0	9	0			

 	भारतीय प्रोद्योगिकी संस्थान भुवनेश्वर 
INDIAN INSTITUTE OF TECHNOLOGY BHUBANESWAR
 शैक्षणीक अनुभाग /Academic Section 	

        COURSEWORK ASSIGNMENT FOR Ph.D. PROGRAMME

1	School :		
2	Date of Joining :		
3	Category to be Enrolled in :	

Institute Scholar 
Sponsored Scholar 
Project Scholar	
4	
Name of the Agency (for Sponsored/Project)		
5	Name of Candidate [BLOCK LETTERS]:		
6	Academic qualifications: [qualifying examination]	
	
Degree	University/
Institute	
Year	Percentage
/CGPA	Class
Placed in	Branch / Subjects
studied	

7	Experience, if any, of Service and/or research:	
	Organization	Place	From	To	Nature of work	Responsibility	

8	Declaration:

I have read the provisions of the Ph.D. regulations and declare that I shall abide by them. I shall also abide by other instructions, which will be given to me from time to time. The particulars, furnished above, are correct to the best of my information and belief.

Date	Signature of candidate in full	

(PTO)

RECOMMENDATION OF DOCTORAL ADVISORY COMMITTEE

i)	The DAC recommends the candidate to be enrolled in the Ph.D. programme w.e.f  	 AREA OF RESEARCH:  	
ii)	His / Her Supervisor (s) is/are 1.   	

     2.    	___

iii)	Coursework Assigned:

Sl. No.	
Subject
Number	
Subject Title	
L-T-P	
Credit	
Semester	
Name of the Subject Faculty	Reasons for
waiver,
if any	
Compulsory Subject	

1								
Technical courses assigned by the DAC 	

1								

2								

3								

4								

Signature of DAC Members with full name and date:

1	 		2	 		

3	
 		
4	

5	
 		
6	

7	
 		 (Supervisor-1)	
8	
 		 (Supervisor-2)

Forwarded by:

9.   		 (Head of the School)

Approved:

Dean (PG&RP)