1. Name of the Applicant

2. Date of Birth

3. Gender

4. Occupation / Profession

5. Permanent Address

6. Address to which communications to be sent

7. Telephone Number

Mobile Number

Email Address

8. Mother Tongue

9. Marital Status

10. Church Afliation

11. Ordained Yes No

12. Academic Qualications

(Attested Photocopies are to be enclosed. The originals should be presented at the time of the interview.)

13. Medium of Instruction

14. Other Language/s Studied (with duration)

Degree Class Obtained Year of Passing

1. Bachelor’s Degree (Secular)

2. Master’s Degree (Secular)

3. Bachelor’s Degree (Theological)

Branch : _____________________

Academic Year : _______________

Affix35mm x 45 mm

Size Photo

Male Female Other

GURUKUL LUTHERAN THEOLOGICAL COLLEGE AND RESEARCH INSTITUTE

94, Purasawalkam High Road, Kilpauk, Chennai-600 010.

Application Form

Doctor of Theology

Secondary School ............................ University ......................................

NOTE: Before filling the Application, please go through the D.Th. Regulations of the Senate of Serampore College (University)and the procedures and regulations of the Gurukul Lutheran Theological College and Research Institute.

4. Master’s Degree (Theological)

6. Others

5. Common Entrance Test (CET)

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15. Titles of Theses (Abstracts to be enclosed.)

B.D. :

M.Th. :

Any Other :

16. Details of Post M.Th. Research Experience and List of Publications(If more space is needed, please attach a separate sheet to this application form.)

17. Details of Work Experience

18. If Employed, give the Name and Address of the Employer

19. Nature and Designation of work at present in the above mentioned Institution

(Including the Telephone and Email address, if any.)

(If more space is needed, please attach a separate sheet to this application form.)

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20. Proposed Branch/Discipline of Doctoral Studies

a) Mention and specify the Focus/Sub-discipline :

Branch/discipline

Sub-branch/discipline

Inter-disciplinary

Any other

b) Proposed Area of Research: (Please give a brief description, to the extent to do so at this point, the area in which intending to do Specialized Research. If more space is needed please attach a sheet of paper.)

21. State the Objective of Proposed Doctoral Studies

22. a) Knowledge of Classical and Modern Languages (Other than English)

Hebrew

Aramaic

Syriac

Greek

Arabic

Latin

Sanskrit

Pali

German

French

Indian Languages/other than Mother Tongue

Any other language/s

-

Specify the number of Courses, their Nature (i.e. Preliminary or Advanced) and Level (B.D., M.Th., and/or any other) as well as Grades obtained in each Course. (Note: Describe proficiency in Non-examined Language skills.)

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b) Knowledge of English (Tick One)

Excellent Good Fair

Comprehension

Spoken English

Written English

Note: English being the medium of Doctoral Studies, candidates are expected to be proficient in English

23. Name and Addresses of two persons who can provide Condential Information about you, one of whom

shall be the Supervisor of your M.Th. Thesis or Head of the Department and a Church Leader.

1. 2.

24. Sponsorship and Financial Support

A. a) The Name and Address of Sponsor/s (Telephone and Email address if any)

b) Ofcial Documents for Sponsorship (Tick One)

Enclosed To Follow

b) The Nature of the Sponsorship (Per Annum)

) Full Rs. ii) Partial Rs.

C. If not a sponsored candidate, specify the means of Financial Support Study Period:

a) Self

b) Family

c) Others

(Other than Relatives or Friends)

Note: Give necessary details. In the case of Financial support from Private Bodies, the College requires legally

1. 2.

binding guarantee letter/s.

B. a) Financially Sponsored by a Theological College, Church or Institution? If so, specify.

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25.To be lled in by the Married Students

a) If intending to bring your family, specify whether for the whole period or part of the period.

b) If the quarters are not available immediately, specify alternative plan for accomadation.

The size of the family

No. of children : Ages of children :

Note : Family quarters (if available) will be provided only for the candidate, spouse and children. Parents or relatives are not entitled to live with the student.

Place :

Date :

I, ______________________________________________________ hereby declare that the particulars

given above are true to the best of my knowledge and if admitted, I shall abide by the Rules and Regulations of

the D.Th. Degree Programme of the Senate of Serampore College (University) and those of Gurukul Lutheran

Theological College & Research Institute.

Signature of the Applicant

26. Applicant’s Declaration

Reimbursement of Medical Expenses(This is not a Financial Guarantee Letter)

I/We hereby assure that I/We will reimburse all medical expenses if incurred by the College in case of

any emergency on behalf of ____________________________________________________

during his/her stay and study at Gurukul Lutheran Theological College & Research Institute.

Place :

Date : Signature of Parent/Guardian/Sponsor

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1. Demand Draft for Rs.600/- favouring “Gurukul Lutheran Theological College” payable at “Chennai” toward Registration fee

2. Attested Photocopy of HSLC / Plus 2 / School Certicate (Proof of Date of Birth)

3. Three Passport size photographs

4. Attested Photocopies of Degree Certicates (Both Secular and Theological)

5. Attested Photocopies of Marks Statements (Both Secular and Theological)

6. Attested Photocopies of Common Entrance Test (CET) Certicate / Mark Sheet

7. Proof of appropriate experience in teaching or any other relevant experience

8. Abstracts of B.D., M.Th., or other Theses

9. Enclosed atleast three recently published/unpublished articles

10. A written description of the proposed Doctoral Research (not more than 1000 words)

11. Proof, if any, of the completion of Seminar on Research Methodology

12. Financial guarantee letter (Bishop/President/Sponsor/Parents/others)

13. Letter from your local pastor (Stating your Communicant membership)

14. Sponsorship letter from the Head of your Church (Bishop/President)

15. Character and conduct certicate from the Institution where you have studied last

16. Health Certicate

17. A Brief autobiographical statement (State clearly what motivated you to study Theology at advanced level)

DOCUMENTS ENCLOSED

Note : Applications will not be processed unless the above mentioned documents are attached. All original certificates/degrees/diplomas should be made available for scrutiny at the time of Personal Interview.

Send the lled-in application with all attachments to The Registrar, Gurukul Lutheran Theological College

and Research Institute, 94, Purasawalkam High Road, Kilpauk, Chennai - 600 010. Tamilnadu.

Date : Signature of the Applicant

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