Appl. No.

MEENAKSHI ACADEMY OF HIGHER EDUCATION & RESEARCH

(DEEMED TO BE UNIVERSITY)

APPLICATION FORM FOR ADMISSION TO Ph.D. DEGREE PROGRAMME

(MEDICAL/DENTAL/PHYSIOTHERAPHY/NURSING/ENGINEERING)

(To be sent through proper channel)

Session for which the candidate is registered :………………..( to be filled in by office only)

Stipendiary Full -Time

Non- Stipendiary Full/Part-Time

1. Applicant’s Name:
(In Block Letters)

2.
Date of
Marital Birth Community
Sex Age Nationality Religion
Status (Evidence to (Evidence to be enclosed)
be enclosed)

Male/ Single/ Indian/ MBC/

OC BC SC ST
Female Married Foreign DC

3. Address to which
Communication should be Sent
(Including Contact Details)
Mobile Number and Email ID
 4. Academic Name of University Year of Major % of Class/Rank
Qualifications the study Subject Marks
Institution in
Subject
P.U.C/+2

Bachelor’s Degree
(Attested Xerox
Copies of Provisional
Certificate or
Degree/Diploma to
be Enclosed)
Master’s Degree
(Attested Xerox
Copies of Mark list
and Provisional
Certificate or
Degree/Diploma to
be Enclosed)
+oi

5. Professional Experience(Start from the present employment

giving full details of duration of each Employment.
Job description and salary drawn up to date of passing the
Master degree examination)
( Service Certificate to be enclosed)
6. Details of Research Experience already gained:
(Include details of themes of study, research work carried out,
Brief mention of inference drawn & its application etc.,)

7. Whether he / She has been awarded fellowship like UGC,

CSIR etc., If so, an attested Xerox copy of the award letter to
be enclosed. Also, indicate the date of joining in the
Department.

8. Awards, Medals. Prizes and Honours achieved in his / her

career

9. Any other particulars he / She would like to present

for the consideration of the authorities.

10. Whether he / She has any publication/articles to his/her

credit. If so, copies to be enclosed.
 11. Title of the proposed Research Topic, Broad Theme
(IN BLOCK LETTERS)

12. Name, Designation and Institution where the Proposed

research supervisor is employed

13. No. of Candidates registered under his / her

14. Date of Retirement of the Supervisor

15. Supervisor’s comments with signature about the suitability

of the candidate for research and consent.

16. Consent of the Head of the Institution for permission to do

research and to provide necessary facilities, with signature
and seal.

17. Consent of the Head of the Institution where the candidate

is employed for permission to do research with signature
and seal.

The above particulars given are correct to the best of my knowledge.

Station :
Date :
Signature of the Applicant

SELF DECLARATION FOR NON- STIPENDIARY

FULL–TIME CANDIDATE

I declare that I am not working anywhere else either on Full–time or Part–time basis.
Signature and seal of the guide
Signature of the Applicant
 Submission of the filled in application form

Last date for submission of

Registration Session
Application

January 30th November

April 28/29th February

June 15th May

October 31st July

Application fee Rs.3000/-

The fee should be in the form of Demand Draft drawn in favour of

“THE REGISTRAR, MAHER” payable at Chennai.