Ph.D. REGISTRATION FORM
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1 Cost of Application : Rs.1000/- Fill up the details in English in BLOCK LETTERS Put mark wherever applicable For Eligibility Criteria, please visit our website Ph.D. REGISTRATION FORM Application No. Registration No. (To be allotted by the University) Demand Draft in favour of The Registrar, A cademy of M aritime E ducation and T raining, Chennai Website: DD No : Affix recent passport size directorresearchoffice@ametuniv.ac.in photo here Bank Name: Branch : Category(Please Tick) a. Full Time b. Part-Time 1. Name of the Applicant 2. Gender Male Female 3. Official Address for Correspondence (Do not repeat the Name) 4. Residential Address (Do not repeat the Name) 5. Date of Birth D 7. Nationality D M M Y Y Y Y 6. Blood Group 8. Religion 9. Social Status SC/ST/MBC/BC/OBC/OC/PWD 10. Mobile No.of the Candidate: 11. ID... 1
2 12. Are you employed? Yes No If yes, specify the Name and Address of the Employer 13. Salary received per month 14. Academic Background (Start with the latest Degree / Diploma obtained) (Enclose copies of Degree/Diploma Certificates duly self attested)-attach Separate Sheet if necessary Sl. No. 1. Degree/ Diploma Year of Passing University/ Institution Major Discipline Percentage of marks and Class obtained Full-Time (or) Part-Time(or) Distance Education Professional Experience (Start from the present employment)-attach Separate Sheet if necessary Sl.No. 1. Organization Period From To Designation Salary Per Month Nature of Job Awards/Medals/Prizes and Honours conferred if any : 17. Major Area of Ph.D. Research 18. Tentative Topic on which the research is proposed to be conducted 19. School & Department in which the candidate proposes to register 2
3 20. DECLARATION OF THE CANDIDATE This is to certify that the particulars given above, are true, correct and complete to the best of my knowledge and belief. Place: Date: Signature of the candidate 21. PART-TIME REGISTRATION ONLY CERTIFICATE FROM THE HEAD OF THE ORGANIZATION i) The candidate will be permitted to be available at Academy of Maritime Education and Trining for fulfilling the residential requirements, as per the Regulations. ii) The required facilities at our University will be provided to the candidate for doing research. iii) The candidate will be permitted to be available at Academy of Maritime Education and Training, whenever required by the Supervisor to have discussions with him, to attend to the prescribed course works, to conduct experimentsand to participate in Seminars/ Conferences/Workshops/Symposias/Short Term Courses etc... Name of the Research Coordinator (Optional) : Designation : Signature of the Research Coordinator Signature of the Head of the Organization Place : Seal of the Organization : 22. CONSENT OF THE SUPERVISOR / GUIDE (i)supervisor / GUIDE a. Name (in BLOCK LETTERS) b. Address for Communication (i) Official Address (Do not repeat the Name) 3
4 4 (ii) Residential Address (Do not repeat the Name) (iii) Contact Phone Number a) Office (with STD Code) b) Residence (with STD Code) c) Mobile (iv) ID... (v) Website address if any... c) Whether the Supervisor / Guide has been recognized by Academy of Maritime Education and Training to guide research scholars : If yes, University Reference No. d) No. of Ph.D Scholars Supervising (i) As a Supervisor / Guide in Acadeny of Maritime Education and Training : (ii) As a Supervisor / Guide in other Universities : e) Panel of Names suggested for the Doctoral Committee (DC) Members* :(Attach Separate Sheet if necessary) (At least six names, excluding Supervisor, Research Coordinator must be given by the Supervisor / Guide out of six, three from academic institution and three from industry) Sl. No. Name Designation Official Address with Pin Code Area of Specialization & Mobile number * This list is to be provided only after getting the consent from the members mentioned above. If Area of Research, Designation & Address are not provided, properly then University will fix the DC Members.
5 CERTIFIED that the details furnished above have been verified and found to be correct and I am willing to supervise the candidate s research work. Place : Signature of the Supervisor (ii) JOINT - SUPERVISOR (Optional) a. Name (in BLOCK LETTERS) b. No. of Ph.D Scholars Supervising (i) As a Supervisor in Academy of Maritime Education and Training : (ii) As a Joint-Supervisor in Academy of Maritime Education and Training : (iii) As a Supervisor/Joint Supervisor in other Universities : c) Whether the Joint-Supervisor has been recognized by the Academy of Maritime Education and Training to guide. : If yes,reference No. CERTIFIED that I am willing to Supervise the candidate s research work. Place : Signature of the Joint-Supervisor 23. CONSENT OF THE Academy of Maritime Education and Training/HEAD OF THE DEPARTMENT Consent of the Academy of Maritime Education and Training / Head of the Department in which the candidate works: Yes / No (For Part-Time (Internal) candidates only) Place : Signature : Name : Seal School / Department : 24. RECOMMENDATION OF THE DIRECTOR-RESEARCH : Admitted / Not Admitted for Provisional registration in the Ph.D Programme Full-Time / Part-Time (Internal) DIRECTOR - RESEARCH 25. FORWARDED BY REGISTRAR 26. APPROVAL OF THE VICE-CHANCELLOR VICE-CHANCELLOR
6 NOTE: 1. Duration of the Ph.D. programme is Three years. 2. Monthly Fellowship / Stipend of Rs.8000/- will be given to the selected candidates for the Full Time Ph.D programme with fellowship category candidates. 3. Completed Ph.D Registration form with enclosures and demand draft should be sent to The Director - Research Academy of Maritime Education and Training, 135, East Coast Road, Kanathur Chennai, India Tel : / 157 Fax :
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