CHAROTAR UNIVERSITY OF SCIENCE AND TECHNOLOGY

CHARUSAT CAMPUS, Changa 388 421. Anand District. Gujarat

Ph# 91-2697-247500 , 248133 Fax # +91-2697-247100
E-mail: admissions.phd@charusat.ac.in Web: www.charusat.ac.in

Ph.D. Application Form

Note: Only one application form can be submitted per candidate

Ph. D. Programme type :

Ph. D. Programme under :

Full time
Part-time
Faculty of ________________________________________
Department :______________________________________

Research Area
1.
2.

________________________________________________________

Paste (do not pin)

passport size
photograph in this
space and get it
attested by
Principal/Head of
College/ University
last attended or a
Gazetted Officer

Name in full (as in qualifying degree certificate): _______________________________________________

Address for Correspondence: _____________________________________________________________
______________________________________________________________________________________
__________________________________________________________ Pin ________________________
Email: ________________________________________________________________________________
Telephone: ______________________ Mobile: _______________________________________________

3.

Date of Birth (DD-MM-YYYY) (Please attach proof of age):

4.

Fathers Name : _________________________________________ Mothers Name: ________________

5.
7.
8.

Gender :
Male
Female
6.
Marital Status: _______________________________
Whether you belong to
SC
ST
OBC or
Other categories
Qualifying Degree: ______________________________________________________________________
University _____________________________________________________________________________
Year of Passing _________________________________________________________________________
Aggregate Marks _________% or CGPA ________ out of _______ Class / Grade_______

9.

Details of academic record (Attested copies of mark sheets / certificates to be enclosed)

Examination

Name of the
Examination
Passed

Board /
University

Passing
Year

Subjects

% of
marks or
CGPA

Division
or
Class

Secondary
Higher Secondary
Bachelors Degree
Masters Degree
Other Degrees
(if any)
10.

Whether cleared any National Eligibility Test*?

Yes
No
(* refer Eligibility clause under Guidelines to Admission available on website.)

10 A.

If yes then give the details as under:

Name of Examination

11.

Score/Percentile

Validity Period (if applicable)

Professional Experience / Other achievements / List of Publications if any: (Attach Separate Sheet).

Declaration
I declare that all information provided by me in the application is true to the best of my knowledge and belief. I
understand that I am liable for prosecution if any of the information is found to be false at any time in future.
Signature of the Applicant
Institute No Objection Certificate:
I/We have No Objection if he/she joins Ph. D. Programme as a Part-time Research Scholar at CHARUSAT.
Place: ______________
Date: ____________
Signature & Seal

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