VISVESVARAYA TECHNOLOGICAL UNIVERSITY,

BELAGAVI, KARNATAKA Paste ( do not pin )

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APPLICATION FORM FOR PHD/ M.Sc. (Engg) BY RESEARCH space and get it
FOR THE ACADEMIC YEAR 2016 -17 attested by Principal
Full time Part time Programme Applied for: Ph.D. M.Sc.(Engg)
/ Head of College /
University last
attended or a
Gazetted Officer
Research Centre applied for: VTU-RC VTU-R&D VTU-RRC

Faculty Applied for : Engineering Architecture Science Management Studies

Category : GM SC ST CAT-I Physically Challenged Others

Male Female

Name: ......Date of Birth:....

Fathers Name:..
Academic Qualification:
Programme Degree University Regular / Specialization % Marks obtained Year of
obtained Distance with Class passing
UG
PG
Others if any

No. of years of experience: Industry: Teaching: Research:

Number of Research papers: Patents: Awards:

Topic of Research proposed:

Proposed course work

Sl.No. Subject Code Subject Title
1 14PHDRM Research Methodology
2
3
4
5
6
Research Centre
1. VTU-RC: .Department:....Recognized: Yes No
2. VTU-R&D: Department:.....Recognized: Yes No
3. VTU-RRC: Belagavi. Department...
Application and Processing Fee Details: D.D. for `. 800/- No.:Drawn on Bank...date:.
Applicants Address for correspondence
.

.
Phone/Cell No..
Information of the Supervisor email_id: ..
Information of the Supervisor

Name: Date of Birth...

 Affiliation : Department:

DesignationArea of Research

Academic Qualification:
Programme Degree University Regular / Specialization % Marks obtained Year of
obtained Distance with Class passing
UG
PG
Ph.D.
Others if any
No. of Publications in the preceding 5 years:
Research papers: 1. National Journal communicated: 1. National Journal
2. International Journal 1. 2. International Journal
Conference: Technical Reports: Book: Patents: Awards:
No. of students Supervising:

Specify Whether
Programme Year of whether acting Area of Final Thesis
University Category
Sl. Name of the Please tick () registration as Supervisor Specialization Submitted
No. Candidate/s or (Y/N)
Co Supervisor
Ph.D. M.Sc.
(Engg)
1
2
3
4
5
6
7
8
Total

Undertaking from the Supervisor

I, is a permanent faculty /employee working as . in the
Department of . in the organisation .......and is aged
less than 65 years as on the date of admission notification, hereby certify that the candidate Mr./Mrs...
.registering for ..... degree under VTU is not my son/daughter/immediate blood relative and the total number of
candidates registered under me in VTU and other Universities for both Ph.D. & M.Sc. (Engg.) by Research taken together excluding presently
applied candidates is (in Words) The information provided above is true to the best of my knowledge.
Date:
Place:
Signature : _________________________________________

Forwarded by ,...

Date: Signature of the Principal/Director/Head of the Research Centre with Seal

 Information of the Co-Supervisor( if applicable)

Name: .Date of Birth...

Affiliation: . .. Department:

DesignationArea of Research

Academic Qualification:
Programme Degree University Regular / Specialization % Marks obtained Year of
obtained Distance with Class passing
UG
PG
Ph.D.
Others if any
No. of Publications in the preceding 5 years:
Research papers: 1. National Journal communicated: 1. National Journal
2. International Journal 1. 2. International Journal
Conference: Technical Reports: Book: Patents: Awards:
No. of students Supervising:

Whether
Specify
Final
Programme Year of whether Area of
University Category Thesis
Sl. Name of the Please tick () registration acting as Specialization
Submitted
No. Candidate/s Supervisor or
(Y/N)
Co Supervisor
Ph.D. M.Sc.
(Engg)
1
2
3
4
5
6
7
8
Total

Undertaking from the Co-Supervisor

I, is a permanent faculty /employee working as . in the
Department of . in the organisation .......and is aged
less than 65 years as on the date of admission notification hereby certify that the candidate Mr./Mrs...
.registering for ..... degree under VTU is not my son/daughter/immediate blood relative and the total number of
candidates registered under me in VTU and other Universities for both Ph.D. & M.Sc. (Engg.) by Research taken together excluding presently
applied candidates is (in Words). The information provided above is true to the best of my knowledge.
Date:
Place:
Signature : _________________________________________
Forwarded by ,...

Date: Signature of the Principal/Director/Head of the Research Centre with Seal

Undertaking by Supervisor / Co-Supervisor *(in case Co-Supervisor is opted)
I / We have no objection in guiding the said candidate in the proposed area of research at the designated Research
Centre. If for any reason, myself /candidate change the Research Centre, I /we will inform the same to the University
without fail.

Signature of Co-Supervisor Signature of the Supervisor

Signature of the Head of the Institution where the research work is proposed:.

