DAE Student (from Non CI)

/ Homi Bhabha National Institute
An Aided institution of Department of Atomic Energy and a Deemed to be University under section 3 of the UGC Act.
Regd. Office: 2nd Floor,Training School Complex, Anushaktinagar, Mumbai 400 094
Enrolment Form for Admission to Doctor of Philosophy (Ph.D.) / Integrated[1] Ph. D. /
Master of Science in Engg. (M.Sc.(Engg.)) Programme
(For students who are Employees of DAE units other than Constituent Institutions (CIs))
Date of enrolment: January 01 / August 01, 20….… / Affix Recent self attested photograph
3.5 x 2.5 cm
Please sign across
Part – A: Application
a. Application No.(To be filled by CI)
A / P / X
/ Enrolment No. (To be allotted by HBNI)
b. CI Name where applicant wants to enroll : / Division:
I desire to enroll in HBNI as an external registrant to the Ph.D. / Integrated Ph.D./ M.Sc.(Engg.)programme in Sciences.
  1. Full Name (as per last Qualifying Degree)

(It is mandatory to write name in Hindi also)
  1. Aadhaar Card No.(Self attested copy of the card to be attached)

  1. Date of Birth (DD/MM/YYYY)

  1. Father/ Mother’s Full Name

  1. Office Address (for Correspondence)

  1. Permanent Address (Residential)

  1. Office Telephone & Personal Mobile No.

  1. Email-ID

  1. Category(General/ SC/ ST/ Others(specify))
/
  1. Nationality

  1. Male/ Female/Transgender
/
  1. Whether Physically/ Visually Challenged (Yes/No, if Yes give details)

  1. Educational Qualifications (starting with graduation degree)

Sr.No.

/

Degree/ Diploma[2]

/ Year / % Marks / Subjects / University
1.
2.
3.
4.
  1. Professional Experience
(Give a broad title here and details up to 500 words as Annex-1)
  1. Publications details in the following format
(Give total number here and enclose a list under separate heads: Refereed Journals, Conferences, Chapters in books, Books, Technical Reports as Annex-2)
  1. Previous enrolment with HBNI (if any)

Name of Academic programme / Enrolment No. / Date of enrolment / Current Status

Certified that I am not enrolled in any other academic programmes of any University / Institute and will not enroll till the completion of the present academic programme. The above information furnished by me is true and correct.If any information is found to be incorrect or false, I understand that my admission is liable to be terminated without notice.It is also certified that I have attached all the mandatory enclosures as per check-list available with the form.

Date: Signature of the candidate

Note: Part-A, Part-B and Part-C of this enrolment form should be submitted together to HBNI central office at the time of joining Academic programme


/ Homi Bhabha National Institute
An Aided institution of Department of Atomic Energy and a Deemed to be University under section 3 of the UGC Act.
Regd. Office: 2nd Floor,Training School Complex, Anushaktinagar, Mumbai 400 094
Part B: Permission by the Designated Authority
  1. Title of research :
  1. Summary of proposed research[3] :
(Maximum 10 lines)
Date: Name & Signature of candidate

Certification by Head of Applicant’s DAE Unit

The applicant Shri/Ms. ______is an employee of this unit. He / she is permitted to pursue the ______(degree) programme at ______CI of HBNI.

