RAYALASEEMA UNIVERSITY KURNOOL – 518 002 (A.P.)

RAYALASEEMA UNIVERSITY
KURNOOL – 518 002 (A.P.)
Serial No:
Registration No: Application for Entrance Test Affix photograph
and Registation forFull Tme Ph.D/M.Phil.
with attestation
H.T.No:
Please indicate whether you are applying
for Ph.D./M.Phil
(write legibly in the box)
Subject
1. The application for Ph.D., shall be accompanied by the consent of the teacher agreeing to supervise the work (in column 15)
2. All the columns in the application form should be filled up with the candidate’s own handwriting. Applications which are
incomplete in any respect will be summarily rejected.
3. The Hall Ticket proforma should be duly filled in and attested.
4. The Prescribed fee of Rs.500/- is to be deposited with application from by sending a DD in favour of REGISTRAR,
Rayalaseema University payable at Kurnool.
1. Name in Full Surname
(Block Letters)
Name
2. Address for Correspondence: 3. Name and Permanent address of the father/guardian
(Details of guardian only when both parents are not alive).
PIN
PIN
4. Occupation of parent / guardian
and his / her annual income
5. Place and Date of birth Sex
6. Whether the applicant belongs to Scheduled
Caste/Scheduled Tribe/Backward Class
(Group A, B, C, D)/Others
(Authentic Certificate to be enclosed).
M F Place
District
State
7. Previous Institutions where studied
Exam Passed Name of the College /
University
I) Graduation
( )
II) Post Graduation
( )
III) Others
( )
Subject Studied Date of Passing Reg. No. Class
Obtained

8. Whether qualified in National Eligibility Test
(NET/SLET, etc.,) (Enclose Photocopy as proof)
9. The Topic of proposed research
(In consultation with the Research Supervisor)
10. Any other information / Evidence of interest in
Research (Publications, Seminar participation etc.,)[[
11. Whether the applicant already obtained M.Phil degree if so
a) Name of the University awarding the Degree :
b) Duration :
c) Topic :
d) Name of the Supervisor :
12. Marks obtained in the Course/
(Qualifying Examination) : Subject with specialization
Examination
Passed
Date of passing Subjects Marks obtained Maximum Marks Class
Certified that the marks entered above are correct (enclose photocopies of marks)
Station : Signature :
Date : Designation :
(to be certified by a Gazetted Officer)
13. I declare that the particulars above are correct, and that I will, if admitted, abide by all the rules relating to discipline
and such other rules as may be made by the University from time to time. I accept that, if registered for the Ph.D.
degree as a full-time candidate. I will carry out full-time research as per the regulations of the University without
holding any full time job or doing any work for payment.
Station :
Date : Signature of the Applicant
14. I hereby state that I shall undertake to see that my son/daughter/ward obeys all the rules of discipline and residence and
such other rules as may be made by the University from time to time.
Station :
Date : Signature of the Parent/Guardian
15. I agree to supervise the research work of the Mr./Ms. ___________________________________ of the Ph.D/M.Phil.
Degree.
Office Address of the Teacher : Signature of the Teacher :
Name of the Teacher :