VISVESVARAYA TECHNOLOGICAL UNIVERSITY,

BELAGAVI, KARNATAKA

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attested by Principal
/ Head of College /
University
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attended
or
a
Gazetted Officer

APPLICATION FORM FOR PHD/ M.Sc. (Engg) BY RESEARCH

FOR THE ACADEMIC YEAR 2015-16
Full time

Part time

Programme Applied for: Ph.D.

Research Centre applied for: VTU-RC

Faculty Applied for : Engineering

Category : GM
Male

SC

VTU-R&D
Architecture

ST

CAT-I

Science

M.Sc.(Engg)

VTU-RRC
Management Studies

Physically Challenged

Others

Female

Name: ......Date of Birth:....

Fathers Name:..
Academic Qualification:
Programme
Degree
University
Regular /
Specialization
% Marks obtained
obtained
Distance
with Class
UG
PG
Others if any
No. of years of experience: Industry:

Teaching:

Research:

Number of Research papers:

Patents:

Awards:

Year of
passing

Topic of Research proposed:

Proposed course work

Sl.No.
1

Subject Code
14PHDRM

Subject Title
Research Methodology

2
3
4
5
6

Research Centre
1. VTU-RC: .Department:....Recognized: Yes

No

2. VTU-R&D: Department:.....Recognized: Yes

No

3. VTU-RRC: Belagavi. Department...

Application and Processing Fee Details: D.D. for `. 800/- No.:Drawn on Bank...date:.

Applicants Address for correspondence

.

.
Phone/Cell
No..
email_id: ..
Information
of the Supervisor
Information of the Supervisor

Name: Date of Birth...

Affiliation : Department:
DesignationArea of Research
Academic Qualification:
Programme
Degree
obtained
UG
PG
Ph.D.
Others if any

University

Regular /
Distance

Specialization

% Marks obtained
with Class

Year of
passing

No. of Publications in the preceding 5 years:

Research papers: 1. National Journal

communicated: 1. National Journal

2. International Journal
Conference:

Technical Reports:

1.

2. International Journal
Book:

Patents:

Awards:

No. of students Supervising:

Sl.
No.

Programme
Please tick ()

Name of the
Candidate/s

Ph.D.

University

Category

Specify
Year of whether acting
Area of
registration as Supervisor Specialization
or
Co Supervisor

Whether
Final Thesis
Submitted
(Y/N)

M.Sc.
(Engg)

1
2
3
4
5
6
7
8
Total

Undertaking from the Supervisor

I, is a permanent faculty /employee working as . in the
Department of . in the organisation .......and is aged
less than 65 years as on the date of admission notification, hereby certify that the candidate Mr./Mrs...
.registering for ..... degree under VTU is not my son/daughter/immediate blood relative and the total number of
candidates registered under me in VTU and other Universities for both Ph.D. & M.Sc. (Engg.) by Research taken

together excluding presently

applied candidates is (in Words) The information provided above is true to the best of my knowledge.
Date:
Place:
Signature : _________________________________________
Forwarded by ,...
Date:

Signature of the Principal/Director/Head of the Research Centre with Seal

Information of the Co-Supervisor( if applicable)

Name: .Date of Birth...
Affiliation: . .. Department:
DesignationArea of Research
Academic Qualification:
Programme
Degree
obtained
UG
PG
Ph.D.
Others if any

University

Regular /
Distance

Specialization

% Marks obtained
with Class

Year of
passing

No. of Publications in the preceding 5 years:

Research papers: 1. National Journal

communicated: 1. National Journal

2. International Journal
Conference:

Technical Reports:

1.

2. International Journal
Book:

Patents:

Awards:

No. of students Supervising:

Sl.
No.

Programme
Please tick ()

Name of the
Candidate/s

Ph.D.

University

Category

Whether
Specify
Final
Year of
whether
Area of
Thesis
registration
acting as
Specialization
Submitted
Supervisor or
(Y/N)
Co Supervisor

M.Sc.
(Engg)

1
2
3
4
5
6
7
8
Total

Undertaking from the Co-Supervisor

I, is a permanent faculty /employee working as . in the
Department of . in the organisation .......and is aged
less than 65 years as on the date of admission notification hereby certify that the candidate Mr./Mrs...
.registering for ..... degree under VTU is not my son/daughter/immediate blood relative and the total number of
candidates registered under me in VTU and other Universities for both Ph.D. & M.Sc. (Engg.) by Research taken

together excluding presently

applied candidates is (in Words). The information provided above is true to the best of my knowledge.
Date:
Place:
Signature : _________________________________________
Forwarded by ,...
Date:

Signature of the Principal/Director/Head of the Research Centre with Seal

Undertaking by Supervisor / Co-Supervisor *(in case Co-Supervisor is opted)

I / We have no objection in guiding the said candidate in the proposed area of research at the designated Research Centre.
If for any reason, myself /candidate change the Research Centre, I /we will inform the same to the University without
fail.
Signature of Co-Supervisor

Signature of the Supervisor

Signature of the Head of the Institution where the research work is proposed:.