Date: Name and Signature of Head of Unit /

Designated Authority at the Unit with stamp

/ Homi Bhabha National Institute
An Aided institution of Department of Atomic Energy and a Deemed to be University under section 3 of the UGC Act.
Regd. Office: 2nd Floor,Training School Complex, Anushaktinagar, Mumbai 400 094
Part C: Standing Academic Committee Recommendations
Enrolment Number
(To be allotted by HBNI)
Name of the Candidate
Name of the Constituent Institution
Recommendation for Admission to ______Programme of HBNI
Certified that: (Tick the appropriate one)
The applicant has a PG Diploma issued by HBNI / M.Tech./ M.Sc.(Engg.)/ (M.Phil.)/ MBA(only for admission to strategic studies programme) or is from Training School and has passed out in the year ______(before 2006). The Standing Academic Committee has conducted the oral examination of the applicant and based on his/ her performance recommends his/her enrolment with effect from January 01, 20.……../ August 01, 20……... under the Board of Studies in ______Sciences. The following courses (minimum 6 credits) are recommended.
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Additional Training School Courses which were not cleared by the candidate (if any) are recommended as follows.
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Or
The applicant has only AMIE / B.Tech. / M.Sc.degree. He / She has been screened through a written test. The Standing Committee has conducted the oral examination of the applicant and based on his/ her performance recommends his/her enrolment with effect from January 01, 20.……../ August 01, 20……... under the Board of Studies in ______Sciences. One year course works(60 credits) have been recommended.
Note: Doctoral / Monitoring Committee may examine the candidate and prescribe additional course work if required with the intimation to HBNI.
Suggested composition of the Doctoral / Monitoring Committee
S. No / Composition / Designation / Name & Email Address / Signature
1 / Sr. Professor / Professor / Associate Professor / Chairman
2 / Guide (HBNI Faculty) / Convener
3 / Co-guide[4] (if any) / Member
4 / External Guide (if any) / Member
5 / Faculty member of the institute specializing in a domain encompassing the topic of research / Member-1
6 / Member-2
7 / One faculty member preferably from any other CI or any other university/ institute in an allied domain as the topic of research / Member-3
8 / Technology Adviser (if any) / Invitee
Declaration by the student

I have been intimated about the composition of my doctoral / monitoring committee and course workrequirements. Copies of marksheet will be sent to HBNI as soon as credit requirements are fulfilled.

Date: Signature of the student

Certification by Guide
Certified that the total number of students registered currently under me is less than 13 and less than 8 of these are Ph.D. students; at any instant I will not have more than 13 students. I have read HBNI documents on “Guidelines for roles and responsibilities of guides/ co-guides, doctoral committees, deans-academic and standing academic committees”. I have taken concurrence of Head of Division / Competent Authority to guide the student and provide him research infrastructure as needed.
Date: Signature of Guide
Date: Signature of Chairman, Standing Academic Committeewith stamp

I have verified the particulars of the applicant as mentioned in the application form and found to be complete with all enclosures.

Date: Signature of Dean Academic for ______Sciences with stamp

To:

Dean, HBNI

[5]Check List for submission of documentswith Ph.D. / M.Sc.(Engg) application

form for enrolment

□Part-A, B & C of enrolment forms duly filled in and signed by all in appropriate place

□Research proposal

□Self attested photo pasted (signature across the photo)

□Self attested copy for proof of DOB

□Self attested copies of Mark Sheets & Degree Certificates (see note below)

  1. B.Sc. and/or M.Sc.

OR

  1. Integrated M.Sc.

OR

  1. B.Tech. and/or M.Tech (equivalent)

□Self attested copy of relevant certificate (eg. marriage certificate) if name is changed

□Self attested photocopy of Training School Mark Sheet (for those who graduated prior to 2006) and/or PG Diploma issued by HBNI (for those who graduated in or after 2006) (if any)

□Course works suggested: i) Class Room -

ii) Self Study Course -

iii) Credit Seminar -

□Self attested copy of Mark sheet for additional course work and/or re-examination (if any)

□Minimum 50% in all subjects & minimum 60% in aggregate

□Enrollment Fee(DD of Rs. 5000/- in favour of Accounts Officer, HBNI payable at Mumbai)

(For students who are Employees of DAE units other than Constituent Institutions (CIs) )

(Tick as applicable)

DD No. / Date / Drawn on Bank / Branch / Amount (Rs.)

Note: All attachments are mandatory

(Name & Signature of the Candidate)

PhD / MSc(Engg) Enrolment form for students who are employees of DAE units other than CIs (version approved during the meeting of Deans held on October 01, 2015) 1/7

[1] In case of Integrated Ph.D., one has to submit filled in option form for dual / single degree along with this form.

[2]Students who have graduated from BARC Training School prior to August 2007, may write ‘One Year PG Course’ under the column ‘Degree/ Diploma’ and ‘BARC Training School at ………….’ under the column ‘University’.

[3] One page research proposal needs to be attached separately with the Part-C of the form

[4]a) Co-guide should be either a faculty of HBNI or a faculty of any other institute with which HBNI has a MOU.

b) Having a Co-guide is Mandatory in the case of guide has less than three years of service left. Co-guide will take over as guide in case of superannuation of guide (only if co-guide is a faculty of HBNI)

[5]To be attached with the enrolment form.