DRAFT_Applicatin form - Centre for Studies in Social Sciences ...
DRAFT_Applicatin form - Centre for Studies in Social Sciences ...
DRAFT_Applicatin form - Centre for Studies in Social Sciences ...
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CENTRE FOR STUDIES IN SOCIAL SCIENCES, CALCUTTAR-1, BAISHNMABGHATA PATULI TOWNSHIPKOLKATA: 700094Affix a recentpassport sizephotographduly signed bythe applicantToThe Registrar<strong>Centre</strong> For <strong>Studies</strong> <strong>in</strong> <strong>Social</strong> <strong>Sciences</strong>, CalcuttaKolkata-700094SIR,Form of Application <strong>for</strong>DOCTORAL PROGRAMME 2011I hereby desire to apply <strong>for</strong> the Ph.D. Programme and submit below the requisite details. If accepted,I shall abide by the rules and regulations of the <strong>Centre</strong>. Particulars given below are true and correct tothe best of my knowledge and belief.1. NAME (IN BLOCK LETTERS) ………………………………………………………(Accord<strong>in</strong>g to the school leav<strong>in</strong>g certificate)2. DATE OF BIRTH …………….... SEX ……… MARITAL STATUS………………...3. FATHER’S NAME ……………………………………………………………………..4. MOTHER’S NAME …………………………………………………………………….5. CASTE: GENERAL/SC/ST/OBC/PHYSICALLY DISABLED ……………………….(Strike out which is not applicable and enclose relevant documents).6. NATIONALITY ……………………………7. PERMANENT ADDRESS …………………………………………………………………..………………………………………………………………………………………………….8. ADDRESS FOR COMMUNICATION ……………………………………………………...………………………………………………………………………………………………..9. TELEPHONE/ MOBILE NUMBER/ E-MAIL ID…………………………………………….
10. PARTICULARS OF ACADEMIC CAREER:Name of theExam<strong>in</strong>ationSchoolLeav<strong>in</strong>g/Secondary/ICSE/CBSE10+2/HigherSecondaryExam<strong>in</strong>ationpassedName ofInstitute/UniversitySubjects/PapersYear ofPass<strong>in</strong>gClass/Division(%) Marks/CGPAUndergraduatePostgraduateM.Phil. /NET/SET/RTP/TeacherFellowshipOtherQualifications(i)(ii)Attested copies of all Certificates and Mark sheet of Degrees etc. must be enclosed.Enclose relevant document if qualified <strong>for</strong> NET/SET/M.Phil./R.T.P./Teacher Fellowship.11. ARE YOU CURRENTLY ON A FELLOWSHIP/SCHOLARSHIP FOR PH.D./M.PHIL.RESEARCH?………………………………………………………………………………………………..12. ARE YOU CURRENTLY EMPLOYED? IF SO, PLEASE GIVE DETAILS :Organization served asJRF/SRF/Employee**Designation Period from and to Pay/Fellowship** Submit documents <strong>in</strong> support of your statement.
EMPLOYER’S CERTIFICATESri/Smt ………………………………………………………………………..is a full time/part timeemployee of this Organization/Institution/Industry work<strong>in</strong>g <strong>in</strong> the capacity of ……………………...…………………. We have no objection to his/her pursu<strong>in</strong>g Ph.D. Research Work at the <strong>Centre</strong> For<strong>Studies</strong> <strong>in</strong> <strong>Social</strong> <strong>Sciences</strong>, Calcutta as permitted under the rules.DATE : …………………..FULL SIGNATURE WITHDESIGNATION OF THE EMPLOYER WITHOFFICIAL SEALA C K N O W L E D G M E N E N TReceived an application <strong><strong>for</strong>m</strong> No ………………………………..From Shri/Smt…………………………………………………….For Ph.D. Programme 2011Date:Signature of Receiv<strong>in</strong>g Assistant & Seal
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