Form No. Ph.D/2015-2016/
(Last date for submission of application 29/06/2015)
Form fee Rs. 750/-
KADI SARVA VISHWAVIDYALAYA
SECTOR-15, GANDHINAGAR-382015
Application for Ph.D 252 / M.Phil 100
(To be submitted by the candidate for appearing the Entrance Test / Claiming
exemption from Entrance Test)
Form submitted on:
/
/2015 (for office use)
Affix
Recent
Form submitted for: Ph.D in
photograph
Form submitted for: M.Phil in
Demand Draft No.
Date:
(Demand draft be drawn in favor of Kadi Sarva Vishwavidyalaya payable at Gandhinagar)
1. Name of the candidate:
(As mentioned in qualifying examination certificate)
2. Father/Husband’s Name:
3. Address for Communication:
Email:
Phone:
Mobile:
4. Date of Birth:
5. Category/Caste:
Open
SC
ST
OBC
(Attach caste certificate if belonging to reserved category)
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Form No. Ph.D/2015-2016/
6. Educational Qualification (HSCE onwards) (Attach testimonials)
University/
Year of
Class/
% of
Degree
Board
Passing
Division
marks
Major
subject(s)
H.S.C
Bachelor of
Master of
Other
7. Employment details: (Attached separate sheet if required)
Sr.
No.
Name of employer
with address
Designation/
Post held
Nature of
duties
From
To
8. Details of research experience if any: (Attach separate sheet if required)
9. Details of Publications, Patents etc. (if any): (Attach separate sheet if required)
10. Exemption from Entrance Test required:
Yes
/
If required: (a) Mention valid reason for seeking exemption.
No
(b) Attach authenticated copy of certificate/document in support
of exemption claim.
11. Proposed Title of Research:
(Research Proposal must be attached)
Date:
Signature of the candidate
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Form No. Ph.D/2015-2016/
TO BE FILLED BY EMPLOYER
(applicable to employed applicants)
This
institution
has
no objection
if
Mr./Ms.
pursues the research work proposed in
this application for the award of Ph.D Degree by Kadi Sarva Vishwavidyalaya.
This is further to assure that all the local facilities will be extended to the candidate.
Name, Address & Email-ID of the Institute:
Contact person:
His/Her Contact No. & Email-ID
Date:
Office seal
Signature of authorized signatory
of the Institute
DECLARATION BY THE CANDIDATE
I hereby declare that the information submitted in this application is correct to be
best of my knowledge and belief.
I am well aware that my candidature will stand
disqualified if and when any of the information submitted by me is found false.
I further declare and undertake that I shall follow all the rules and regulations in
force at the University from time to time.
Date:
Place:
Signature of the candidate
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