CENTRE FOR STUDIES IN SOCIAL SCIENCES, CALCUTTA R-1, BAISHNABGHATA PATULI TOWNSHIP : 700094

Affix a recent passport size photograph duly signed by the applicant Application Form for Doctoral Programme 2021

Last Date of receiving application 26th February 2021

1. D.D. No. ………………….……..Dated ____/____/_____ Name of bank…………….………….

2. Master’s (or its equivalent degree) in______Percent of marks obtained ______

3. M.Phil. in (mention discipline) ______

4. Please tick in the appropriate box

SC ST OBC(A) OBC (B) General PD M. Phil. (2 yrs.) Only if awarded NET SET

5. Name of the Applicant (IN BLOCK LETTERS) ………………………………………..….. (According to the school leaving certificate)

6. Proposed research work:

(A)Discipline (choose from amongst the disciplines offered)………. ………………………..

(B)Sub-field: ……………………………………..…………………………………………………

(C)Title of Proposal………………………………….……………………………..……….…………

………………………………………………………………………………………………………

…………………………………………………………………………………………………….…..

(D)Enclose a synopsis of not more than 1000 words on the area or topic of research in which you are interested (use separate sheet)

1 To The Registrar Centre for Studies in Social Sciences, Calcutta (CSSSC) Kolkata-700094

Sir, I hereby desire to apply for the Ph.D. Programme which is conducted by Centre for Studies in Social Sciences, Calcutta (CSSSC) and is affiliated to , Kolkata and submit below the requisite details. I declare that all statements made in the application are true to the best of my knowledge and belief. Any statement made in the application, if found incorrect on scrutiny, shall render the application liable to rejection and admission, if granted on the basis of the statement, shall stand cancelled. If admitted, I undertake to abide by all the existing Rules and Regulations of the CSSSC and Jadavpur University. Particulars given below are true and correct to the best of my knowledge and belief.

Dated: ____/___/2021 Yours sincerely,

………………………………………… (SIGNATURE OF THE APPLICANT)

1. Name (IN BLOCK LETTERS) ………………………………………..………………… (According to the school leaving certificate)

2. Date of Birth …………….... Sex ………… Marital Status………………...

3. Father’s Name ………………………………………………………………………..

4. Mother’s Name …………………………………………………………………….

5. Category: General /SC / ST /OBC (A/B) / PD ………………………………. (Strike out which are not applicable and enclose relevant documents).

6. Nationality ……………………………

7. Permanent Address …………………………….…………………………………………….…………..

…………………………………………………………………………………………………….………….

8. Address for Communication …………………….……………………………………..……………...

……………………………………………………………………………………………………………..

9. Telephone/ Mobile Number …………………………………..………………………………………….

10. E-Mail ID …………………………………………………….………………………………………..

2 11. Particulars of Academic Career:

Name of the Examination Name of Subjects/ Year of Class/ (%) Examination passed Institute/ Papers Passing Division Marks/ University CGPA School Leaving/ Secondary/ ICSE/ CBSE

10+2/Higher Secondary

Undergraduate

*Postgraduate

#M.Phil. /NET/ SET

Other Qualifications

Please note: (i) *Self attested copies of Mark sheet etc. must be enclosed. (ii) #Enclose relevant Self attested certificate if qualified for NET/SET/M.Phil.

12. Are You Currently on a Fellowship/Scholarship for Ph.D./M.Phil. Research?

………………………………………………………………………………………………..

3 13. Are You Currently Employed? If So, Please Give Details :

Organization served as Designation Period from Pay Employee**

** The candidate must submit employer’s NOC in the following format

Employer’s Certificate

Sri/Smt ………………………………………………………………………… is a full time/part time employee of this Organization/Institution/Industry working in the capacity of ……………………………………………………………… We have no objection to his/her pursuing Ph.D. Research Work at the Centre For Studies in

Social Sciences, Calcutta as permitted under the rules.

…..………….…………………………… Date:………………… Full Signature With Designation Of The Employer With Official Seal

______

14. Publications, if any

List of Publications, # Name of the Journal Date of Publication Title of Book/Paper# Volume No. of Journal

# Use separate sheet if necessary

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Please note that all applicants are required to e-mail their proposals along with a title and his / her name to [email protected]

……..………………………………. DATE: …………………………. (SIGNATURE OF THE APPLICANT)

PLACE: ………………………… ……………………………………….. (NAME IN BLOCK LETTERS)

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