FORM OF APPLICATION FOR RECOGNITION AS Ph.D. SUPERVISOR 1. Name (in Block Letters) : 2. Designation/Official Address : 3. Date of Birth : 4. Phone No. & E-Mail : 5. Qualifications (start with highest to lowest) : Degree* Name of College / School & Location University

Period attended From To

Area of Specialization

Class / Rank / Percentage

Furnish the details in separate sheet as per the format

* State whether Part time (P) Full time (F) Correspondence (C)

6. i) Total Experience (No. of Years) ** :

Name of Institution & Place

Duration Designation Reasons for Leaving From To

Furnish the details in separate sheet as per the format

** Attach copies of certificates / proof

ii) Teaching Experience (No. of years) :

iii) Practical / Industrial Experience (No. of yrs). :

7. Membership in Professional Societies : 8. Number of Sponsored Research Projects : (as Principal Investigator give details separately)

[Declared as Deemed to-be-University under Sec.3 of the UGC Act, 1956] KARUNYA NAGAR, COIMBATORE 641 114

9. Research Guidance (No. of Thesis guided) (a) Ph.D Thesis :

(b) Master's/M.Phil. Thesis : 10. Publications (Please attach list of publications and reprints of at least two publications published recently in National/International Journals/ refereed Conference Proceedings) (a) Number of papers in Referred Journals

i) National Journals : ii) International Journals :

(b) Number of Papers published in refereed Conference Proceedings : 11. Any other information :

Signature with date Note : All the attachments should bear the candidates signature Encl: (1) List of Publications (2) Reprints

(3) Other Information & Xerox copy of Ph.D. Degree Certificate No-Objection Certificate from the employer (for external candidates only)

I forward the application of our employee Dr . who wish to guide the Research Scholars of Karunya University. Our organization has no objection in guiding Research Scholars of Karunya University by him / her. Name & Designation : Head of the Organisation

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Whether the certificates of the candidate are verified: YES / NO

Remarks : RECOMMENDED / NOT RECOMMENDED

Head of the Department

Director of School

Approved by the Board of Research & Consultancy in its meeting held on ......

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RECOMMENDED AND FORWARDED TO ACADEMIC COUNCIL

DEAN (RESEARCH)