K L University

Vaddeswaram, Green Fields, Guntur District

Ph: 08645246948, http:// www.kluniversity.in

Application Form for Admission into Ph.D. Program

(Read important points available at the end of this application and also
Appendix-A which details all rules and regulations)

Tick the Appropriate from following options

Applicant Category: Regular □Long standing □ Re-Registration □

Industrial □ Research Organization □

Mode of registration: Full Time □ / Part Time □

Application Fee Passport Size Photo

DD/Pay Order Bank Name Branch Name Amount

Num/ Cash Paid
receipt Num

1. Name of the candidate :

First Name-Middle Name-Last Name

2. Date of Birth(DD/MM/YY) : □□/□□/□□

3. Gender : Male/Female: □□□□□□
4. Father’s / Husband’s Name :

5. Nationality : □□□□□□□□□□□□
6. Address for communication

D.No :

Flat No:

Name of the Apartment:

Name of the Street:

Name of the City :

District:
 K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in

State:

Pin Code:

Email ID:

Phone (with STD/ISD

codes)/ Mobile No’s:
7. Educational details (Up-to latest degree obtained) :
Srl Qualification Specialization/ Name of the Year of Percentage /
No Major University Passing CGPA
1 Xth class

2 XIIth Class

3 UG-1

4 UG-2

5 PG-1

6 PG-2

8. Details of Teaching/Industrial Experience :

Designation Name of the Period Total Duration

S.No. Organization From To In Months
MM/YY MM/YY
1

Total Experience

9. Research Discipline /(s) in which Registration is desired

Dicipline-1(Code) □□□□□□
Dicipline-2 (Code) □□□□□□ in case of Inter-discipline

Refer to Annexure-A for the Code Numbers

 K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in

10. Details of Honor(s) / Ranks if any:

S.No. Type of Rank Rank Institution Awarded Year

Obtained Obtained
1

11. Details of Internships in Industry / Academia if any:

S.No. Name of the Industry / Duration of internship Total duration

Institution From To Months
MM/YY MM/YY
1

12. Details of Membership(s) in Professional Bodies if any :

S.No. Name of the Body Type of Membership Nature of

(AM/LM/Fellow etc) Membership
(Annual / Five Years
/ Life Time)

13. Details of Research Publications in the proposed research area:

Number of Publications:

International Journals □□□ National Journals: □□□

International Conferences □□□ National Conferences □□□
 K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in

Details of Publications:
Journals:

S.No. Title of the paper Name of the Journal Vol No. Month &
& Issue Year of
No. Publication
1

Conferences:

S.No. Title of the paper Name of the Name of the Month

Conference Organizing Body &
Year
1

14. Details of Research Projects carried / Associated with (if any):

S.No. Title of the Project Funding Body Nature of

Association
1

5
 K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in

15. Proposed Area of Research

16. Title of the Research

17. Proposed Plan of Research work with its scope (Please attach a write-up with
phase wise plan: The research plan must be submitted as per Annexure-C

18. Status of the research work if being carried already: Should be submitted as
per Annexure-D

Signature of the Candidate

 K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in

Instructions to the Candidates

Important Points to Note before filling the Application Form:

1. The candidate opting for full time Program must give their Research
director/ co-director choice from the Existing faculty on rolls of K L E F
University. The research area of the applicant must be same as the focus
area of the Research director.
2. Please attach No objection Certificate from the Present Employer in case
of Part time program (Annexure-E). No objection Certificate is not
required in case of K L University candidate
3. Please attach a cancellation letter addressed to the university at which the
registration is made if Re-Registration is sought (Annexure-AI)
4. Please attach the attested copies of all your certificates starting from SSC.
5. Enclose the DD of Rs.500/- towards application fee.
6. Enclose the Proofs for Teaching Experience for Part time program.
7. In case of part-time program attach a Letter from Head of Institution
expressing the willingness to extend the infrastructural and lab facilities
for undertaking the Ph.D program.
8. Mention your name and phone number on the back side of the DD.