JSS Mahavidyapeetha

JSS Science and Technology University

JSS Technical Institutions campus, Mysuru-570 006, Karnataka-India

APPLICATION FOR ADMISSION TO Ph.D.

1. Name in Full (In Capital Letters)

First Name: Affix Recent

Passport Size
Photo with
Middle Name: Signature

Last Name:

2. Contact Details

(a) Address for Correspondence (b) Permanent Address

Telephone Number(With Mobile Number E-mail Address(s)

STD code)

3. Date of Birth: (as per matriculation or equivalent certificate):

(Attach a self-attested photocopy of the matriculation or equivalent certificate)

4. Gender (M/F/TG)

5. Nationality
 6. Caste/Community

7. Category- please tick any one as applicable: GM/SC/ST/Cat-1/Cat-2A/Cat-2B/Cat-

3A/Cat-3B/PWD (Enclose attested photocopy of the necessary certificate)

8. Details of Academic Records from Matriculation Onwards

(Attach self-attested photocopies of certificates)

Sl. Examination Branch/ Board/College/ Month & % of Marks CGPA Class/ Mode of
No. Passed Subject University/Institute Year of Division Study
Passing (Regular/
Distance/
Open)
9. Whether qualified in UGC/CSIR (NET) (JRF)/SLET/K-SET/GATE for JRF or Teacher
Fellowship? Yes/No (If Yes, Specify the details)

Name of Examination & Score/Percentage Validity Period

Year of passing

10. Research Experience

A. Details of the UG/PG/Any Other Project/Thesis/Dissertation

Name of the Year of Name of the Title
University/Institute Submission Supervisor

B. Total Number of Publications & List of Publications*, if any

(*Attach a separate sheet with details such as title of paper, name of the
author(s), name of Journal/Conference, Page (s) and year of publication)

11. Preferred Mode of Admission (Tick suitable box)

a. Full-Time:

b. Part-Time (Industry):

c. Sponsored Research Candidate / QIP:

12. Application for Ph.D. (Tick suitable box)

12.a Faculty of Engineering and Technology

(Select Department)

Civil Engineering
Environmental Engineering
Mechanical Engineering
Electrical and Electronics Engineering
Electronics and Communication Engineering
Electronics and Instrumentation Engineering
Computer and Information Sciences Engineering
Biotechnology
Polymer Science and Technology

12.b. Faculty of Science

(Select Department)

Physics
Chemistry
Mathematics
Computer Applications

12.c. Faculty of Management Studies

13. Mention Area of Your Research Interest in the Chosen Field of the Subject of Faculty
 14. Professional/Work Experience, if any:
<<

Date/Period
Name of the Organization Designation
From To

15. Awards/ Honors/ Fellowship/ Scholarships (Senior Secondary Onwards)

(Attach self-attested photocopies of the certificates)

16. Place of Entrance Examination Test : JSS STU, Mysuru

17. Particulars of the Entrance Fee (to be paid only through online)
Amount: Rs: 2000.00 (Two Thousand Only)
Bank Details:

A/c Holder JSS SCIENCE AND TECHNOLOGY UNIVERSITY

Bank Name Union Bank of India

Branch Kuvempunagar Branch, JSS STU Extension Counter
A/c No. 554201010050293
IFSC Code UBIN0578916
Branch Code 905844
MICR 570026009

18. Any Other Relevant Information

19. Declaration: I do hereby solemnly declare that the information given above is correct to the best
of my knowledge and belief. I am fully aware that I must submit attested copies of
my qualifying degree certificate / final transcripts, failing which, my admission will
stand canceled. I have read and understood the course details, University norms and
eligibility criteria for admission. I am also aware that providing incorrect
information in the application form can result in the cancellation of my admission at
any stage.

Signature of the Applicant

Place:
Date:

List of enclosures to be enclosed with the application form.

1. A Xerox copy of the entrance fee paid.

2. Two Passport size photographs.
3. Proof of Date of Birth (SSLC/10th Class Certificate or Birth certificate).
4. Marks card of Academic Records from Matriculation onwards for all years.
5. A copy of the Photo identity issued by Central / State Government
(Eg. passport/voters card/pan card/driving license/Aadhar card).
6. Attach No Objection Certificate issued by the sponsoring institution (in the given
below format as applicable).

NOTE: Please submit the filled in application form with relevant documents to the Dean
(Research), JSS Science and Technology University, JSS Technical Institutions Campus, Mysore-
570 006, Karnataka State, India in an envelope (27cmx20cm) without folding the application
materials. The envelope should be marked as “Application for Ph.D. Programme”
 Format

No Objection Certificate

Undertaking by the Sponsoring Company/Industry/QIP Institution

(Employed Candidate)

This is to give our consent for Mr./Mrs.________________________ to register for Ph.D. (Full-time
category) program in the Department of _________________, JSS Science and Technology
University.

It is certified that he/ she has completed ……….. year of service in our
company/organization/institute as a regular employee.

We shall give him/her leave of absence at our company/organization to pursue Ph.D. program
at JSSSTU.

Signature & Date

Name & Designation:

(Head of the Institution with seal)

Format

No Objection Certificate

Undertaking by the Company

(Part-time Candidate - Industry)

This is to give our consent for ________________________ to register for Ph.D. (Under Part-time
category) program in the Department of _________________, JSS Science and Technology
University.

The candidate is permitted to make use of the facility in the Organization/Company to pursue
his/ her Ph.D. research program.

Signature & Date

Name & Designation:
(Head of the Institution with seal)