K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in
Application Form for Admission into Ph.D. Program
(Read important points available at the end of this application and also
Appendix-A which details all rules and regulations)
Tick the Appropriate from following options
□Long standing □ Re-Registration □
Industrial □ Research Organization □
Mode of registration: Full Time □ / Part Time □
Applicant Category: Regular
Passport Size Photo
Application Fee
DD/Pay Order
Num/ Cash
receipt Num
Bank Name
Branch Name
Amount
Paid
1. Name of the candidate :
First Name-Middle Name-Last Name
□□/□□/□□
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2. Date of Birth(DD/MM/YY) :
3. Gender : Male/Female:
4. Father’s / Husband’s Name :
5. Nationality :
□□□□□□□□□□□□
6. Address for communication
D.No :
Flat No:
Name of the Apartment:
Name of the Street:
Name of the City :
District:
K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in
State:
Pin Code:
Email ID:
Phone
(with
STD/ISD
codes)/ Mobile No’s:
7. Educational details (Up-to latest degree obtained) :
Srl
No
Qualification
1
Xth class
2
XIIth Class
3
UG-1
4
UG-2
5
PG-1
6
PG-2
Specialization/
Major
Name of the
University
Year of
Passing
Percentage /
CGPA
8. Details of Teaching/Industrial Experience :
Designation
S.No.
Name of the
Organization
Period
From
MM/YY
To
MM/YY
1
2
3
4
Total Experience
9. Research Discipline /(s) in which Registration is desired
Dicipline-1(Code)
Dicipline-2 (Code)
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in case of Inter-discipline
Refer to Annexure-A for the Code Numbers
Total Duration
In Months
K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in
10. Details of Honor(s) / Ranks if any:
S.No.
Type of Rank
Rank
Obtained
Institution Awarded
Year
Obtained
1
2
3
4
5
11. Details of Internships in Industry / Academia if any:
S.No.
Name of the Industry /
Institution
Duration of internship
From
MM/YY
To
MM/YY
Total duration
Months
1
2
3
4
12. Details of Membership(s) in Professional Bodies if any :
S.No.
Name of the Body
Type of Membership
(AM/LM/Fellow etc)
Nature of
Membership
(Annual / Five Years
/ Life Time)
13. Details of Research Publications in the proposed research area:
Number of Publications:
International Journals
International Conferences
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□□□
□□□
National Conferences □□□
National Journals:
K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in
Details of Publications:
Journals:
S.No.
Title of the paper
Name of the Journal
Vol No. Month
&
& Issue Year
of
No.
Publication
1
2
3
4
5
Conferences:
S.No.
Title of the paper
Name
of
Conference
the Name
of
the Month
Organizing Body
&
Year
1
2
3
4
5
14. Details of Research Projects carried / Associated with (if any):
S.No.
1
2
3
4
5
Title of the Project
Funding Body
Nature
Association
of
K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in
15.
Proposed Area of Research
16. Title of the Research
17. Proposed Plan of Research work with its scope (Please attach a write-up with
phase wise plan: The research plan must be submitted as per Annexure-C
18. Status of the research work if being carried already: Should be submitted as
per Annexure-D
Signature of the Candidate
K L University
Vaddeswaram, Green Fields, Guntur District
Ph: 08645246948, http:// www.kluniversity.in
Instructions to the Candidates
Important Points to Note before filling the Application Form:
1. The candidate opting for full time Program must give their Research director/ co-director choice from the Existing faculty on rolls of K L E F University. The research area of the applicant must be same as the focus area of
the Research director.
2. Please attach No objection Certificate from the Present Employer in case of
Part time program (Annexure-E). No objection Certificate is not required
in case of K L University candidate
3. Please attach a cancellation letter addressed to the university at which the
registration is made if Re-Registration is sought (Annexure-AI)
4. Please attach the attested copies of all your certificates starting from SSC.
5. Enclose the DD of Rs.800/- towards application fee.
6. Enclose the Proofs for Teaching Experience for Part time program.
7. In case of part-time program attach a Letter from Head of Institution expressing the willingness to extend the infrastructural and lab facilities for
undertaking the Ph.D program.
8. Mention your name and phone number on the back side of the DD.