Office Reference No.

ANNA UNIVERSITY : CHENNAI - 600 025

CENTRE FOR RESEARCH

APPLICATION FOR ADMISSION TO RESEARCH PROGRAMME - JULY 2012

Ph.D.

M.S. (By Research)

Strike out whichever is not applicable

Note: Regular Faculty members working in University Departments/Engineering Colleges/Architecture Schools within Tamil Nadu and Regular employees working in the R&D centres which are approved by this University as recognized research centres are only eligible to apply under Part-time mode. Others can apply for Full-time mode. Refer the information brochure before filling the application form.
1. 2. 4. 5. 7. 9. 10. Name (in Block letters) : (As in UG/PG degree certificate) Sex: Male/ Female

3. Nationality: Indian/ Foreign

If foreign national: Country ________________ Passport No.________________ Social Status: ST/SC/SCA/MBC/BC/BCM/OC 6. Community _______________

(Affix Passport size Photo recently taken)

Age & Date of Birth: ________________ 8. Marital Status: Married/ Unmarried Email ID Address : : Residential Address : _____________________________________________ _____________________________________________ _____________________________________________ District : ____________________________________ State : ___________________ Pin code: ___________
Phone : Mobile : Photograph shall be attested by a Grade A/B Officer or Head of the Institution.

Office Address : Designation : ____________________________________ Department : ____________________________________ Organization : ____________________________________ Place Dist. /State
Phone :

: ____________________________________ : __________________ Pin code:__________

Mobile :

11.

Category applied for Full-time All eligible candidates as given in the information to the candidates

: (Tick appropriate box, after referring the information to the candidates carefully)

Part-time 1. Regular Faculty members of University Departments, University Colleges of Engineering, Govt./Govt. Aided/Self-Financing Engineering Colleges within Tamil Nadu 2. Teaching Research Associates of this University 3. Regular employees working in Industries/ Research organizations which are recognized as research centres by this University for pursuing Ph.D./M.S. (Refer: Annexure I sec V) Please specify:

12.

Details of current employment (if applicable) Name & address of the employer: Nature of employment : Regular/Approved Probationer/ Probationer/ Consolidated pay/ Contract/ Visiting Faculty/Temporary/TRA/Teaching Faculty Scale of Pay: _________________________ working since _________________ (Certificate from the employer need to be attached) Details of employment in project (if applicable) Name of the Principle Investigator: ___________________________________________________________

13.

(copy of the project sanction order to the principle Investigator should be enclosed)
Title of the Project: ________________________________________________________________________ Funding Agency: _____________________________________ Duration of the Project : _______________ Stipend: ____________ working since ____________ Date of Expiry of the project : _____________ (copy of the project appointment order should be attached)

14.

ACADEMIC BACKGROUND

Candidates with UG/PG degree other than the Universities listed in the Annexure III and degrees obtained other than Regular mode shall obtain course equivalency certificate from The Director (Academic Courses), Anna University, Chennai 600 025.
(Enclose copies of Degree Certificates and Mark sheets duly attested see Clause 8.0 of Information to Candidates) Start with the latest degree obtained: Sl. No 1. Year of Passing Major % of Class Discipline / Marks / Obtained Specialization CGPA Regular mode / Others (specify) Additional Information, if any

Degree

College

University

2.

3.

4.

5.

15. Sl. No 1. 2. 3. 4.

Professional Experience (Start from the present employment) : Period From To Total Salary P.M. Additional Information, if any

College/Organization

Designation

Nature of Job

16. 17. 18.

Details of Publications in refereed journal, if any (Photo copy shall be enclosed) Proposed Major area for Ph.D. / M.S. (By Research) programme Tentative research topic (One page write-up of proposed

: : :

research with signature of the candidate & supervisor, Joint supervisor, if any should be enclosed)
19. i) Department in which the candidate proposes to register :

ii) College in which the candidate proposes to register

iii) Faculty

(See Annexure II of information

: CIVIL/MECH/ELECTRICAL/I&C/ TECH/ARCH/S&H/MANGT. SCIENCE

to the candidates)
20. Name, Designation and Address of the proposed a) Supervisor * (Recognized supervisors working in the recognized departments) :

b)

Joint Supervisor (applicable only for candidates from industry : / research organizations recognized as a research centre by this University and for those candidates who propose to undertake Interdisciplinary research)

* Refer: http://www.annauniv.edu/research/supervisor.php for Recognized Supervisors list. 21. Demand Draft Particulars: Name of the Bank & Branch Demand Draft No. Date Amount

22.

