1

VINAYAKA MISSIONS UNIVERSITY, SALEM

Ph.D. REGISTRATION APPLICATION FORM
FULL TIME / PART TIME
Ph.D., Section E-mail ID:
vmu.phd@vmu.edu.in

DETAILS OF REMITTANCE
(To be filled by the Candidate)

a. Name of the Bank / Branch

b. Amount remitted
c. Demand Draft Number
d. Date of Issue
_______________________________________________________________________________________
1. PARTICULARS OF THE APPLICANT
Affix
a. Name of the Applicant
(In Block letters)
b. Date of Birth and Age

:
:

c. Sex

d. Residential Address

e. Office Address

Attested
photo
Male / Female

Pin Code

Pin Code
:
Landline No :
E-mail Address:

Mobile:

(Indicate Communication Address)

2. EDUCATIONAL QUALIFICATIONS:
(Attested certificates to be enclosed)
.
S.No DEGREE
SUBJECT
NAME OF THE
INSTITUTION
a.
UG
b.

PG

c.

M.Phil., *

d.

SPECIALITY
* For M.Phil., Date of viva voice is to be furnished.

UNIVERSITY

YEAR

CLASS
/ RANK

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3. DETAILS OF Ph.D. COURSE APPLIED
a. Name of the proposed department
for conducting Research

b. Department Recognised by this University

c. Name of the proposed institution

Yes / No

(full address)

Pin :
Tel :

d. Name and designation supervisor / guide

e. Area of research

f. Research title

4. ACADEMIC DISTINCTION
a. Awards / Medals / Prize and Honours achieved
during his/her educational carrier.
(separate list may be enclosed)

b. Whether the applicant has been recipient of

any fellowship (UGC / ICMR / CSIR/ NET etc.)

c. Whether the applicant has presented any

Research Papers at National / International
Conferences / Seminars / Workshops
(Certified Xerox copies to be enclosed).

d. Whether the applicant has any Publications /

Articles to his/her credit in any accredited journals.
(Certified Xerox copies to be enclosed).
:

e.

Details of any Research Experience already

gained (Details of state research schemes /
ICMR/ CSIR Projects)
(Certified Xerox copies to be enclosed).

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5. SERVICE PARTICULARS
a. Designation and Department in
which Working

b. Full address of the Institution

Pin :
Tel :
c. Details of date of first appointment
and posts held and duration

d. Teaching Experience after Post Graduation :

UG -----------years
PG -----------years

6. CERTIFICATION
a. Guide / Supervisors remarks
and consent.

:
Signature and seal

b. Co guides consent (if any)

:
Signature and seal

c. Consent of the Head of the

Department for Permitting the
Candidates to Carryout the research
work and to provide necessary facilities. :
Signature and seal
d. Consent of the Head of the institution
where the candidate proposed to carry
out his/her research work

:
Signature and seal

e. Consent of the Director of Public /

Medical / Collegiate / Technical
Education etc.,
(for Teaching candidates working with
Govt.Institutions)

:
Signature and seal

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7.

DETAILES OF CERTIFICATES ENCLOSED :

i.
ii.
iii.
iv.
v.

I ____________________declared that the Particulars furnished in the application are true

and correct. In case any particulars furnished in the application are found incorrect, I agree to
forfeit my admission without any prior notice at any stage.

PLACE

DATE

:
SIGNATURE OF THE CANDIDATE

_____________________________________________________________________________________

FOR OFFICE USE ONLY

NAME OF THE CANDIDATE

REGISTRATION NO

SESSION / YEAR

REMARKS

JAN / JUL / OCT / DEC / YEAR -----------

ANNEXURE

VINAYAKA MISSIONS UNIVERSITY, SALEM, TAMILNADU, INDIA

(To be filled by the Guide / Supervisor only)

a.

NAME

b.

DESIGNATION and

c.

OFFICIAL ADDRESS

Pin Code
:
Landline No :
Mobile No
:
E-mail Address:

No

NAME OF CANDIDATES SO
FAR ADMITTED UNDER
YOUR GUIDESHIP
INCLUDING THIS
APPLICATNT

FULL-TIME /
PART-TIME

DATE OF
REGISTRATION

DUE DATE FOR

SUBMISSION OF
THESIS

PRVISIONAL TITLE
OF THESIS/AREA
OF RESEARCH

I here by declare that the Rules and Regulations of the University related to the course will be
strictly abided.
I will attend without fail all the meetings convened by the University relating to the candidates
research work.

Signature of the Guide/Supervisor