Category under the registration is sought (Please tick appropriate)
Full Time |
External |
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Part Time |
Internal |
Session applied for (Please tick appropriate and Write year against the year column)
Session |
January |
July |
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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 |
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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 |
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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 |
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iv. |
Popular Article |
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v. |
Patent * Filed*Approved |
Award, Medal, Prize, Honours (if any): (Please enclose photocopies of testimonials ):
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: __________________________________________
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 |
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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)
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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