No Objection Certificate of the Organisation

This is to certify that the

Organisation

has

no objection in recommending the candidature of

our

employeefor carrying out research for his/her Ph.D./ M.Sc. (Engg.) by research
at .... on part
time / full time basis. The information provided by the candidate is found correct as per our records.

Signature of the Principal/Head with Seal.

Employment Certificate of the Supervisor

This is to certify that Dr. presently working in the capacity
ofin the Department of... is a full time employee of
our Organisation, since..
Organisation:

Seal and Signature of the

Head of the Organisation

Employment Certificate of the Co-Supervisor (in case Co-Supervisor is opted)

This is to certify that Dr presently working in the capacity
ofin the Department of... is a full time employee of
our Organisation, since..

Organisation: ..

Seal and Signature of the

Head of the Organisation

Supervisors Address for correspondence

.
.

Phone No.. email_id: ..

Co-Supervisors Address for correspondence

.
.

Enclose attested copies of the following, before sending the application :

1.

Detailed Bio-data of the Candidate, Supervisor

(and Co-Supervisor, if applicable)

2.

UG and PG degree Certificates and Marks cards of the

Candidate

3.

UG, PG and PhD

Supervisor/Co-supervisor

4.

Category certificate of candidates belonging to SC/ST/CatI/ and any other if applicable

5.

Synopsis of the proposed research

6.

Syllabus of the Course work chosen for the present study

7.

Demand Draft of `.800 drawn in favour of The Finance

Officer, VTU, Belagavi towards Application and Processing
fee

Degree

Certificates

8.

of

the

Any other additional Certificates supporting your claim

for benefits like:

Medical Certificate for the degree of disability in

support of candidates claiming benefit

Test Score Card along with Admission ticket in

support of clearance of UGC-CSIR ,JRF.

In case candidate/Supervisors are possessing

degree from Foreign Universities, The Equivalence
Certificate issued by the Association of Indian
Universities( AIU)

Passport with Visa in the case of Foreign candidates

Ph.D./M.Sc.(Engg)

Name of the Applicant:

Name of the Supervisor : .....
Name of the Co-Supervisor:.
Research Centre(VTU-RC/VTU-RRC):...
Programme:..
Mobile No: Phone ..

VISVESVARAYA
TECHNOLOGICAL
Application
No.

UNIVERSITY

Jnana sangama
Belagavi-590 018, Karnataka, India

APPLICATION FORM FOR VTU RESEARCH APTITUDE TEST (VRAT)

Note:
1. This Form should be filled by all the candidates irrespective of their eligibility to be exempted from the VRAT as
such an exemption is subject to a thorough scrutiny of supporting documents satisfactorily provided by the candidate
along with this Application

Test Centre Code:

Bengaluru

Belagavi

Kalaburagi

None

For those having

validity of VTU Tech.
Aptitude Test

Programme Stream Applied for:

1. Mechanical Engineering

7. Bio-Technology

13. Maths

2. Computer Science Engineering

8. Polymer Science

14. Physics.

3. Electrical Engineering

9. Silk Technology

15. Chemistry

4. Civil Engineering

10. Textile

16. Management Studies

5. Environmental Engineering

11. Chemical

17. Computer Applications

6 . Architecture.
Statistics

12. Geology

18. Library Science

19. Physical Education

1 17.

Educational Qualification which makes you eligible for the Programme

Program

Degree Awarded

Specialisation

Percentage of
Marks/CGPA with
Class

Specify Regular or Distance

Education

UG
PG
Nationality: Indian
Category:

General

Others (NRI/FN/PIO):
SC

ST

Whether Physically challenged

Cat-1
Yes

To be filled by candidates

Gender: Male
OBC
No

Seat No.:

Female

Any Other.
: If Yes, Nature of disability:....

For Office Use only

Name:
Address.

Specify
the status of VTU TAT: Cleared in July 2010
Cleared in Jan 2011
Write the TAT Seat No.
.......................................
National
Test qualified with valid score
Date of VRAT:
.
Programme
Test Centre:
Are you
a facultyapplied
under for:
QIP/FIP:
Yes
No
Address for correspondence:
Reporting Time:
..

Cleared in

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size
photograph in this
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by
Principal / Head of
College / University
last attended or a
July
2011
Gazetted Officer

Candidates Signature

Exemption from VRAT

The following categories of candidates will be exempted from appearing at the VRAT:
(a) Faculty Members under QIP / FIP and
(b) Candidates qualified in UGC-CSIR ,JRF.
If you possess VTU -VRAT validity, then provide Seat No :...
Declaration by the Candidate

hereby acknowledge that all the information given

by me are true to the best of my knowledge. In the event of any information being found incorrect or
misleading, my candidature shall be liable to cancellation by the University at any time and I shall not be
entitled for refund of any fee paid by me to the University. I have carefully studied the Regulations(Amended)
Governing the Degree of Doctor of Philosophy (Ph.D.)-2014 framed under Section 32 of VTU Act 1994.

Date:

Signature of the Candidate

Visit www.vtu.ac.in for Recognized Research Centres, Fee Structure and Syllabus for

VRAT.