BHARATHIAR UNIVERSITY,COIMBATORE 641 046

Established by Tamilnadu State Legislature under the Bharathiar University Act 1981 (Tamilnadu Act 1 of 1982) Accredited with A Grade by NAAC APPLICATION FOR ADMISSION TO PART TIME Ph.D. (Category B)

Session: JULY / DECEMBER

* Payment of fee Subject for Research Specialization .
D M Y

Amount: __________

DD No: ___________ Date

Proposed Place of Research : Department : . Institution : .

(Indicate the Department and Institution where the candidate proposes to do research. For e.g.: Department of Physics, Bharathiar University or Department of Chemistry, Government Arts College, Coimbatore.)

1. Name (In Block Letters as in records) :

2. Sex : M / F 3. Age: yrs D 4. Date of Birth : M Y

5. Nationality : 6. Religion :

7. Community ______________________ BC / MBC / DNT / SC / ST Other

8. Address : (a) Permanent .. .. .. Pin.

(b) Address to which communications are to be sent . .. .. Pin.

9. a). Name, Occupation and address of father / guardian b). Name of mother

: :

* An application fee of Rs. 1000/- should be paid in the form of DD. A demand draft should be taken in a scheduled bank in favour of Registrar, Bharathiar University, payable at Coimbatore. The DD should be submitted along with the application form.

10. Present occupation of the candidate : and place where working 11. Academic Particulars : Exam. passed. PUC / +2 Bachelor Degree Master Degree M.Phil. Degree 12. Professional / Teaching / Research Experience : Designation Institution Duration From To Total Period Y M D Particulars of work done BOARD / Univ. Month & yr of passing Duration of course Class obtained Major % of marks subjects obtained

13. Details of proposed research (a). Broad field of research (should be related to the main branch of PG Degree) : (enclose a brief resume of 250 words) (b). Scholarship, if any awarded, for the present research programme: 14. Awards / Medals / Prizes / Honours achieved :

15. * (a). Name of Research Supervisor (b). Institution where Supervisor is working

: :

(i). Whether the Research Supervisor has applied for Registration under the scheme (ii). Whether the Research Supervisor has been Registered. If so date and number of Registration No. 16. Any other particulars

Yes / No Yes / No Date:

* Research Supervisors may be chosen from the Pool of Research Supervisors posted in the University Website http: //www.b-u.ac.in

DECLARATION BY THE RESEARCH SUPERVISOR

I ____________________________ (M / F) aged __________ Recognized as a Research Supervisor for Ph.D. programme by _________________________ University, _______________ state, hereby accept to guide and supervise the candidate Mr. / Mrs. / Miss. _________________ for Ph.D. programme under the above mentioned scheme. I will abide by the rules and regulations of the Ph.D. programme. Place : Date : Signature Name : :

Address for Communication

Phone: Land Line: (including code)

Mobile: E Mail:

DECLARATION BY THE CANDIDATE

I ____________________________ (M / F) aged_________, S/O, D/O, W/O, H/O ______________________ declare that all the above mentioned details are true to the best of my knowledge and belief and assure that I will abide by the rules and regulations of the Part Time Ph.D. Category-B Place : Date : Signature Name : :

Address for Communication

Phone: Land Line: (including code)

Mobile: E Mail:

ENCLOSURES NEEDED

1. Copies of marks and degree certificates for PG and M.Phil. 2. DD / Challan for payment of Application fee 3. Transfer Certificate copy from the previous institution of study 4. Conduct Certificate copy from Head of the department of study / Senior Faculty (Institution where studied) * Application may be sent to the The Director Research and Development Centre Bharathiar University, Coimbatore Tamilnadu, India. Pin 641 046 NOTE

1. Envelopes may be superscribed as Application for Admission to Part Time Ph.D. (Category B) 2. For eligibility conditions and further information, visit http: //www.b-u.ac.in 3. Applications will be received till 31st May for July Session and 31st October for December Session.