Application form for Ph.D.

  
Instructions
1. PLEASE BRING ORIGINAL AND ATTESTED COPIES OF THE DEGREE CERTIFICATE/ MARKSHEET(S)/EXPERIENCE CERTIFICATES AT THE TIME OF INTERVIEW
2. FILLING OF FALSE INFORMATION MAY LEAD TO CANCELLATION OF ADMISSION
3. Tick (√) the relevant box wherever provided
4. An application which is incomplete in any respect is liable to be rejected
Name*
Gender* Male Female Third Gender
Category
Date of Birth in School leaving certificate*
Nationality*
Father's Name*
Mother's Name*
Blood Group*
RH Factor*
Nominee for insurance*
Relationship with the student*
Full Address*



Correspondance Address



Mobile no*
E-mail* Alternate Contact no:

ACADEMIC RECORD

Name of the qualifying examination: (M.Tech./M.Phil./ M.Sc.)*
Duration of the course
Year of passing
Discipline *
Name of the University/Institute *

Details of Marks/GPA/CGPA secured in the qualifying examination

Exam Passed/Appeared I Semester II Semester
I Year
II Year
III Year
IV Year
Maximum marks of all the years/semesters
Marks secured
Aggregate % of marks (of all the years/semesters)
Total
NB: In case where semester system is not followed, the marks should be indicated in the first part against each year.

# If the programme is not completed, indicate the aggregate marks/grade point obtained so far.

Details of marks secured in the examinations other than qualifying examinations

Main subjects Institute/University Year of passing % of marks/CGPA
10+2
B.Sc.
M.Sc.
B. Tech
Others (specify)

Relevant examination

a. IELTS Appeared   Qualified
Total Band Score
b. GATE Appeared   Qualified
c. CSIR-UGC: JRF/LS/SRF Appeared   Qualified
d. ARS NET Appeared   Qualified
Year appeared
Percentile/Other score :
Discipline chosen in GATE / NET
Awards and scholarships received (if any)
Proposed area of research (Title)

Please fill in the following

1. A brief research proposal stating the rationale for research, relevant literature with identified gaps, key research questions, methodology and references (The proposal can be between 1200 to 1500 words in length) *

2. A statement of purpose indicated why you wish to do a PhD at the TERI-Deakin Nanobiotechology Centre (TDNBC) and how it fits into your career goals. (Maximum 300 words) *
Two referees who are familiar with your academic background and their addresses (Please provide their official contact number and email id) *
a.
b.

EMPLOYMENT RECORD:

Name of Employer(s) Period of Employment Designation & Salary Nature of Duties
Any other relevant information, which you want to furnish
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DECLARATION BY THE APPLICANT:
Submission of this form is construed that he/she abides by the declaration. If selected for admission, I undertake to abide by the rules and regulations of TERI. I certify that the information given above is correct and I am aware that providing incorrect information in the application form may result in the cancellation of admission secured. I am further aware that, if the admission is secured before the results for the qualifying examination are published and if I fail to satisfy the minimum academic requirement for admission when such results become available, the admission will be cancelled.