Sathyabama University - Justice Peace Revolution

Name :

Email :

Sex :

Male

Female

Application Processing Fee Detail : (Amount : Rs 250/-)

Bank Name :

DD No. :

Date :

*(dd-mm-yyyy)

Address :

Official (With Designation) :

Residential :

Date of Birth :

(dd-mm-yyyy)

Age :

Nationality :

Category :

Are you employed? :

Yes

If Yes, Specify the following

Company Name :

Company Address :

Salary received per month :

Academic Background (Start with the latest Degree Obtained) (Enclose copies of Degree/Diploma duly attested) :

Degree/Diploma	Years of Passing	University	Major Discipline	Percentage of marks

Professional Experience (Start from the present employment) :

Organisation	Period From To	Designation	Total Salary P.M	Nature of Job

Awards/Medals/Prizes and Honours conferred (if any) :

Major Area of Ph.D Research :

Tentative Topic on which the researh is proposed to be conducted (Attach one-page write up on this topic) :

Faculty & Department in which the candidate proposes to register :

Name, Designation and address of the Research Coordinator (Outside the University) (For Part-Time candidates (External) only) :

Part-Time Candidates (External) shall have a Supervisor recognized by Sathyabama Deemed University and in addition, shall have a Research Coordinator at the organization in which they are working.

DECLARATION OF THE CANDIDATE

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

Place :

Date :

(dd-mm-yyyy)

PART-TIME (External) REGISTRATION ONLY CERTIFICATE FROM THE HEAD OF THE ORGANIZATION

i) The candidate will be permitted to the available, at Sathyabama Deemed University for fulfilling the residential requirements, as per University Regulations.

ii) The required facilities at our organization will be provided to the candidate for doing research.

iii) The candidate will be permitted to be available at Sathyabama Deemed 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.

Name of the Research Coordinator :

Designation :

Place :

Date :

(dd-mm-yyyy)

Seal of the Organization :

CONSENT OF THE SUPERVISOR

(i) SUPERVISOR

NAME :

Whether the supervisor has been recognized by Sathyabama Deemed University to guide :

Yes

If Yes University Reference No :

No. of Ph.D Scholars Supervising :

i) As a Supervisor :

ii) As a Joint - Supervisor :

Panel of Names suggested for the Doctoral Committee :

(At least six names, excluding Supervisor, Joint-Supervisor, Research Coordinator must be given)

Name	Area of Research Interest	Designation and Address

CERTIFIED that the details furnished above have been verified and found to be correct and i am willing to supervise the candidate's research work.

Place :

Date :

(dd-mm-yyyy)

ii) JOINT - SUPERVISOR

NAME :

No. of Ph.D Scholars Supervising :

i) As a Supervisor :

ii) As a Joint-Supervisor :

Whether the Joint-Supervisor has been recognized by the Sathyabama Deemed University to guide :

Yes

If Yes University Reference No :

CERTIFIED that i am willing to Supervise the candidate's research work.

Place :

Date :

(dd-mm-yyyy)

CONSENT OF THE HEAD OF DEPARTMENT AND THE DEAN ( PG & RESEARCH)

Consent of the Head of the Department in which the candidate works (For Part-Time (Internal) candidates only) :

Yes

Place :

Date :

(dd-mm-yyyy)

Name :

Department :

Consent of the Head of the Department where the candidate proposes to register for work :

Yes

Place :

Date :

(dd-mm-yyyy)

Name :

Department :

Approval of the Dean (PG & Research) :

Yes

Place :

Date :

(dd-mm-yyyy)

Name :

Department :

RECOMMENDATATIONS OF THE BOARD OF RESEARCH

Admitted / Not Admitted for Provisional registration in the Ph.D. Programme Full-Time / Part-Time (Internal) / Part-Time (External). Details of Reference number with date.