IHG
INDIA / FOR OFFICE USE ONLY
Reg. No. / Reg. No.
Application for Admission to a Research Degree Programme
1. Personal details / 2. Further Details
Surname/Family Name / Age
Years / Months
Male (M) Female (F)
Date of Birth
Disability/special needs (refer to Notes for Guidance)
Country of Permanent Residence ______
Country of Birth ______
Nationality ______
If born outside the India
Residential Category (refer to Notes for Guidance)
For teaching related professionals only
For health related professionals only
First Name(s)
Home Address
Postcode
Home contact numbers
(inc. STD/Area Code) / Tel:
Fax:
E-mail:
Correspondence Address (if different)
Postcode
Home contact numbers
(inc. STD/Area Code) / Tel:
Fax:
E-mail:
Previous surname/Family Name
3. Details of Higher Degree for which you wish to apply
Month and Year in which you wish to start:
PhD/Certificate course in Genetics
Please tick (* not available Full-Time ) / PhD-Net / Certificate / PhD Direct / Full-time
Preferred areas of research.
Please be as specific as possible. If it is not possible to be specific, state discipline and general field(s) in which you would like to work
Name of proposed supervisor/contact (if known)
Please indicate how you heard of these courses
4. Details of intended Fee Payment arrangements
i) I will be paying my own tuition fees - Please tick - / Yes / No
ii) I will be in receipt of a grant or scholarship
(please give details) / Yes / No
iii) I will be sponsored by my employer or other organisation
(please give details) / Yes / No
I am a previous student of the University and will be requiring institution fellowship / Yes / No
Previous Course Attended
5. Physical or other disability or medical condition which might necessitate special arrangements or facilities:
6. Qualifications
Applicants should list all qualifications taken, whatever the results, in chronological order.
If you are awaiting the result of any examination recently taken write PENDING in the result column.
Where examinations are still to be taken, please list. Continue on a separate sheet if necessary.
First Degree (please attach a photocopy of the official notification for results known)
Institution / Full Title of Award / From (year) / To ( year) / Grade
Postgraduate Qualifications (please attach a photocopy of the official notification for results known)
Institution / Full Title of Award / From (year) / To ( year) / Grade
Professional Qualifications (please continue on a separate sheet if required)
Institution / Full Title of Award / From (year) / To ( year) / Grade
Other Qualifications including OpenCollege, Access, Foundation, HND, Diploma, Overseas Qualification
(please continue on a separate sheet if necessary)
Type of Qualification / Awarding Body / Month / Year / Subject / Grade
English Language Qualifications
Type of Qualification / Awarding Body / Month / Year / Grade
7. Employment (please indicate your employment experience including any details relevant to the research for which you are applying)
Employer / Nature of Work / Full-time/Part-time / Dates
Present Employer (if any)
Name
Address
Tel. No.
Previous Employers (continue on a separate sheet if necessary)
8. Further Information
Please give a short outline of your project and state here your reasons for wishing to pursue a research degree, and give any details of any other relevant skills including IT and statistical analysis skills, achievements or experience in support of your application. (you may wish to discuss this section with the relevant Departmental Research Degrees Tutor before completion). Continue on a separate sheet if necessary.
8. Further Information (continued)
9. References
Please supply the name and address of the referees to whom you will send the reference form
Your referees should be able to tell about your academic ability, character and your suitability for research work.
1st Referee / 2nd Referee
Name / Name
Address / Address
Occupation / Occupation
Tel. No. / Tel. No.
NB: The reference may accompany this application or be sent to the University separately
10. Previous applications
Give details (with dates) of any previous application, or of correspondence relating to admission to study for a higher degree at this University.
Declaration:I confirm that the information given on this form is true, complete and accurate and no information requested or other significant information has been omitted. I have read the Notes for Guidance for Completion of the Application Form.
Applicant's Signature: ...... Date: ......
Reference
Statement by Referee
Applicants Full Name
Name of Referee
MA/MSc/LLM (by Research) / MPhil / MD / PhD (*delete as applicable)
Post / Occupation / Relationship to applicant
Address
Tel. No (including STD)
Fax. No. (including STD)
Can this reference be discussed with the applicant / Yes / No
Can this reference be revealed to the applicant / Yes / No
Notes for the guidance of referees
In order to select those students who will benefit from their chosen programme of study, the University requires a supporting statement from a referee.
Your reference about the applicant should, if possible, cover the following:
- Suitability for a research degree
- Intellectual qualities including previous academic performance and any relevant subject experience through work or study
- Personal characteristics including evidence of ability to sustain study at the level of their chosen research
- Career aspirations
- How long have you known the applicant
Signed ......
Date ......
(Please affix official stamp where appropriate at end of the statement) / Please Return to: Director
Institute of Human Genetics
FRIGE House
Jodhpur Gam Road
Opp: Subhada colony bus stop
Satellite
Ahmedabad:380015
India
Reference
Statement by Referee
Applicants Full Name
Name of Referee
MA/MSc/LLM (by Research) / MPhil / MD / PhD (*delete as applicable)
Post / Occupation / Relationship to applicant
Address
Tel. No (including STD)
Fax. No. (including STD)
Can this reference be discussed with the applicant / Yes / No
Can this reference be revealed to the applicant / Yes / No
Notes for the guidance of referees
In order to select those students who will benefit from their chosen programme of study, the University requires a supporting statement from a referee.
Your reference about the applicant should, if possible, cover the following:
- Suitability for a research degree
- Intellectual qualities including previous academic performance and any relevant subject experience through work or study
- Personal characteristics including evidence of ability to sustain study at the level of their chosen research
- Career aspirations
- How long have you known the applicant
Signed ......
Date ......
(Please affix official stamp where appropriate at end of the statement) / Please Return to:
Research Administrator
Institute of Human Genetics
FRIGE House
Jodhpur Gam Road
Opp: Subhada colony bus stop
Satellite
Ahmedabad:380015
India