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ANNA UNIVERSITY OF TECHNOLOGY MADURAI
Alagar Koil Road, Madurai – 625 002
APPLICATION FOR ADMISSION TO RESEARCH PROGRAMME – JANUARY 2011
Ph.D. M.S. (By Research) (Tick whichever is applicable)
Affix recently
taken passport
1. Name (in Block letters with size photo
Initials at the end) :
2. Sex : Male/Female
3. Nationality : Indian/Foreign
6. Community :
9. Email Address :
10. Address:
Office Address Residential Address:
Designation :
Organization :
Place :
Taluk/Dt./State :
Pincode : Pincode :
Phone : Phone :
Fax : Fax :
Mobile : Mobile :
11. Category applied for: (Tick appropriate box, after referring Instructions)
Page 1 of 5
12. Details of Current employment (if Applicable)
Name & Address of the employer :
Major % of Regular/Part
Sl. Degree/ Year of Class
College University Discipline/ Marks/ time/ others
No Diploma passing Obtained
Specialization CGPA (specify)
1.
2.
3.
4.
5.
Page 2 of 5
17. Major area for Ph.D./M.S(By Research) Degree Programme :
21. D.D Particulars: (Rs.600/- for General Candidates(Rs.300/- for SC/ST Candidates) drawn in favour of
“The Director, Centre for Research, Anna University of Technology Madurai”, payable at Madurai.)
Name of the Bank & Branch Demand Draft No. Date Amount
This is to certify that the particulars given above are true, correct and complete to the best of my
knowledge and belief. I am aware that any wrong information or suppression of information and facts may
result in punitive action in addition to cancellation of my candidature for Ph. D. / M.S. (By Research)
programme admission.
Place:
Date : Signature of Candidate
Page 3 of 5
CONSENT OF THE SUPERVISOR / JOINT SUPERVISOR
(Recognized supervisors working in the recognized departments shall only function as supervisor)
SUPERVISOR*
JOINT SUPERVISOR
(should furnish the
(Applicable only for candidates from
University Ref. No. for
Industry / Research Organisations
Supervisorship
Recognized by this University)
Recognition)
Name
Designation
Nature of Appointment
Department
College / Organization
Address
Date of Birth
Area of Research
As on Date
As Supervisor
As Joint Supervisor
Total
Signature
* The supervisor while giving his / her consent should furnish the list of panel members for DC / MC in the
enclosed format (page 5). A Supervisor shall not normally guide more than ten research scholars
(including MS by Research Scholars) for Ph. D. at any time. Additional candidates, if any under
extraordinary circumstances, shall be decided on the merit of the cases, subject to the approval of
Research Board.
Joint Supervisor is mandatory if the supervisor is not regular faculty member of this university. A
maximum of ten research scholars only be permitted under such supervisors.
If the supervisor wants to guide in areas other than his / her area of research, these areas shall be
accepted based on two publications in reputed journals or the staff member shall have handled PG level
classes in the above areas, during last three years preceding the date of application.
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CENTRE FOR RESEARCH
ANNA UNIVERSITY OF TECHNOLOGY MADURAI, MADURAI – 625 002
LIST OF PANEL MEMBERS FOR DC / MC
[To be sent in a sealed cover]
Ph.D. M.S. (By Research) (Tick whichever is applicable)
Mobile : Email:
2. Name :
Designation :
Department :
Address :
Mobile : Email:
3. Name :
Designation :
Department :
Address :
Mobile : Email:
From Industry/R&D organizations:
1. Name :
Designation :
Department :
Address :
Mobile : Email:
2. Name :
Designation :
Department :
Address :
Mobile : Email:
3. Name :
Designation :
Department :
Address :
Mobile : Email:
SIGNATURE OF THE HOD* SIGNATURE OF THE JOINT SUPERVISOR SIGNATURE OF THE SUPERVISOR
(NAME WITH ADDRESS) (NAME WITH SEAL) (NAME WITH SEAL)
*HOD of the Supervisor (if applicable)
Page 5 of 5