S.No.__________________ APPLICATION FOR M.

PHIL GUIDESHIP TO BE FILLED BY OFFICE ONLY:

Guideship No.

Guideship Subject

Self Attested Photograph of Applicant

Subject Specialization

CONTACT DETAILS:
Name of the Guide: Present Designation: Present Organization: Date of Birth & Age: Permanent Address:

Contact Numbers: Permanent Address:

E-mail ID:

EDUCATIONAL QUALIFICATION:

Degree

University

Year of Completion

Class

Remarks

PhD

M.Phil

Post Graduation

Graduation

PG TEACHING EXPERIENCE:
Name of Organization / College / University Designation From To Total Duration

UG TEACHING EXPERIENCE:
Name of Organization / College / University Designation From To Total Duration

INDUSTRY EXPERIENCE:
Name of Organization / College / University Designation From To Total Duration

RESEARCH EXPERIENCE:
No. of Ph.Ds Award under your Supervision (List and Topics may be given in Annexure - I)

No. of M.Phil awarded (List and Topics may be given in Annexure - II)

No. of Publications (Annexure - III)

No. of Conferences / Seminars / Workshops attended (Annexure - III)

DECLARATION
This is to certify that all the information given above are true to the best of my knowledge and belief. I am willing to guide Mr. / Ms. ________________________________________ for his/her M.Phil course being the selected subject ______________________________ for the registered term__________________________________________________. The rules and regulations of the University, concerning to the courses and relevant matters are fully acceptable to me and will be abided.

Place :_________________ Date:________________

Signature of the Candidate