10 (ANNEXURE III) Assam down town University Gandhinagar, Panikhaiti Guwahati-781026 Registration Form for Ph.D.

Degree PERSONAL DATA
Name (in block letters)
Date of Birth (DD/MM/YYY Sex

DHRUBA GURUNG 10.03.1956
¥ Male Female

Phone E-mail Religion Mother Tongue Nationality
Residence Address With PIN Code Office Address With PIN Code

Res: 0376-2305217 Mobile: 9435352199 gurungd@rediffmail.com; gurungd@icfre.org Hindu Caste Blood Group Indian State of Domicile General A+ Meghalaya

Q 4/II, Rain Forest Research Institute, Sotai Ali, Post Box :136 Jorhat, Assam PIN-785001 Rain Forest Research Institute, Sotai Ali, Jorhat, Assam 785001 ¥

Address for Correspondence ACADEMIC RECORD Examination Passed M.Sc. B. Sc. Specialization Ecology & Environment Zoology (Honours)

Office

Residence

Institution

University Sikkim Manipal University North Eastern Hill University

Year of Passing 2009 1977

Class obtained I II

St. Anthony¶s College, Shillong

______________________________________________hereby declare that the information that I have furnished here in is to the best of my knowledge Place: Date: _______________________ Signature of the Candidate DECLARATION BY THE GUIDE I am a recognized Guide for the Ph.d./Mrs«««««««««««for his/her Ph. AdtU. Programme under my guidance are Sl. Assam.com CO-GUIDE DATA (If any) e-mail I. Assam Public School. degree in the proposed field of research. Name of the Student Registering University Date of Registration Guide/Co-guide Place Date _________________ Signature . Pin 786602 Institute in which the candidate proposed to work and prepare thesis Phone Res: Mobile Name of the Guide Address for correspondence Institute in which the candidate proposed to work and prepare thesis Phone Res: Mobile 9954632856 e-mail ritukamlapuri@yahoo. I undertake the responsibility of guiding Mr.11 PROPOSED RESEARCH DATA Title of the proposed thesis Department in which candidate proposed to work and prepare thesis Institute in which the candidate proposed to work and prepare thesis Whether full Time or Part Time Full Time Part Time GUIDE DATA Name of the Guide Address for correspondence Dr.D.of the Registrar. Dist. No. The student is not related to me. Rita Gurung Kamalapuri Principal. The students who are presently working for Ph.. Duliajan.dated««««««.D. programme of Assam down town University as per the communication No««««««««. Dibrugarh.

Jorhat. Signature STN-122 Enclosures: y y y y y y y Name Institute Seal Declaration by the Guide Declaration by the Co-guide Recommendation by the head of the Department Recommendation by Head of the Institution Attested copy of the degree certificate of qualifying examinations Attested copies of the marks cards of qualifying examination Brief description of the research protocol must include the Title.D. Rajib Kumar Borah ««.I recommend that the candidate may be permitted to register for Ph. RECOMMENDATION OF THE HEAD OF THE INSTITUTION The Department of Forest Protection Division «of «« Rain Forest Research Institute. programme of Assam down town University as per the communication No .d. Sotai Ali. No.Institute has adequate facilities for conducting the research work by « Shri Dhruba Gurung .D.. 1 2 3 4 Name of the Student Registering University Date of Registration Guide/Co-guide RECOMMENDATION OF THE HEAD OF THE DEPARTMENT The Department of «Forest Protection Division«.««« Dated««««««.of ««. I recommend that the candidate may be permitted to register for Ph. Assam « has adequate facilities for conducting the research work by «Shri Dhruba Gurung««««under the guidance of ««Dr. Assam «. objectives. degree in the proposed field of research. Programme under my guidance are Sl.Under the guidance of «« Dr. The student is not related to me.D. Jorhat. . Introduction and importance of proposed research investigation. degree under Assam down town University. Signature Name Department seal. Methodology and References./Mrs«««««««« «« « for his/her Ph. I undertake the responsibility of guiding Mr. The students who are presently working for Ph.Rain Forest Research Institute.Sotai Ali.12 DECLARATION BY THE CO-GUIDE I am a recognized Guide for the Ph.of the Registrar. Rajib Kumar Borah«. degree under Assam down town University. AdtU.D.

Rajib Kumar Borah ««. Assam «.D. I recommend that the candidate may be permitted to register for Ph. Note: Attach the list of research facilities available in the department required for the research work of above candidate.Institute has adequate facilities for conducting the research work by « Shri Dhruba Gurung . Rajib Kumar Borah ««. Signature Name Department seal.Under the guidance of «« Dr.D. The list of research facilities available in our department is attached. Note: Attach the list of research facilities available in the department required for the research work of above candidate.Institute has adequate facilities for conducting the research work by « Shri Dhruba Gurung . Sotai Ali. Sotai Ali. Jorhat.Forest Protection Division «of «« Rain Forest Research Institute. degree under Assam down town University. The list of research facilities available in our department is attached. Assam «. I recommend that the candidate may be permitted to register for Ph. RECOMMENDATIONOF THE HEAD OF THE INSTITUTIN (From the Candidate¶s Parent Institution.Under the guidance of «« Dr.. For Extern ± Part Time Candidates only) The Department of ««. Signature Name Institute seal.13 RECOMMENDATIONOF THE HEAD OF THE DEPARTMENT (From the Candidate¶s Parent Institution. degree under Assam down town University. For Extern ± Part Time Candidates only) The Department of ««.Forest Protection Division «of «« Rain Forest Research Institute. .. Jorhat.

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