sr. No. Name of Organization Designation(JRF/SRF/RA/others) Duration (From – To) Total Exp. in Yrs – Months

 

       

 

       

 

       

 

       
Research Publications (if any) (Please enclose photocopies of first page of papers duly certified by the applicant ):
Sr. No. Publication Type National/International Number Enclosure No.

I.

Research Paper      

Ii.

Review Article      

iii.

Book

     

iv.

Popular Article

     

v.

Patent * Filed*Approved

     
Award, Medal, Prize, Honours (if any): (Please enclose photocopies of testimonials ):
Sr. No. Award/Medal/Honours National/International Remark

 

     

 

     

 

     

 

     

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: __________________________________________

 Please attach your recent Curriculum Vitae (CV).
 Please state briefly your research interests. (Attach a separate sheet as required.)

Details of Online Payment of Fees – Rs. 2500/-

Fees Payment URL: http://seminar.atmiya.edu.in/

Date

 

Transaction ID

 

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)

Personal details

(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.

 

Application No.:

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)

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