Whether at present registered or discontinued Ph.D./M.E./M.Tech. / M.S.(By Research) programme in any other University Checklist for enclosures : (Tick appropriate) 1. 2. 3. 4. 5. 6. SSLC or its equivalent HSC/Diploma or its equivalent UG Mark sheets UG Provisional/Degree certificate PG Mark sheets PG Provisional/Degree certificate [ [ [ [ [ [ ] ] ] ] ] ] 7. 8. 9. 10. 11. 12.

YES/NO (If yes, please specify)

23.

M. Phil. Degree certificate (if applicable) [ Community Certificate (if applicable) [ Service certificate from the employer [ Demand Draft [ One page Research topic write up [ Rs.5/- stamped Self Address (4) covers [

] ] ] ] ] ]

DECLARATION BY THE CANDIDATE 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 admission to Ph.D./M.S. (By Research) programme at any stage. Place Date : : Signature of the candidate

CERTIFICATE FROM ENGINEERING COLLEGE/RESEARCH ORGANISATION WHERE THE CANDIDATE IS EMPLOYED

Certified that Mr./Ms./Mrs._________________________________________________ is employed as (Designation)_________________________________ in the (Department/Division Name)_______________________________________ of (Engineering college/Organization Name) ___________________________________________________________________________________

The College/Organization has no objection to forward his/her application for admission to Ph. D./M.S. (By Research) Programme. FOR FULL TIME*: The employee will be sanctioned study leave for the minimum duration of the research programme and will be relieved from duty from ______________ to ______________ in order to undertake Full-time research work in the University Departments/recognized Departments of Engineering Colleges. The necessary relieving order will be given during admission. (or) FOR PART TIME**: The employee will be permitted to undertake Part-time research in the University Departments/recognized departments of Engineering Colleges and he/she will be permitted to be present for attending course works, discussion with the supervisor, conduct experiments and participate in seminars and related discussion. Further, the required facilities at our Institute/ organization will also be provided to the employee for doing research. (Note: Choose the appropriate * / ** marks)

Place: Date: Signature of the Principal with office seal / Signature of the Head of the R&D organization with office seal

CONSENT OF THE SUPERVISOR / JOINT SUPERVISOR (Application filled without the consent of recognized supervisor of Anna University, Chennai (or) department of the supervisor is not a recognized research centre of Anna University, Chennai, such applications shall be summarily rejected without any further notice) (i). Recognized supervisors of this University who are working in (a) University Departments, Govt./Govt. aided Engineering Colleges (as given in Annexure I sec I to III) (b) Recognized Departments (as given in Annexure I sec IV) of Self-financing Engineering College shall only function as Supervisor. (ii). Recognized supervisors working in R&D centres (as given in Annexure I sec V) and in the non recognized departments of self-financing Engineering Colleges are eligible to act only as Joint supervisor.
SUPERVISOR (should furnish Anna University, Chennai Ref. No. for Supervisorship recognition)
@

JOINT SUPERVISOR Applicable only for candidates from Industry/Research Organizations recognized as a research centre by Anna University, Chennai and for candidates propose to undertake interdisciplinary research

Name Designation Nature of Appointment Department Regular / Contract / Temporary / Visiting Faculty Regular / Contract / Temporary / Visiting Faculty

College / Organization Address Mobile No. Date of Birth Date of Retirement Area of Specialization Whether the supervisor fulfills the YES / NO YES / NO norms as per clause 7of Ph.D/M.S If Yes, Please furnish Univ. Ref. No. If Yes, Please furnish Univ. Ref. No. (By Research) Regulations (R 2010) for Supervisorship recognition for Supervisorship recognition

No. of Research Scholars working as on Date As Supervisor As Joint Supervisor Signature

@

Ph.D.

