Senate of Serampore College (University) College founded by Carey, Marshmann and Ward, 1818 Incorporated by Royal Charter, 1827 and Bengal Act IV of 1918 as modified upto 1997 by Govt of West Bengal DEPARTMENT OF RESEARCH/SATHRI 10 William Carey Road, P.O. Serampore 712201, Dist. Hooghly, West Bengal, India. Application for Admission to the DOCTOR OF MINISTRY (D.MIN.) PROGRAMME 2017-2018 A. be filled by the Applicant Note: Before filling the application, please go through the D.Min. Regulation of the Senate of Serampore College and the notes given below. 1. Name (in capital letter) Rev./Fr./Mrs./Ms./Mr./ Dr Photo 2. Present Occupation 3. Present Postal Address and Contact Information.. Pin code Email :...( in capital letter) Phone no: ( ) Cell phone: +91-.. STD Code 4. Date of Birth 5. Age. 6. a. Married Unmarried (check one) b. Spouse name... c. Occupation.. d. No of Children.. 7. Mother tongue.. 8. Church affiliation..
2 9. Academic Record (see note 3) Examination Name of College Year of Branch Class Passed and University Completion B.A./B.Sc.etc. M.A/M.Sc.etc. B.D/M.Div. M.Th./ PhD Others* (*If claim to equivalent academic status is being made given full details and enclose Photostat copies or certified copies of the original certificates) 10. Title of Theses (If any) B.D......... M.Th.......... PhD. 11. Details of work experience: (Extra sheet may be used) 12. Details of research experience and list of publications (Extra sheet may be used) a. Year... b. Year. c.. Year.. 13. Proposed area of D. Min research a) Tick one i. Liturgy and Worship ii. Preaching iii. Pastoral Care and Counseling iv. Leadership and Church Administration v. Ministry of the People of God vi. Communication vii. Women and Children viii. Religion and Culture ix. Mission and Evangelism x. Others.. b) In a separate sheet mention the Proposed area of research- please describe briefly, to the extent you are able to do so at this point, the area in which you hope to do your specialized research
3 14. Give particular about the proficiency you have in the following languages No. of courses taken- specify Grades/Marks obtained the duration of each course for each course Hebrew/ Aramaic/ Syriac/ Greek Arabic/ Latin/ Sanskrit/ Pali German/ French/ Spanish Indian languages other than mother tongue 15. Who will sponsor your D Min studies (Please tick) a. Church/ Institution Sponsor YES/NO (Letter from church/institution) b. Family Sponsor YES/NO (Letter from guardian/ family member) c. Self YES/NO (Self explanatory letter) 16. Are you employed? YES / NO (If employed, give details with last salary drawn) Name and address of the Institution Nature and designation of the work of the applicant in the mentioned Institution Last salary drawn I Rev./Fr./Mrs./Ms./Mr./ Dr.... 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. Min degree programme of the Senate of Serampore College. Date. Signature of the Applicant
CHECK LIST a. Date of Birth Certificate/ Document showing Date of Birth b. Application fee Rs 2000/- c. Attested copies of certificates of all the mark list, degrees and certificates d. Financial guarantor s form e. Declaration form f. A Letter from the Head of the Church/Institution/Organization i. stating your leadership position in the church ministry ii. permission to the candidate to register the D.Min Program iii. Approved leave application from the head of the Church/ Institution/ Organization Note to the applicant: 1. This application should reach the office of the Department of Research/ SATHRI on or before 15 th May, 2017. 2. The candidate should send along with this application the Photostat certified copies of all the certificates and transcript of Theological degrees/ Degrees other than those from the Senate of Serampore College. 3. Application form should be sent in prescribed format along with fee of Rs.2000/ - (Rupees Two Thousand only) by Demand Draft drawn in favour of DEPARTMENT OF RESEARCH/SATHRI payable at Serampore or Kolkata. Last date to receive the application: 15 th May, 2017 When completed, please send the application along with Rs 2000/- to the under signed: DEAN Department of Research & SATHRI Senate of Serampore College (University) 10 William Carey Road P.O. Serampore 712201 Dist. Hooghly, West Bengal India. 4
B. DECLARATION (Declaration to be filled by student) I Rev/Mr/ Ms/Mrs/ Dr understand that D.Min programme is ministry oriented research programme, which involves serious academic study, field / empirical studies and Library work. I am willing to gie the time required for the D.Min programme including attending 5 seminars consisting of 10-12 days each semester and write 5 Comprehensive examination and a thesis. I will be able to give time and resources in meeting the finance and attend the programmes My institution / Church has concented to allow me to register for D.Min Programme Signature Date: _ Place: (Declaration to be filled by Head of the Institution/ Church/ Organization) I.. hereby certify that this application is being made with my consent and permission. I will take responsibility to see that is given necessary leave for his/her study as per the regulations of the Senate of Serampore College... Date.... Designation Seal 5
C. MINISTERIAL EXPERIENCE Date Institution / Church Nature of Work Your specific ministry engagement 6
D. be filled by the Sponsor/ Individual FINANCIAL GAURANTOR S FORM The Dean Department of Research/ SATHRI Senate of Serampore College Mack House Complex, Willam Carey Road P.O. Serampore 712201, Hooghly, West Bengal I/We hereby undertake to Support/ give financial guarantee that Rev/Mr/ Ms/Mrs/ Dr for the D Min research program under Department of Research / SATHRI by arranging to transfer either in Full or in Installments as per the provision made in rules, the revised Fee Structure will be intimated to you soon Sponsor/ Financial Guarantor s detail Name: Father s Name: Designation: Complete Postal Address State Pin code, Mobile Number Email: Date: SEAL Signature of Sponsor/ Financial Guarantor s (In case of family/relative, please mention sponsor s relation with the research student)
7 E. TO BE FILLED BY THE RESEARCH COMMITTEE 1. The applicant is permitted / not permitted for admission into the D.Min. programme. The following persons are appointed as candidate s Interview/ Screening Committee. i.. ii. iii.... 2. The applicant is admitted / not admitted into the D.Min. degree programme The following persons are appointed as candidate s Supervisory Committee. i.. ii.. iii.. 3. Alternatives i.. ii.. Date.... Signature of the Dean