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2024 NICHE BRDC PhD Interview Application Form -14

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anusha n
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34 views

2024 NICHE BRDC PhD Interview Application Form -14

Uploaded by

anusha n
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BOARD OF RESEARCH, DEVELOPMENT & CONSULTANCY (BRDC)

Phone + (91) 4651-250462, Website: www.niuniv.com, E-mail: dir-


NICHE/R&D/02 10 00/2024 [email protected]

APPLICATION FOR ADMISSION TO RESEARCH PROGRAMME

1. Name of the Applicant : Mr./Ms. Affix Photo


(Block Letters with Initials at the End)
2. Category Applied :
Full Time Part Time ( Internal) Part Time (External)

(Tick Appropriate Box, after Referring NICHE Ph.D. Rules and Regulations)

3. Age & Date of Birth :


4. Gender : Male / Female
5. Department :
6. Father’s Name :
7. Occupation of the Father :
8. Mother’s Name :
9. Occupation of the Mother :
10. Nationality : Indian / Foreign
11. Social Status : ST / SC / MBC/OBC / BC / OC / General/Others
(Attach Attested Xerox Copy)
12. Religion & Caste :
13. Marital Status : Married/Unmarried
14. Whether Applied Previously:
15. Address :
Address for Communication Permanent Address
Door Number : ---------------------------------------- Door Number : ---------------------------------------
Town/Village : ---------------------------------------- Town/Village : --------------------------------------
Street : ---------------------------------------- Street : ---------------------------------------
District : --------------------------------------- District : ---------------------------------------
State : --------------------------------------- State : ---------------------------------------
Pin/Zip : --------------------------------------- Pin/Zip : ---------------------------------------
Email ID : ---------------------------------------- Email ID : ---------------------------------------
Cell Number : +(91)--------------------------------- Cell Number : +(91)---------------------------------
Telephone Number: Telephone Number :
+(91)--------------------------------- +(91)---------------------------------
(with STD Code) (with STD Code)

1
16. Educational Qualification:
(Attach Attested Xerox Copies)
Sl. Examination Specialization/ Year of Percentage/CGPA/
University/Institute Class/ Division
No. Passed Subjects/Discipline Passing Equivalent
1. HS (10 Level)

2. HSc (10=2 Level)

BA/BSc/BE/BTech/
3.
BBA/BCA
MA/MSc/MBA/
4,
MCA/

5. Others

17. Either of NET/SLET or GATE Information is Required:


a. Performance in NET/SLET:
i. Discipline: ii. Year of Examination:
b. Performance in GATE :
Sl. No. Discipline Year of Examination Score Percentile AIR (All India Rank) Validity
1.

2.

18. Experience, If Any, of Service and/or Research including Present Position Held:
(Start From the Present Employment)
Organization/Name and Address of Nature of Period Salary Draw
Sl. No. Designation
Employer Work From To (in INR)

NOTE: Please fill the current month and year in "DateTo" field, if you are continuing with a position/service.

19. Area of Research (Broad) :

20. Title of the Proposed Topic :


(Enclose a One Page Write-Up)
21. Details of Supervisor :
Name of the Supervisor Designation Official Address Signature

22. Joint Supervisor / Research Advisor (If Identified):


Name of the Joint Supervisor Designation Official Address Signature

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23. Publication in Referred Journals (If Any):
a. Papers Published in National / International Journals: (Attach Photocopy of First and Last Page of Paper)
Name, Volume,
Sl. Page No.
Title of Paper Author(s) Number/Issue, Year of
No.
Publication From To

Note: Attach Separate Sheet If Required)

b. Papers Presented in National/International Conferences (Attach Photocopy of First and Last Page of Paper)

Sl. No. Title of the Paper Author(s) Name of the Conference Venue & Date

Note: Attach Separate Sheet If Required)

23. Fellowship/Membership of Professional Bodies: (Attach Photocopies for Proof)

Sl. No. Name of Professional Body Grade of Membership Membership Number

DECLARATION
“I hereby declare that the entries in this form are true to the best of my knowledge and belief.
If they are found to be incorrect at any time after admission, my admission can be
automatically cancelled without any reference to me. Further, if selected, I will abide by the
rules and regulations of the University and also the directions given to me from time to time”.

Station:
Date: Signature of the Candidate

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NO OBJECTION CERTIFICATE
(For Ph.D. Part-Time Registration Only)

This is to certify that Mr. /Mrs. ………………………………………….is serving at


…………………..…………………………………….……………………..………………….
from…….……...……onwards, as ...................................................................................... in
………………….………………………… department. We have no objection on him/her to
join part-time research during the academic year……………………… at Noorul Islam
Centre for Higher Education, Kumaracoil in the discipline/department/faculty of
…........................................................ without financial commitment to the institution where
he/ she is working and without detriment to his normal duty.

Place:
Date: Name and Signature of Head of the Institution

Office Seal:

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