M.S.

Ph.D.

M.S.

The Supervisor while giving his/her consent should furnish list of panel members for DC/MC in the enclosed format (page 7). A supervisor shall guide only a maximum of Twelve [Ph.D./M.S. (By Research) put together] scholars as Supervisor/Joint Supervisor. Joint Supervisor is mandatory, if the supervisor is not a regular faculty member of the University Departments. A maximum of six Ph.D./M.S.(By Research) scholars only be permitted under such supervisors.

A MAXIMUM OF 4 CANDIDATES SHALL ONLY BE ALLOWED TO REGISTER WITH A SUPERVISOR IN ANY ONE SESSION.
5

DETAILS OF RESEARCH SCHOLARS PURSUING RESEARCH UNDER HIS/HER GUIDANCE AS SUPERVISOR AND JOINT SUPERVISOR (Shall be furnished by the supervisor while giving his/her consent) INCOMPLETE DETAILS RESULTS REJECTION OF THE APPLICATION Details of Ph.D. / M.S (By Research) Scholars:
SL. NO NAME OF THE SCHOLAR REG. NO. Ph.D. / M.S. SUPERVISOR / JOINT SUPERVISOR RESEARCH STATUS

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Signature of the Supervisor (Name with seal) 6

ANNA UNIVERSITY CENTRE FOR RESEARCH

LIST OF PROPOSED DC/MC* MEMBERS

Name of the Candidate Research Topic of the Candidate
(Abstract of topic duly signed by the supervisor should be enclosed)

Programme Ph.D. M.S.**

: : : Name with full address Supervisorship recognition No. : Supervisorship recognition No. : Area of Research in Ph.D.

Name of the Supervisor Sl.No.

Name of the Joint Supervisor, if any :

Members from University Departments and Engineering colleges Name : 1.

Designation : Department : Address :

Phone: 2.
Name : Designation : Department : Address :

E-mail:

Phone: 3.
Name : Designation : Department : Address :

E-mail:

Phone: E-mail: Members from other Institutions (preferably within Tamil Nadu) Name : 1.
Designation : Department : Address :

Phone: 2.
Name : Designation : Department : Address :

E-mail:

Phone: 3.
Name : Designation : Department : Address :

E-mail:

Phone:

E-mail:

** For M.S (By Research) scholars, only three members need to be given.

SIGNATURE OF THE HOD / DIRECTOR OF THE CENTRE

SIGNATURE OF THE JOINT SUPERVISOR (NAME WITH ADDRESS SEAL)

SIGNATURE OF THE SUPERVISOR (NAME WITH ADDRESS SEAL)

of the Supervisor
(NAME WITH ADDRESS SEAL)

(If applicable)

Programme

Ph.D.

M.S.

Office Ref. No.

DATA SHEET FOR Ph.D./M.S. (By Research) ADMISSION (TO BE FILLED BY THE CANDIDATE ALL LETTERS SHOULD BE IN CAPITAL LETTERS) 1. Name (As in UG/PG Degree with initials at the end) 2. Date of Birth 5. Community: 6. Communication Address with Mobile No. Email I.D. 7. B.E./B.Tech./ B.Sc.(Engg.)/B.Sc./ Others Major: Year of Passing University 8. M.E./M.Tech./ M.Sc.(Engg.)/M.S.(By Research)/M.Sc./ /M.Phil./M.A./M.B.A./M.C.A./ Others Major: Year of Passing University 9. Employed Yes No (If Yes, provide Office address with designation; If No, provide Residential address) Percentage of Marks/CGPA Mode of Study R O Percentage of Marks/CGPA Mode of Study R O ST SC 3. Sex SCA M MBC F 4. Nationality BC BCM Indian OC Foreign

10. Category Applied for

Full time

If Part time College Organization Regular Contract TRA Project

11. Name of the Supervisor: Designation : Department : College : 12. Name of the Joint Supervisor (if applicable) Designation : Department : College : 13. Tentative topic of Research

14. Demand Draft Particulars Bank Name R Regular O Others

Amount

D.D. No. Branch

D.D. Date

SIGNATURE OF THE CANDIDATE