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APPLICATION FORM FOR ADMISSION TO Ph.D. PROGRAMME IN SCIENCES

(All columns to be filled only in CAPITAL LETTERS)
1. Name of the candidate as given in the Academic record (leave blank space between name and initials)

2. Gender: Male / Female/ Transgender

3. Contact Details:
(a) Address for communication: (b) Permanent address:

PIN Code: PIN Code:

Phone No.
(STD Code)

Mobile No. _________________________________

E-mail ID:

4. Admission Details:

(a) Department in which the candidate proposes to register for Ph.D:

(b) Area of Research: ______________________________________________________________________

(c) Tentative Title of proposed Research:

(Please enclose a one page write-up about your proposal)

(d) Preferred Campus: Amritapuri / Bangalore / Coimbatore

(e) Category of Admission: Full time/ Part-time

(f) Name of the proposed Thesis Advisor (within Amrita), if any:

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5. Academic record
Percentage of
Degree Year of
S.No. Area of specialization University marks / CGPA (on
obtained Passing
a 10 point scale)

Note: If any degree (UG or PG) was obtained through correspondence course / distance education mode,
please specify.

6. Publications, if any (please enclose copies):

7. Additional examinations passed if any (like GATE/ GRE/ CAT/ UGC- JRF/ Lectureship/ CSIR/ DAE).

8. Professional experience (Teaching / Research / Industrial), if any:

Period
S.No. Organization Designation & Nature of work
From To

9. Please enclose 3 letters of reference from persons you know professionally. List the Name, Designation and
Address of your referees.

Name Designation Address

10. Personal details:

Age & Date of Birth: Religion:

Caste: Community: (SC, ST, MBC, BC, OBC,OC)

Marital Status: State:

Mother Tongue: Nationality:

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 11. List of documents to be enclosed. (Please enclose only the attested copies)

1. SSLC or Equivalent Certificate.

2. Plus two Certificate.
3. Degree/ Provisional Certificate.
4. Statement of marks for all the Semester/Years.
5. Certificate/Mark sheet of additional examinations in respect of serial no. 7.
6. Transfer Certificate and Conduct Certificate from the Institution last attended.
7. One page write-up about the proposed area of research.
8. Reference Letters Original (see item no. 9)
9. Copies of Research Paper Publications, if any.
10. NOC from the present employer

12. DECLARATION

I, Son / Daughter of hereby declare

that the particulars given by me in the application are true. I shall produce the original certificates at the time
of admission or on demand. If, in future, any information is found to have been furnished falsely or incorrectly
or any information suppressed to secure admission, I shall withdraw from the programme without any claim or
consideration

Place:

Date: Signature of the Applicant

The completed application together with the necessary enclosures should be submitted to any one of the
following campuses

Amritapuri Bangalore Coimbatore

The Chair, PGP The Chair PGP The Chair PGP

Amrita Vishwa Vidyapeetham
Amritapuri, Clappana P.O.,
Kollam 690 525.
Phone: +91 476 2801280
Amrita Vishwa Vidyapeetham
Kasavanahalli, (off Sarjapur
Road), Carmelaram P.O.,
Bengaluru-560 035
Phone: +91 80 25183700
Amrita Vishwa Vidyapeetham
Amrita Nagar P.O.,
Coimbatore 641 112
Phone: +91 422- 2685118

along with a demand draft of Rs.600/- in favour of Amrita Vishwa Vidyapeetham Amrita School of Engineering payable at
(Amritapuri/Bangalore/Coimbatore)

Bank Draft No. Dated: . for Rs.

Drawn on (Bank and Branch):