No Objection Certificate of the Organisation

This is to certify that the Organisation has no objection in recommending the candidature of our
employeefor carrying out research for his/her Ph.D./ M.Sc. (Engg.) by research
at .... on part
time / full time basis. The information provided by the candidate is found correct as per our records.

Signature of the Principal/Head with Seal.

Employment Certificate of the Supervisor

This is to certify that Dr. presently working in the capacity

ofin the Department of... is a full time employee of
our Organisation, since..

Organisation: Seal and Signature of the

Head of the Organisation

Employment Certificate of the Co-Supervisor (in case Co-Supervisor is opted)

This is to certify that Dr presently working in the capacity

ofin the Department of... is a full time employee of
our Organisation, since..

Organisation: .. Seal and Signature of the

Head of the Organisation

Supervisors Address for correspondence

.
.

Phone No.. email_id: ..

 Co-Supervisors Address for correspondence

Enclose attested copies of the following, before sending the application :

1. Detailed Bio-data of the Candidate, Supervisor 8. Any other additional Certificates supporting your claim
(and Co-Supervisor, if applicable) for benefits like:
Medical Certificate for the degree of disability in
2. UG and PG degree Certificates and Marks cards of the support of candidates claiming benefit
Candidate Test Score Card along with Admission ticket in
support of clearance of UGC-CSIR ,JRF.
3. UG, PG and PhD Degree Certificates of the In case candidate/Supervisors are possessing
Supervisor/Co-supervisor degree from Foreign Universities, The Equivalence
Certificate issued by the Association of Indian
4. Category certificate of candidates belonging to SC/ST/Cat- Universities( AIU)
I/ and any other if applicable Passport with Visa in the case of Foreign candidates
5. Synopsis of the proposed research

6. Syllabus of the Course work chosen for the present study

7.
Demand Draft of `.800 drawn in favour of The Finance
Officer, VTU, Belagavi towards Application and Processing
fee

Ph.D./M.Sc.(Engg)

Name of the Applicant:

Name of the Supervisor : .....

Name of the Co-Supervisor:.

Research Centre(VTU-RC/VTU-RRC):...

Programme:..

Mobile No: Phone ..

 VISVESVARAYA TECHNOLOGICAL UNIVERSITY Application No.
Jnana sangama
Belagavi-590 018, Karnataka, India

APPLICATION FORM FOR VTU RESEARCH APTITUDE TEST (VRAT)

Note:
1. This Form should be filled by all the candidates irrespective of their eligibility to be exempted from the VRAT as
such an exemption is subject to a thorough scrutiny of supporting documents satisfactorily provided by the candidate
along with this Application
For those having validity
Test Centre Code: Bengaluru Belagavi Kalaburagi None of VTU Tech. Aptitude Test

Programme Stream Applied for:

1. Mechanical Engineering 7. Bio-Technology 13. Maths
2. Computer Science Engineering 8. Polymer Science 14. Physics.
3. Electrical Engineering 9. Silk Technology 15. Chemistry
4. Civil Engineering 10. Textile 16. Management Studies
5. Environmental Engineering 11. Chemical 17. Computer Applications
6 . Architecture. 12. Geology 18. Library Science 1 17.
Statistics 19. Physical Education
20 Nano Technology
Educational Qualification which makes you eligible for the Programme
Program Degree Awarded Specialisation Percentage of Specify Regular or Distance
Marks/CGPA with Education
Class
UG
PG

Nationality: Indian Others (NRI/FN/PIO): Gender: Male Female

Category: General SC ST Cat-1 OBC Any Other.

Whether Physically challenged Yes No : If Yes, Nature of disability:....

To be filled by candidates For Office Use only Paste ( do not pin )

Seat No.:
passport size
Name: photograph in this
space and get it
attested by
Address. Principal / Head of
College / University

Specify the status of VTU TAT: Cleared in July 2010 Cleared in Jan 2011 Cleared in last attended or a
July 2011
Gazetted Officer
Write the TAT Seat No.
.......................................
National Test qualified with valid score Date of VRAT:
.
Programme
Are you a facultyapplied
under for:
QIP/FIP: Yes No Test Centre:
Address for correspondence: Reporting Time:
.. Candidates Signature
 Exemption from VRAT
The following categories of candidates will be exempted from appearing at the VRAT:
(a) Faculty Members under QIP / FIP and
(b) Candidates qualified in UGC-CSIR ,JRF.

If you possess VTU -VRAT validity, then provide Seat No :...

Declaration by the Candidate

I hereby acknowledge that all the information given

by me are true to the best of my knowledge. In the event of any information being found incorrect or
misleading, my candidature shall be liable to cancellation by the University at any time and I shall not be
entitled for refund of any fee paid by me to the University. I have carefully studied the Regulations(Amended)
Governing the Degree of Doctor of Philosophy (Ph.D.)-2014 framed under Section 32 of VTU Act 1994.

Date: Signature of the Candidate

Visit www.vtu.ac.in for Recognized Research Centres, Fee Structure and Syllabus for VRAT.