1 Application No. DR. B. R. AMBEDKAR OPEN UNIVERSITY Road No. 46, Prof. G. Ram Reddy Marg, Jubilee Hills, Hyderabad 500 033 1.PROGRAMME i)Ph.D./M.Phil.ii)Subject 2.NAME:First Name Middle Name Surname 3.FATHERS/ MOTHERSNAME 4.DATE OF BIRTH DDMM YYYY 5.GENDER: Male Female 6. SOCIAL CATEGORY [Please tick [] 7.Are you employed?Yes No If employed, mention

Designation:...... Name & Address of the Organization: ............. OCBC-ABC-BBC-CBC-DBC-ESCSTPH Application for Admission into Master of Philosophy (M.Phil.)/Doctor of Philosophy Programme (Ph.D.) 2 8.EDUCATIONAL QUALIFICATIONS (Tick the relevant box(s) and write the subject in the blank space) 8.1Qualified at the UGC-CSIR/JRF/NET/SLET/GATE exam in the subject_____________ 8.2M .Phil. in the subject of ____________________________________________________ 8.3Post-graduation with 55% marks and above in the subject of_______________________ 8.4Post-graduation with 50% marks and above in the subject of_______________________ 8.5 Any other (specify the programme & subject) __________________________________ Total Marks in Post-graduationMarks Secured

Percentage of Marks

*Forthecalculationofpercentageofmarks,marksofallthesubjects/papersofthe postgraduateprogrammementionedwillbetakenintoconsiderationirrespectiveof respective universitys method to calculate the percentage. 9.Proposed Topic for the Ph.D. programme: (Enclose a research proposal on separate sheets) ....... ... 10.Articles published,if any: (enclose published articles) ... ... 11.Mention the Registration fee particulars: DD. No.... Date..Amount ..... Bank. Branch Place..... (Please pay the required fee in the form of Demand Draft from a nationalized bank drawn in favour of The Registrar, Dr. B. R. Ambedkar Open University, payable at Hyderabad). 12.Affix Passport-size Photograph and signature in the space given below: Signature of the Applicant

Paste Your Latest Passport Size Photograph 3 12.ADDRESS FOR CORRESPONDENCE Name: ....Full Address: ..... ........ Pin Code Phone (with STD code) : . E-mail ID :. Mobile No. :. 13.DECLARATION BY THE APPLICANT Iherebydeclarethatalltheparticularsfurnishedabovearetrueandcorrecttothebestofmy knowledge.I amawarethatifanyparticularsfurnishedbymearefoundtobefalseorincorrecton scrutiny or at any stage, my application may beliable for rejection. Even my admission granted based on such incorrect information may be cancelled. Date : Applicants Signature : . N.B.:ThefilledinApplicationalongwiththesupportingdocumentssuchasDegreeCertificate, MemoofMarks,ExperienceCertificate,Publications,ResearchProposaletc.shouldreachThe Director(StudentServices,Dr. B.R.AmbedkarOpenUniversity,RoadNo.46,JubileeHills, Hyderabad-500033 on or before_______________. Check List of enclosures.Tick ( ) the relevant boxes against your enclosures 1... 2. .. 3. .. Research Proposal (only for Ph.D.) Photo copies of Articles published Demand Draft One spare Passport size Photograph Relevant Certificate(s) of QualifyingExamination Give the list of other enclosures (if any) Examination Memorandum of Marks of Post-graduation Examination UGUGC/ CSIR/JRF/ NET/SLET/ GATE/M.Phil. Cert ificate if qualified