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    2.smvec PH.D Reg Form

    Uploaded by

    ohmsakthi vel
    This Ph.D. registration form collects information about the applicant such as name, address, contact details, educational qualifications, work experience, area of research, and supervisor details. If selected as a part-time external candidate, they will need a research coordinator from their organization in addition to a supervisor from the university. The applicant declares that all information provided is true and complete. Signatures of relevant heads of department/institutions are also required.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    2.smvec PH.D Reg Form

    Uploaded by

    ohmsakthi vel
    29 views4 pages
    This Ph.D. registration form collects information about the applicant such as name, address, contact details, educational qualifications, work experience, area of research, and supervisor details. If selected as a part-time external candidate, they will need a research coordinator from their organization in addition to a supervisor from the university. The applicant declares that all information provided is true and complete. Signatures of relevant heads of department/institutions are also required.

    Original Description:

    Phd form

    Original Title

    2.Smvec Ph.d Reg Form

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    This Ph.D. registration form collects information about the applicant such as name, address, contact details, educational qualifications, work experience, area of research, and supervisor details. If selected as a part-time external candidate, they will need a research coordinator from their organization in addition to a supervisor from the university. The applicant declares that all information provided is true and complete. Signatures of relevant heads of department/institutions are also required.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views4 pages

    2.smvec PH.D Reg Form

    Uploaded by

    ohmsakthi vel
    This Ph.D. registration form collects information about the applicant such as name, address, contact details, educational qualifications, work experience, area of research, and supervisor details. If selected as a part-time external candidate, they will need a research coordinator from their organization in addition to a supervisor from the university. The applicant declares that all information provided is true and complete. Signatures of relevant heads of department/institutions are also required.

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    You are on page 1of 4

    Application No

    Ph.D. REGISTRATION FORM Affix Recent


    Color
    1. Name (in Block Letters) : …………………………………….. Passport Size
    Photograph

    2. Sex : Male / Female

    3. Address

    (a) Official (with Designation) : …………………………………………………………………...

    …………………………………………………………………..

    …………………………………………………………………..

    …………………………………………………………………..

    (b) Residential : …………………………………………………………………...


    ……………………………………………………………………

    ……………………………………………………………………

    ……………………………………………………………………………

    (c) Contact Phone Number

    i) Residence (with STD Code) : …………………………………………………………………..

    ii) Office (with STD Code) : …………………………………………………………………..

    iii) Mobile : …………………………………………………………………..

    (d) E-Mail Address : …………………………………………………………………...


    4. Date of Birth &Age : …………………………………………………………………..

    5. Nationality : …………………………………………………………………...

    6. Social Status : ST/SC/OBC/BC/OC/PH

    7. Community : …………………………………………………………………………………………………….

    8. Category : a. Full Time

    : b. Part Time (Internal)

    : c. Part Time (External)

    9. Are you employed? : Yes /No

    If yes specify the


    Name and Address
    of the employer

    10. Salary received / Month : …………………………………………………………………..

    Processing Fees Details


    Amount Cash/DD No Cash/DD Date Bank Name

    10. Academic Background (Start with the latest Degree Obtained)


    (Enclose copies of Degree/Diploma certificates duly attested)

    Sl.No Degree/Diploma Year of University/Institution Major Percentage


    passing Discipline of Marks
    and Class
    obtained
    11. Professional Experience (Start from the present employer)

    Sl.No Organization Period Designation Total Nature of


    From To salary/Month Job

    12. Publications, if any (Books / Research Papers) :

    Sl.No Title Name of the ISSN/Impact Year


    Journal/Conference/Published in Factor/Scopus
    the case books

    13. Awards/Medal/Prizes and Honours


    Conferred (if any) : …………………………………………………………………..

    14. Major area of Ph.D Research : …………………………………………………………………..

    15. Tentative Topic on which the research : …………………………………………………………………..


    is proposed to be conducted
    (Attach one-page write up on this topic)

    16. Department in which the candidate : …………………………………………………………………..


    Propose to register

    17. Name and Designation of the : …………………………………………………………………..


    Research Supervisor

    18. Signature of the Research Supervisor : …………………………………………………………………..


    with Designation

    19. Name, Designation & Address of the : …………………………………………………………………..


    Research Coordinator (Outside the University)………………………………………………………………….
    For Part Time (External) Candidates only ……………………………………………………………………

    Note: Part-time (external) candidates shall have a supervisor at SMVEC and in addition, shall have a
    Research Coordinator at the organization in which they are working.
    20. DECLARATION OF THE CANDIDATE :

    This is to certify that the particulars given above are true, correct and complete to the best of
    my knowledge and belief.

    Place :
    Date :
    Signature of the candidate

    Signature of the Head of the Department/Institution Signature of the Head of the Institution

    (where the candidate is working) (where the candidate propose to conduct Research)

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