ANNEXURE-I
Faculty of Science & Technology
Registration fee: Rs. 2500/-
Subject: Environmental Science
RASHTRASANT TUKADOJI MAHARAJ NAGPUR UNIVERSITY
“(Established by Government of Central Provinces Education Department by Notification No. 513 dated the 1st of August, 1923 & presently a State
University governed by Maharashtra Public Universities Act, 2016.(Mah. Act. No. VI of 2017))”
APPLICATION FORM FOR REGISTRATION AS A RESEARCH SCHOLAR FOR THE DEGEREE OF DOCTOR OF
PHILOSOPHY IN THE Faculty of Science & Technology SUBJECT Environmental Science
This form must be submitted to the Director, Board of Examinations and Evaluation, Rashtrasant Tukadoji Maharaj
Nagpur University, through the Supervisor and Head of Place of Research where proposed research is carried out, so as to
reach on or before 13/12/2023.
Registration No. : PHDRG202303582403
To,
The Director, Board of Examinations& Evaluation,
Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur.
Sir/Madam,
I hereby apply for being registered as a research scholar for the degree of Doctor of Philosophy (Ph.D.) Full Time in
the Faculty of Science & Technology Subject Environmental Science of the Rashtrasant Tukadoji Maharaj Nagpur University,
Nagpur, as Full Time research scholar as per the DIRECTION NO. 11/2023
The required Registration fee of Rs.2500/- (Two Thousand five hundred rupees) has been paid in the University account
on date 11-12-2023 vide receipt No.RTMNU/OLR/2019-20/PHD/403. (A copy of the receipt is enclosed herewith)
*Pre -Ph.D. Coursework of minimum 06 Credit points Completed letter no. & Date : SMM/1580/23 & 2023-11-25
*Research Advisory Committee Supervisor allotment letter no. & Date : SMM/1592/23 & 2023-11-25
A) PERSONAL DETAILS :
1)a. Name in Full
First Name: Ekta
Middle Name: Dinesh
Surname Khairkar
b)Maiden Name(In case of married women)
First name
Middle Name
Surname
2) Mother Name: Kalpana D. Khairkar
3) Father/Husband Name: Dinesh N. Khairkar
4) Date Of Birth: 14/09/2000
In words: Fourteen September two thousand
5) Aadhar Number: 788782692206
6) Permanent Address:
7) Address for Correspondence : Falke Regency, near lokmanya school, abhayankar ward, warora, Chandrapur
Phone/Mobile No.: 9518566119
Email Id: ektakhairkar@gmail.com
8) Marital Status(Married/Single): Single
9) Religion: Buddhist
10) Nationality: Indian
11) Caste: Mahar
12) (a)Whether Belong to Backward
Class(Yes/ No): Yes
b)If Yes SC/ST/OBC/VJ/NT/SBC
Specify Category: SC
13) Mother Tongue: Marathi
Languages Known: English,Hindi,Marathi
14) Name of the University from where
qualifying degree has been obtained: Rastrasant Tukdoji Maharaj Nagpur University, Nagpur
15) College last attended: Sevadal Mahila Mahavidyalaya, Nagpur
16) Enrollment Number, if passed
from R.T.M. Nagpur University: 2021016600534812
B) DETAILS OF EXAMINATIONS PASSED :
Examination Year of Obtained Maximum
Board/University Subject offered Division %/Grade
Passed Passing Marks Marks
Maharashtra State Board of
First
Secondary and Higher Secondary 2018 420 650 64.62
Class
Education, Pune
Environmental
Bachelor's of First
Gondwana University, Gadchiroli 2021 Science, Chemistry, 2700 3600 75.00
Science Class
Microbiology
Master's of Rastrasant Tukdoji Maharaj First
2023 Environmental Science 528 625 84.48
Science Nagpur University, Nagpur Class
C) EMPLOYMENT STATUS :
17) Are you employeed (Yes/No): No
(a) Designation:
(b) Address of office:
(c) If Candidate are Employed NOC/Study Leave Certificate from
Employer are to be Submited:
D) INFORMATION ABOUT PROPOSED RESEARCH :
18) Subject(Relating to the Board of Studies): Environmental Science
19) Topic of Research: The Study and Application of Electro-Coagulation Technique for the
Removal of Fluorides and Heavy Metals in Drinking Water of Chandrapur District.
20) Name and address of the College/Department/ Institution
where the proposed research is to be carried out:Sevadal Mahila Mahavidyalaya, Nagpur
Mobile. No. 7122705037 E-mail sevamahilamv@gmail.com
21) Date & Letter number of Recognition of place of Research
issued by university RTMNU/CDS/2019/4908 Dated: 09/04/2018
22) Name, designation and College/Dept./Institute address of the allotted Supervisor
under whose supervision the proposed research is to be prosecuted
Name of the Guide: Dr. Pravin Ulhas Meshram
Designation of the Guide: Professor
Address of the Guide: Sevadal Mahila Mahavidyalaya and Research Academy, Sakkardhara Square, Nagpur
Mobile no :9890432005 EmailPravin2668@rediffmail.com
Note : University approval letter of Professor / Associate Professor / Assistant
Professor should be attached with this application form.
