APPLICATION FORM
Cost of Application Form Rs. 5000/-
GOVERNMENT COLLEGE OF ENGINEERING
(An Autonomous Institute , Govt. of Maharashtra) Station Road, Osmanpura, AURANGABAD-431 005 (M.S)
In Pursuit of Global Competitiveness
Affix Passport size photograph attested by Gazzetted officer
: (0240) 2366160, 2366161, 2366111, 2334348 Fax: (0240) 2332835 E-mail: principalgeca@yahoo.com Website: http://www.geca.ac.in APPLICATION FOR REGISTRATION OF THE Ph.D. DEGREE PROGRAMME IN ENGINEERING / TECHNOLOGY - 2011-12 Discipline: 1. 2. Full Name of Applicant:
(Starting with surname) (Capital letters only)
Correspondence Address:
Permanent address:
Email-ID : Phone / Mobile No: 3. 5. 7. 8. Date of Birth : Nationality: Category & Caste D.D. Details:
Name of Bank & Branch
Email-ID : Phone / Mobile No: 4. SEX ( ) 6. State of Domicile : Male Female
D.D. No. & Date (in chronological order) attach attested photo copies of the same
University / Board Marks Obtained out of % of Marks up to 3rd Decimal
9.
Educational Qualification
Month & Year of Passing
Name of the Examinations (from graduation)
Name & Address of Inst.
10. GATE Score: Year
(if qualified attach photo copy of the score card duly attested)
Discipline
Percentile
11. Experience: (Attach attested certificates if any)
Name of the Organization where Employed Period of Service Designation From To Reason of Leaving Remark
12. Languages / Tools of Computer programming / research known:
13. Area / Specialization in which the research is to be carried out:
(Enclose synopsis mentioning the state of the art)
14. Previous research experience / contribution: (if applicable, enclose duly signed hard copies)
15. Attested Xerox copies of the documents attached with application form. ( ) 1 Mark List of qualifying exam (M.E. / M.Tech. / M.S.) YES / NO P.G. Degree Certificate 2 YES / NO Migration Certificate 3 YES / NO Institute Leaving Certificate 4 YES / NO Employers NOC in prescribed format given below 5 YES / NO Experience certificates 6 YES / NO Caste Certificate YES / NO 7 GATE Score Card (if qualified) 8 YES / NO 16 DECLARATION by the candidate: I, hereby declare that, the information given in the application form is correct to the best of my knowledge and belief. I shall also abide the by rules and regulations of Ph.D. programme. At any stage of prosecution of my research work, if the information is found incorrect, I am aware that my candidature shall be liable for cancellation with immediate effect. Date: Place: Signature of candidate Name For office use only Marks for presentation: Marks for Interview: Marks total: Remark:
Course applied for: GATE Score (if qualified):
Scrutinized by:
Head of the Dept.
NO OBJECTION CERTIFICATE (On letterhead of the Institute /Organization)
Outward No.: Date :
To, The Principal, Govt. College of Engineering, AURANGABAD-431 005 This is to certify that Mr. / Ms ............................................................................................ . are serving in our Organization / Institution as.....................................................
Since..................The Organization / Institution has no objection to join the Ph.D. Course in Engineering at Government College of Engineering, Aurangabad. The Organization / Institution will render all possible help to him / her in persuasion of studies. He / She will be relieved for a requisite period, if selected for the course.
Official SEAL
Signature of Competent Authority Name : Designation:
SPONSORSHIP CERTIFICATE (on letterhead of the Institute / Organization) [For
Sponsored Candidates only] No: Date:
To, The Principal, Govt. College of Engineering, AURANGABAD-431 005 Sub: Sponsoring of an Employee for Ph.D. in................................ Dear Sir, I / We hereby sponsor the candidature of Mr / Mrs / Ms. An employee working in this organization, for undergoing his / her Ph.D. in ... .. Engineering at your Institute as a full time candidate. He / She is working in this organization / Institute since as
.. We shall bear the expenses of his / her studies. We shall relieve him / her for the entire period of his / her Ph.D. course as above to enable him / her to devote full time to studies, In case he /she is selected for the course. Further certified that, during his / her deputation period, the candidate would be paid his / her full salary.
Official SEAL
(Sign of sponsoring authority)
