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Detailed scheme and important dates are in following pages. This is original document downloaded from university website in the greater interest of M.phill/ Ph.d aspirants. For more details you may visit Universitys website www.ignou.ac.in Thanks ..
INDIRA GANDHI NATIONAL OPEN UNIVERSITY RESEARCH UNIT, MAIDAN GARHI, NEW DELHI-110068
PART A : Person specific details 1. Programme applied : (M.Phil / Ph.D) : _____________________________ 2. Research Discipline applied for : __________________________________ 3. Whether already registered with IGNOU : (YES/ NO) ________________ 4. If yes, enter (i) enrolment no. ____________ (ii) Programme __________ 5. Name of the candidate : __________________________________________ 6. Fathers /Spouses name : ________________________________________
11. If OBC, please specify whether : Creamy Layer / Non-Creamy Layer 12. Territory : Urban / Rural / Tribal 14. Religion : _____________________ 16. Social Status : Ex-serviceman / War Widow/
Not Applicable 13. Marital Status : Married / Unmarried 15. Whether Minority : YES / NO 17. Whether Kashmiri Migrant : YES / NO
18. Whether a person with Disability : YES / NO 19. (i) If Yes, specify nature of disability : Speech & Hearing Impairment / locomotor impairment /
Visual impairment / Low vision/ Any other (specify) _________________________________ (ii) Percentage of disability : _______________________________________________________
21. Scholarship, if any, received : YES / NO 22. If yes, specify (i) Deptt offering scholarship : UGC /CSIR/ ICMR / DST/ ICSSR/ICHR/
Others (specify) _________________& (ii) Amount (yearly)________________
24. Address for correspondence (do not give PO Box No. Provide full address. Leave a box blank between
each unit of address like House No, Street No. PO, etc)
City / District
State
Pin Code :
Telephone number with STD codes : __________________________________________________ (i) Mobile number : _______________________ (ii) Email Id ______________________________
26. Specify details of Demand Draft of Rs 750( in favour of IGNOU payable at New Delhi) to be
submitted towards Prospectus & application and processing fee: DD No. Amount (Rs) Name of Issuing bank & place Date of Issue
PART B : Specific details on the Research Programme for which application submitted 1. Programme applied : (M.Phil / Ph.D) : _______________________ 2. Name of the Research Discipline
: _______________________
5. If employed, give details of current employment : a. Designation : ____________________________________________________________ b. Period of employment : From ___________________ to __________________________ c. Name & address of organization : ____________________________________________
________________________________________________________________________ ________________________________________________________________________
9. Furnish details pertaining to the External Research Supervisor (in case you propose)if any : (i) Name of the proposed external supervisor: _______________________________________________ : _______________________________________________ _______________________________________________ (iii) (a) Present position (if in service) (b) If retired (specify details) (iv) Address & contact details (v) Consent letter for guiding student : _______________________________________________ : _______________________________________________ : _______________________________________________ _______________________________________________ : Enclosed / Not Enclosed (vi) CV of the Research Supervisor : Enclosed / Not Enclosed (Brief in 2-3 pages duly signed by him/her) (ii) Name & address of the institution
DECLARATION I declare that the statements made in this application form are true and complete to the best of my knowledge and belief. I am aware that if at any stage it is found that the statements made are not true or misleading, the admission/ registration if made will be cancelled and I shall not be entitled to refund of any fee paid by me to the University. Further, I have carefully studied the rules of the University as printed in the Prospectus and I accept them and shall not raise any dispute anywhere in India/abroad over the same rules.
(Signature of the Candidate) Place : __________________ Date : __________________ Full Name of the Candidate
Checklist : (Tick the relevant boxes) 1. Certificates in support of educational qualification(s) 2. Date of birth Certificate (Age Certificate) 3. Category certificate for SC/ST/OBC/PH/Kashmiri Migrant/War widow (if applicable) 4. Work Experience Certificate (for Category A compulsory)