23) Number of candidate already registered working under Supervisor : 2
24) #Date of Retirement of Supervisor/Co-Supervisor : 08/31/2028
(Direction no. 11 of 2023 (9) (B) Allotment of Supervisor (7) : Supervisors with less than three years of service before
superannuation shall not be allowed to take new research scholars under their supervision.)
25) Date & Letter number of Recognition of Supervisor issued by university: No.Acad./Recog./Guide./Sci/2305 , Date:
Jan. 3, 2005
E) Name of examination with Year of passing & Marks/Percentage :
26) Whether the Ph.D. Entrance Test passed which was conducted by the University passed: Yes
If yes please give details: :
(a) Roll Number/ year : 60372
(b) Marks obtained: 75
27) Whether the candidate is exempted from PET Examination(Yes/No): No
If yes, please give details (Attached relevant documents also) :
Year of
Name of Examination Marks/Percentage
Passing
UGC-NET(including JRF)
UGC-CSIR NET(including JRF)
SLET
GATE
GPAT
DST-Inspire
SET
TEACHER fellowship holder
Central Govt. apex body holder
Passed M.Phil program (admitted through entrance test) in the concerned subject from any
Statutory University- Attached the copy of Entrance Test Pass Certificate)
Foreign/ NRI candidates who have obtained master’s degree with at least 55% marks or
equivalent CGPA (6.0) and passed PET examination conducted by the University
Candidate already possessing Ph. D. degree in any discipline from any statutory university shall
also be exempted from PET.
Candidate who have cleared PET examination in the past shall also considered eligible for
admission to Ph. D. programe. (Attached the PET examination Passed Certificate)
F] List of Documents enclosed :
Sr.NoDocument Yes/No
1 Receipt of Payment Yes
2 UG marksheet & UG Degree Yes
3 PG marksheet & PG Degree Yes
4 Score card of PET examination Yes
5 PET exemption documents No
6 Report of Research Advisory Committee Yes
7 Approval/ Renewal of place of research issued from University Yes
8 Pre Ph. D Course work Certificate (Minimum Six Credits) Yes
9 Designation certificate/Date of Retirement certificate of Supervisor from Head of Research Centre.Yes
10 Caste & Caste Validity certificate No
11 Original Eligibility certificate, other than R T M Nagpur university candidate No
12 Copy of Supervisor Recognition letter Yes
13 Residence Certificate other than R T M Nagpur University (Full time mode candidate) No
14 No objection Certificate from the Employer No
15 Synopsis (No. of Copies -05) Yes
Place: Warora
Date: 11/12/2023
(Signature of Candidate) (Signature of the Supervisor/Co-Supervisor)
G)Instructions
1) Attested True copies of the Marklist/Degree(with verification certification) certificate must be attached.
2) Candidate who has passed the qualifying examination from any University other than Rashtrasant Tukadoji Maharaj Nagpur
University, Nagpur should submit an original eligibility certificate from Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur.
3) If the Candidate belonging to the Backward Community, copy of caste/validity certificate must be enclosed.(wherever is
essential a copy of Non-creamy layer certificate is also enclosed)
4)Incomplete application will be rejected under any circumstances.
H) UNDERTAKING :
I promise to abide by the provisions of Directions, rules and regulations issued in this regard from time to time and discipline of
the University and read the above mentined instructions carefully.
(Signature of the Candidate)
I) ENDORSEMENT OF THE SUPERVISOR :
1) I am willing to supervise the research work of the applicant. The proposed subject of research and the outline enclosed
herewith have my approval.
2) The subject of research refers to the Board of Studies in Environmental Science in the Faculty of Science & Technology
3) The number & name of students already registered to work under my supervision as below : 2
Sr.NoName of Student Date Of RegistrationPlace Of Research Name of UniversityRemarks
1 Savi Shende 08/05/2019 Sevadal Mahila Mahavidyalaya, NagpurRTMNU, Nagpur
2 Shreya D. Indurkar08/03/2022 Sevadal Mahila Mahavidyalaya, NagpurRTMNU, Nagpur
3
4
5
6
7
8
4) I have been recognized as a research supervisor by the University vide letter No .No.Acad./Recog./Guide./Sci/2305 , Date:
Jan. 3, 2005
(Signature of the Supervisor/Co-Supervisor)
J) ENDORSEMENT OF THE HEAD OF PLACE OF RESEARCH:
Forwarded and recommended. Necessary facilities available in this Department/Institution/College will be provided to the
applicant.
Sr.NoName of Subject Sanctioned Intake for Ph. D.Student already registeredSeats are vacant
Environmental Science10 11 0
Date :2023/12/11 Head of the Place of Research
