/
Office Reference No.

ANNA UNIVERSITY: CHENNAI 600 025

APPLICATION FOR ADMISSION TO RESEARCH PROGRAMMES - JULY- 2006


Tick whichever is applicable

1. Name (with initials at the end) :

2. Sex : Male/ Female 3. Nationality: Indian/ Foreign

4. If foreign national: country______Passport No.______

5. Social Status: OC/BC/MBC/DNC/SC/ST 6. Community ______

7. Age & Date of Birth: ______8. Marital Status: Married/ Unmarried

9. Email Address :

10. Address :

Office address
Designation ______Organization ______
Place ______
Taluk/ Dt./State ______
______ /
Residential address
______
______
______
______
______

11. Category applied for : (Tick appropriate box, after referring Instructions)

Full Time / Part Time
Regular Faculty of all
A.U Colleges / Part Time
Project Staff of recognized depts. of A.U.Colleges / Part Time
Industry/ Research Organization

12. Details of current employment (if applicable)

Name & address of employer:

Nature of employment: Regular/Approved Probationer/ Probationer/ Consolidated pay/ Contract/

Visiting nature/ Part Time/ temporary

Scale of Pay: ______working since date ______

(Certificate from employer to be attached)

13. Details of employment in project (if applicable)

Title of Project : ______

Funding Agency : ______

Pay : ______working since date ______Expiry date of Project______

(Copy of the project appointment order to be attached)

14. Academic Background :

(Start with the latest degree obtained)

* Candidates with PG Degree other than the Universities listed in the annexure-III have to obtain course equivalency from the Director (Academic Courses), Anna University and submit the same at the time of interview.

(Enclose copies of Degree / Diploma Certificates duly attested – see Clause 8.0 of Information to Candidates)

Sl
No / Degree /
Diploma / Year of
Passing / College / University
* / Major
Discipline / Specialization / Class
Obtained / % of Marks /
CGPA / Regular
Course /
Others
1.
2.
3.
4.

15. Professional Experience (Start from the present employment) :

Organisation

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

16. Awards, Medals, Prizes and Honours Conferred (if any) :

17. Major Area for Ph.D. / M.S. Degree Programme :

18. Tentative Topic of research (Attach one-page write-up :

of proposed research, with candidate’s signature)

19. i) College in which the candidate proposes to register :

ii) Department in which the candidate proposes to register :

iii) Faculty of the Department (to be ascertained with U.G/P.G for

M.S / Ph.D and Annexure-II) :

(See Annexure - I & II in Instructions)

20. Name, Designation and address of the proposed Supervisor/ Joint Supervisor (Optional)

a)  Supervisor (within the recognized departments of this University

-Refer http://www.annauniv.edu/research) :

b)  Joint Supervisor (applicable for candidates from industry / research

Organisations) :

21. D.D.Particulars

Name of the Bank & Branch / Demand Draft No / Date / Amount

DECLARATION OF THE CANDIDATE

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

and belief. I am aware that any wrong information or suppression of information and facts may result in punitive

action in addition to cancellation of my candidature for the M.S.(By Research) / Ph.D. admission.

Place :

Date : Signature of the candidate

CERTIFICATE FROM THE ORGANISATION WHERE THE CANDIDATE IS EMPLOYED

Certified that Mr./Ms./Mrs.______is employed as

(Designation)______in the (Department/Division Name) ______

of (Institution Name)______

We have no objection in forwarding his/her application for the M.S.(By Research) / Ph.D. Research Programme

On Full Time.

* The candidate will be sanctioned leave for the duration of the research programme and will be relieved from

duty from ______to ______to undertake the research work in the University/College for

full time study.

Or

On Part Time

** The candidate will be permitted to undertake part time study in the University/College and will be allowed to

be present for discussions with the supervisor, attending course works, conduct of experiments and participations in

seminars and related presentations. Further the required facilities at our organisation will also be provided to the

candidate for doing research.

(Note: Choose the appropriate * / ** marks)

Date : Signature of the Head of organisation with office seal

CONSENT OF THE SUPERVISOR / JOINT SUPERVISOR (OPTIONAL)

SUPERVISOR / JOINT SUPERVISOR
Name
Designation
Department
College / Organisation Address
Date of Birth
University Ref.No.
& Recognised Area of Research
No.of Research Scholars
As on Date
As Supervisor / Ph.D M.S / Ph.D M.S
As Joint Supervisor
Signature
Office Ref.No. /

Course

/ Ph.D. / M.S.

DATA SHEET FOR Ph.D./M.S. ADMISSION

(TO BE FILLED BY CANDIDATES – ALL LETTERS SHOULD BE IN CAPITAL LETTERS)

1. NAME

(Initials at the end)

2. Date of Birth / 3. Sex / M / F / 4. Nationality / Indian / Foreign
5. Community / SC / ST / BC / MBC/DNC / OC
6. Social Status / Married / Unmarried
7. E. mail I.D.

7. B.Tech./B.E./B.Sc.(Engg.)/AMIE. / Etc.

Major:
Year of Passing / Percentage of Marks/CGPA / Mode of Study / R / O
University

8. M.Tech./M.E./M.Sc.(Engg.)/M.Sc./M.S.(By Research)/M.A./M.B.A./M.C.A., Etc.

Major:
Year of Passing / Percentage of Marks/CGPA / Mode of Study / R / O
University
9. Employed / Yes / No / (If Yes, provide Office address with designation (or) If no, provide Residential address)
10. Category Applied for / Full time / Part time
If Part time / College / Organisation / Staff / TRA / Contract / Project
11. Proposed Department for Research and Institution address
12. Supervisor Name, Designation & Address
13. Area of Research (Topic)

R – Regular O – Others SIGNATURE

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