INDIANINSTITUTEOFTECHNOLOGYBOMBAY

APPLICATIONFORREGISTRATIONFORPh.D.PROGRAMME
NameoftheApplicant:Mr./Ms.______________________________________________________
RollNo.:________________CategoryofPh.D.Registration:______DateofBirth:___________
(TA/RA/TAP/SF/CSIR/SWetc.)

Department:________________________________________________________________________
Admissioncategory:GN/OBCNC/SC/ST/PD

DateofJoiningtheInstitute:_______________

(Registration/SigningtheattendanceintheDepartmentRegister)

Detailsofprofessional/researchexperience
(Includenameoftheorganizationworkedfor,workdone,publications,nameofsupervisoretc.in
chronologicalorder.Attachaseparatesheetifnecessary.)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
ProposedcourseworkfortheentireProgramme*
Year

Semester CourseNo.

CourseTitle

No.of
Credits

*Tobecompletedinconsultationwithfacultyadvisor/supervisor.
IrequestthatImaybeadmittedtothePh.D.programmeandberegisteredforthecoursework.
IpromisetoabidebyalltherulesandregulationsoftheInstitute.
Date:_________________________________________________________
(SignatureoftheApplicant)
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ForExternalSponsoredCandidates
a) NameoftheSponsoringOrganization
b) Presentdesignationoftheapplicant
c)

Divisionwhereresearchworkisproposed
tobedone

d) (i) Name of the supervisor from the

sponsoringorganization
(ii)Designation
(iii)Qualification
e)

Istheoriginal/truecopyoftheletterfromsponsoringauthorityintheprescribedformat
attached?
Yes/No

f)

Statementoftheexternalsupervisor
IfMr./Ms.__________________________________________isregisteredfortheDoctoral
degreeatyourInstitute,Iagreetoactashis/herexternalresearchsupervisor.

Signature:___________________________________
Pleaseunderstandthatthereisaresidentialrequirement forALLdoctoralcandidatesintheir
firstsemester.

RemarksoftheDPGC/IDPC/PGC:___________________________________________________
___________________________________________________________________________________
Theproposedcourseworkasgivenaboveisapproved:

Yes/No

Themeoftheproposedwork__________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
NameoftheSupervisor:

Prof.______________________________________________________

Department:

___________________________________________________________

NameoftheCosupervisor:Prof.______________________________________________________
Department:

___________________________________________________________

Nameoffacultymember(s)otherthanthesupervisorconversantwiththetopic:
1.Prof._____________________________________________________________________
2.Prof._____________________________________________________________________
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CertificatebytheSupervisor
AtpresentIamsupervising________candidatesforPh.D.asshownbelow:
RollNo.

Name

Category

Department

Inadditiontotheabove,IagreetosuperviseMr./Ms.___________________________________
____________________________________

________________________

SignatureofSupervisor/FacultyAdvisor

SignatureofCosupervisor

Remarks,ifany:____________________________________________________________________
___________________________________________________________________________________

Date:_______________________________________
ConvenerDPGC
Remarks,ifany:
___________________________________________________________________________________
___________________________________________________________________________________

Date:________________

______________________________
ConvenerPGAPEC

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