Indian Institute of Technology Indore

Transcription

1 IIT Indore Indian Institute of Technology Indore IET Campus: IET-DAVV Campus, Khandwa Road, Indore (M.P.) Ph.: , Fax: (for Basic Sciences & HSS) PACL Campus: 113/2-B (Opp. to Veterinary College), Village Hernia Khedi, MHOW Road, Indore (M.P.) Ph.: (for Engineering) Application Form for Admission A. Admission for the Year: Semester: Autumn ( ) or Spring ( ) B. Registration No.: (To be filled in by the Office) C. Programme.: (Please tick) Paste (do not pin) passport size photograph in this space M.Tech ( ) or M.Tech + Ph.d. Dual Degree ( ) Communication & Signal Processing ( ) Production & Industrial Engineering ( ) M.Sc. ( ) or M.Sc.+ Ph.D. Dual Degree ( ) Chemistry ( ) Physics ( ) Ph.D. ( ) Computer Science Engineering ( ) Electrical Engineering ( ) Mechanical Engineering ( ) Chemistry ( ) Mathematics ( ) Physics ( ) Psychology ( ) Sociology ( ) Bioscience and Bioengineering ( ) Philosophy ( ) English ( ) 1. Full Name in Capital Letters: (as mentioned in the qualifying degree certificate) Type or Write Legibly in English Keep one block blank between the two words 2. Date of Birth: (as per matriculation or equivalent certificate): (DD/MM/YYYY) 3a. Category GN/OBC-NC/SC/ST 3b. Physically Disabled (Yes/No) 3c. Marital Status (Single (S)/ Married (M)) 3d. Hostel Accommodation required (Yes/No) 4. Sex (M/F) 5. Nationality 1

2 6. Contact details*: (a) Address for Correspondence: (b) Permanent Address: City: Pin Code City: State: State: Pin Code Telephone Number (with STD code) Mobile No Address(s) * It is the responsibility of the candidate to intimate change of address. 7. Category of PhD admissionunder which you want to apply: 1) 2) (in order of preference) At present the Institute admits PhD students as Full Time categories of: Full-Time Scholars Categories- A. Teaching Assistantship (TA) # B. Govt./ Semi-Govt. Fellowship Awardees (FA) (CSIR, UGC, DAE, DBT, NBHM, Commonwealth, Nehru Memorial Doctoral Fellowship, etc.) # As per MHRD Directives, candidate selected under TA category cannot accept or hold any appointment paid or otherwise or receive any emoluments, salary, stipend from any source during the tenure of TA ship. Hence, candidates selected as TA and having employment with or without pay with any organization/institution/establishment/project etc. must leave the job and submit relieving certificate before joining the Ph.D. programme under TA category. For Institute Fellowship i.e. Teaching Assistantship (Except students with ME/M.Tech./M.Phil degree) all candidates should have qualified GATE or CSIR-JRF or CSIR -NET or UGC-JRF or UGC-NET. 8. Details of Educational Qualifications from Matriculation onwards (Original Certificates should be produced at the time of interview) Degree/ Examination Passed Branch/Subject University/ Institute Month & Year of Entering Month & Year of Passing % of Marks or CPI/CGPA Class/ Division 9. Details of qualifying examination like GATE, CSIR-NET, UGC-NET, or any other equivalent examination (Original Certificates should be produced at the time of interview) Name of Examination Year of Passing Validity Period Number of Candidates Appeared Marks Obtained AIR Rank Score/Percentile 2

3 10. Details of Professional/ Work Experience: Organization Designation Date Nature of Responsibilities From To 11. Present Employment status: (Employed /Not Employed) If employed, then details of the employer: 12. Details of the Research Experience: 12 (A). Details of the Bachelors and Masters project/ thesis/ dissertation Name of the University/ Institute Year of submission Name of the supervisor Title 12 (B). List of Publications*, if any (Attach a separate sheet if required) * mention in the order of giving name(s) of author(s), title of paper, details of the journal/conference, year, volume, page numbers. 3

4 13. Broad Area of Specialization in which intend to work in the PhD programme: 14. Any other relevant information (Attach a separate sheet) 15. Contact Details of the Referees: (The referees may be contacted telephonically or through to comment on you academic or professional capabilities) Particulars Referee 1 Referee 2 Name Designation Organization Office Address Office Telephone (with STD code) 16. Number of Enclosures attached with this application form: 17. Declaration: I do hereby solemnly declare that the information given above is correct to the best of my knowledge and belief. I am fully aware that I must submit attested copies of my qualifying degree certificate / final transcripts, failing which, my admission will stand canceled. I am also aware that providing incorrect information in the application form can result in the cancellation of my admission at any stage. Place: Signature of the Applicant with date Name of the Applicant: Please post ONLY the completed application form to the following address. The envelope should be marked Application for Ph.D. admission in the Discipline of " and should be sent to the Deputy Registrar (Academic Affairs) INDIAN INSTITUTE OF TECHNOLOGY INDORE PACL Campus, 113/2-B (Opp. to Veterinary College), Village Hernia Khedi, Indore-Mhow Road, Indore (M.P.) India To, Deputy Registrar (Academic Affairs) INDIAN INSTITUTE OF TECHNOLOGY INDORE PACL Campus, 113/2-B (Opp. to Veterinary College), Village Hernia Khedi, Indore-Mhow Road, Indore (M.P.) India Website: 4

5 IIT Indore Indian Institute of Technology Indore IET Campus: IET-DAVV Campus, Khandwa Road, Indore (M.P.) Ph.: , Fax: (for Basic Science & HSS) PACL Campus: 113/2-B (Opp. Ti Veterinary College), Village Hernia Khedi, MHOW Road, Indore (M.P.) Ph.: (for Engineering) Statement of Purpose (Attach separate sheet for details, if required) Statement of Purpose (SoP) is an opportunity for the applicant seeking admission to the PhD programme at IIT Indore, to share your thoughts with the Admissions Committee about why you want to pursue PhD studies. While writing the SoP, please describe briefly about the past project / research work done by you. However, restrict yourself to words. The personal SoP will aid the admission committee in evaluating your application. Place: Signature of the Applicant with date Name of the Applicant: 5