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Cost of Application : Rs.

1000/-

(Under Sec. 3 of UGC Act 1956)

Ph.D. REGISTRATION FORM


Application No.

Fill up the details in English in BLOCK LETTERS

Registration No.

Put mark wherever applicable


For Eligibility Criteria, please visit our website

(To be allotted by the University)

Demand Draft in favour of The Registrar, AMET University, Chennai


Website: www.ametuniv.ac.in

DD No :

Email : directorresearchoffice@ametuniv.ac.in

Date

Affix recent
passport size
photo here

Bank Name:
Branch

Category(Please Tick)

a. Full Time

b. Part-Time (Internal)

1. Name of the Applicant

2. Gender

Female

Male

3. Official Address for Correspondence (Do not repeat the Name)

State

PIN Code
Country

4. Residential Address (Do not repeat the Name)

State

PIN Code
Country
5. Date of Birth

D D

M M

6. Blood Group

7. Nationality
9. Social Status

8. Religion

SC/ST/MBC/BC/OBC/OC/PWD

10. Mobile No.of the Candidate:


11. Email ID .................................................................................................................
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c. Part-Time (External)

12. Are you employed?

Yes

No

If yes, specify the Name and Address of the Employer

State

PIN Code
Country
13. Salary received per month

14. Academic Background (Start with the latest Degree / Diploma obtained)
(Enclose copies of Degree/Diploma Certificates duly self attested)-Attach Separate Sheet if necessary
Sl. No.

Degree/
Diploma

Year of
Passing

Percentage
of marks and
Class
obtained

Major
Discipline

University/
Institution

Full-Time (or)
Part-Time(or)
Distance
Education

1.

2.

3.

4.

15. Professional Experience (Start from the present employment)-Attach Separate Sheet if necessary
Sl.No.

Organization

Period
From
To

Designation

Salary
Per Month

1.

2.

3.

4.

16. Awards/Medals/Prizes and Honours conferred if any :


17. Major Area of Ph.D. Research
18. Tentative Topic on which the research is proposed to be conducted

19. School & Department in which the candidate proposes to register


2

Nature of Job

Part-time Candidates (External) shall have a Supervisor/Guide recognized by AMET University


preferably or from other organizations and in addition, shall have a Research Coordinator at the
organization in which they are working(optional).
20. DECLARATION OF THE CANDIDATE

This is to certify that the particulars given above, are true, correct and complete to the best of my
knowledge and belief.
Place:
Date:

Signature of the candidate

21. PART-TIME (External) REGISTRATION ONLY


CERTIFICATE FROM THE HEAD OF THE ORGANIZATION

i) The candidate will be permitted to be available at AMET University for fulfilling the residential
requirements, as per University Regulations.
ii) The required facilities at our University will be provided to the candidate for doing research.
iii) The candidate will be permitted to be available at AMET University, whenever required by the
Supervisor to have discussions with him, to attend to the prescribed course works, to conduct
experiments and to participate in Seminars/Conferences/Workshops/Symposias/Short Term
Courses etc...
Name of the Research Coordinator (Optional) :
Designation
:

Signature of the
Research Coordinator

Signature of the Head


of the Organization

Place :
Date :
Seal of the Organization :
22. CONSENT OF THE SUPERVISOR / GUIDE
(i)SUPERVISOR / GUIDE

a. Name (in BLOCK LETTERS)

b. Address for Communication


(i) Official Address (Do not repeat the Name)

PIN Code

State

Country
3

(ii) Residential Address (Do not repeat the Name)

State

PIN Code
Country
(iii) Contact Phone Number
a) Office (with STD Code)
b) Residence (with STD Code)
c) Mobile

(iv) Email ID ................................................................

(v) Website address if any .......................................................

c) Whether the Supervisor / Guide has been recognized by


AMET University to guide research scholars
:
If yes, University Reference No.
d) No. of Ph.D Scholars Supervising
(i) As a Supervisor / Guide in AMET University
:
(ii) As a Supervisor / Guide in other Universities
:
e) Panel of Names suggested for the Doctoral Committee (DC) Members* :(Attach Separate Sheet if
necessary) (At least six names, excluding Supervisor, Research Coordinator must be given by the
Supervisor / Guide out of six, three from academic institution and three from industry)
Sl.
No.

Name

Designation

Official Address
with Pin Code

Area of Specialization

E-Mail & Mobile


number

* This list is to be provided only after getting the consent from the members mentioned above. If Area of Research,
Designation & Address are not provided, properly then University will fix the DC Members.
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CERTIFIED that the details furnished above have been verified and found to be correct and I am
willing to supervise the candidates research work.
Place :
Date :

Signature of the Supervisor

(ii) JOINT - SUPERVISOR (Optional)

a. Name (in BLOCK LETTERS)

b. No. of Ph.D Scholars Supervising


(i) As a Supervisor in AMET University

(ii) As a Joint-Supervisor in AMET University

(iii) As a Supervisor/Joint Supervisor in other Universities :


c) Whether the Joint-Supervisor has been recognized by
the AMET University to guide.
:
If yes, University Reference No.
CERTIFIED that I am willing to Supervise the candidates research work.
Place :
Date :

Signature of the Joint-Supervisor

23. CONSENT OF THE AMET UNIVERSITY SCHOOL / HEAD OF THE DEPARTMENT


Consent of the AMET University School / Head of the Department in which the candidate works: Yes / No
(For Part-Time (Internal) candidates only)
Place :
Date :

Signature

Name
School / Department

:
:

Seal
24. RECOMMENDATION OF THE DIRECTOR-RESEARCH :
Admitted / Not Admitted for Provisional registration in the Ph.D Programme Full-Time / Part-Time
(Internal) / Part-Time(External).

DIRECTOR - RESEARCH

25. FORWARDED BY

REGISTRAR

26. APPROVAL OF THE VICE-CHANCELLOR

VICE-CHANCELLOR

NOTE:
1. Duration of the Ph.D. programme is Three years.
2. Monthly Fellowship / Stipend of Rs.8000/- will be given to the selected candidates for the
Full Time Ph.D programme with fellowship category candidates.
3. Completed Ph.D Registration form with enclosures and demand draft should be sent to
The Director - Research
AMET University,
135, East Coast Road,
Kanathur - 603 112
Chennai, India
Tel : 044 - 27472155 / 157 Fax : 044 - 27472804