Pacific University

Appendices
A1- Application Form for Recognition as Ph.D. Research Supervisor

A1
PACIFIC ACADEMY OF HIGHER
EDUCATION AND RESEARCH UNIVERSITY,
UDAIPUR

	Faculty
	Subject/Branch:
1.	Full Name of the Teacher:
2.	Organization & Designation
3.	Date of the first appointment in College
4.	Date of Birth:
5.	Age at the time of Application:
6.	Offical address:
7.	Permanent address:
		Same as Permanent Address
8.	Address for Correspondence:
	Email Address
	Phone No. (O)
	Phone No. (R)
	Mobile No.
	Passport Size Photograph:

9. Educational Qualification
Name of the Examination (Strating from Graduation)	Institute/ University	Year of Passing	Percentage/CGPA & Division	Specialization

10. Experience

Name of the organization	Designation	Duration	UG Teaching Experience	PG Teaching Experience

Please furnish the required detailed information on the following items by attaching your Resume (11 – 17)

11.Research Experience

(a) Ph.D - Topic, Faculty, Department and University

(b) M.Phil. - Topic, Faculty, Department and University

12. Research Publications

13. Book Authored/Co-Authored and Publications

14. Other Publication

15. Paper Presentation copies of relevant certificates/documents)

16. Any other information(s) you would like to submit:

17. Are you a Registered supervisor of UGC recognised universtiy
If Yes, Name & Address of University.

Upload Signature

Declaration

I solemnly declare that, the information given inthe application form is correct to the best of my knowledge and belif. i shall also abide the byrules and regulations of Ph.D. programme as well as the code of conduct for recognized research supervisor

Please send the attested copies of all the testimonial to the office of Dean, P.G. Studies Pacific University.