GEN/ SC/ ST/OBC (Please put a tick mark)
Rs. 400/- (Rs. 200/- for SC/ST)
UNIVERSITY OF KALYANI
Kalyani, West Bengal
Application for Admission to
D.Litt / D.Sc. Programme in
(Subject)
Photograph
Session: 20.
Space for Office Use
1. Name of the applicant:(Block Letters)
Surname
First name
Middle name
2. Fathers/ Guardians name: .
3. Permanent Address:
Pin : .
6. Mailing Address (Postal):
Pin : .
E-mail:.Tel. :
7. Nationality: ..
8. Date of Birth( According to School Leaving Certificate:
/ .. /
Day
Month
Year
9. (a) Academic Qualifications:
Degree
Name of the University/ Institution
Year of passing/awarded
Masters
Ph.D.
Others
10. Ph.D thesis title:
11. Research Experience:
a) Number of years:
b) Number of Research Papers published in ISSN/refereed journals:
c) Number of Research papers published in the area of the proposed
D.Litt/D.Sc. work:
d) Number of Books published:
e) Number of articles/chapters in Books:
e) Number of citations received supported by Google Scholar/SCOPUS profile:
% of marks
f) Number of Ph.D. students supervised/supervising:
( Please enclose detailed list of publications with bibliometric indicator (impact factor, H-index)
along with a copy of each publication. Please use additional sheets.)
12. Title of Research Proposal for D.Litt/D.Sc. program*:
(* Enclose a copy of the summary of the research proposal)
13. Application Fee (Challan copy to be attached)
Please note the application should be accompanied by:
i. Attested copies of mark-sheets, diplomas and certificates obtained by the candidate in the past.
ii. Summary of the Ph.D. thesis.
iii. SC/ST/OBC candidates must submit copy of certificate.
iv. No objection certificate from the employer.
*Candidates are requested to read the University Regulations for M.Phil and Doctoral Degrees before
applying.
(Print the Application Form using Legal-sized paper)
DECLARATION: I solemnly declare that the particulars and information supplied above are correct to the
best of my knowledge and belief. I also promise that I will not indulge in any such activity, misbehavior or
violence of any sort that will bring disrepute to the University. In case I am found involved in any such act, my
admission should be withdrawn immediately and I should be subjected to any punishment that the University
Authorities deems fit.
Date:
Signature of the candidate in full
Place:
________________________________________________________
RECEIPT
UNIVERSITY OF KALYANI
Received the filled-in application form from Smt/Sri
for the D.Litt/D.Sc. Course in .. .
Signature of Official with date & stamp
ADMISSION SECTION
P.O-KALYANI,DIST-NADIA,PIN741235,W.B
APPLICANT'S COPY
SBI Powerjyoti Account
Note: Fees collection Charges is to be paid additionally
Fee Payment Challan
Fee Collection Account Number
32183583982
State Bank of India
Branch Name
Branch Code
Date
Applicant's Name
Address & Mobile
No.
Application fees
Fee collection
charges
Total
Amount in words....
only
Signature of the Applicant
For Bank use only
Journal No.
Seal /Date
Authorized Signatory
UNIVERSITY OF KALYANI
ADMISSION SECTION
P.O-KALYANI,DIST-NADIA,PIN741235,W.B
COPY TO BE SUBMITTED WITH APPLICATION FORM
SBI Powerjyoti Account
Note: Fees collection Charges is to be paid additionally
Fee Payment Challan
Fee Collection Account Number
32183583982
State Bank of India
Branch Name
Branch Code
Date
Applicant's Name
Address & Mobile
No.
Application fees
Fee collection
charges
Total
Amount in words....
.only
Signature of the Applicant
For Bank use only
Journal No.
Seal /Date
Authorized Signatory
Third Copy
UNIVERSITY OF KALYANI
Second Copy
First Copy
UNIVERSITY OF KALYANI
ADMISSION SECTION
P.O-KALYANI,DIST-NADIA,PIN741235,W.B
BANK COPY
SBI Powerjyoti Account
Note: Fees collection Charges is to be paid additionally
Fee Payment Challan
Fee Collection Account Number
32183583982
State Bank of India
Branch Name
Branch Code
Date
Applicant's Name
Address & Mobile
No.
Application fees
Fee collection
charges
Total
Amount in words....
only
Signature of the Applicant
For Bank use only
Journal No.
Seal /Date
Authorized Signatory
