latest ph_d_ application form

8/2/2019 LATEST Ph_D_ Application Form

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HOW TO APPLY

The candidate is required to download Bank Challan Proforma along with theapplication form from www.iitr.ernet.in/admissionsand then deposit the requisitefee of Rs. 200/- in any branch of Punjab National Bank throughout the country. The

Bank Challan will be printed in triplicate. It is only available on Institute website andpay the fees through it. Bank will retain a copy and will return two copies to you. Inthose two copies, retain the Candidates copy with you and attach the IITRs copywith the application form.

OROROROR

In case Punjab National Bank Branch is not available at his/her place or nearbyplace, then send the demand draft of Rs.200/- in favour of Chairman PGAdmission, IIT Roorkee payable at Roorkee. The completed application formshould be sent to Chairman, PG Admission-2012, IIT Roorkee in A4 size enveloponly.

Note:- Separate application be sent for separate departments/centres and foreach department/centre separate fees will be required with each completedapplication form.


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BANK COPYBANK COPYBANK COPYBANK COPY CANDIDATESCANDIDATESCANDIDATESCANDIDATES COPCOPCOPCOPPunjab National Bank

(Challan Form)Ph.D. Admission for Spring Semester 2011-12 session

I.I.T. Roorkee, Roorkee

Punjab National Bank

(Challan Form)Ph.D. Admission for Spring Semester 201

I.I.T. Roorkee, Roorkee

Account No. 4044000100112597

IFSC CODE: PUNB0404400

Account No. 404400010011259

IFSC CODE: PUNB0404400

Date Date

Name of Candidate : Name of Candidate :

Fathers Name : Fathers Name :

City : City :

Department Applied for : Department Applied for :

Application Fee Rs. 200/- Application Fee

Branch Transaction Charges :(Transaction charges if any are to be borne by the candidates) Rs. 10/-

Branch Transaction Charges :(Transaction charges if any are to be borne by the candidates)

Total Rs. 210/- Tot

Signature of the Depositor

Address

Phone No. :

Signature of the Depositor

Address

Phone No. :

Authorized Signatory Stamp Authorized Signatory Stamp


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INDIAN INSTITUTE OF TECHNOLOGY ROORKEEROORKEE-247 667, Uttarakhand, India

APPLICATION FORM FOR ADMISSION TO Ph.D. PROGRAMMESFOR SPRING SEMESTER -2011-12

1. Separate Application Form should be used for each Department/Centre.

2. Enclose attested copies of all certificates with this Form. Bring original certificates atthe time of Interview/Test and Admission.

3. Giving false information will lead to cancellation of Admission.

4. No column should be left blank. Write Not Applicable against a column if the same

does not apply to you.

5. Tick () the relevant box wherever provided.6. Application incomplete in any respect, is liable to be rejected.7. Candidates who are in the final year of their qualifying examination can be considered for admission only if they

complete the requirement of their final examination including Viva-Voce before the registration date.

Name of Department/Centre in which admission is sought :

Details of Fee Paid : Challan Ref./DD No. __________ Dated __________ Amount ________ Bank Name________

Note: IITR Copy of Bank Challan/ Demand Draft must be attached with the application form.

Proposed Status Full Time Part Time Sponsored Self Financed

If PART TIME a) Whether working in a project at IIT Roorkee? Yes / No

b) Are you an employee of IIT Roorkee? Yes / No

c) Are you working in a Org./Univ./Inst. Approved by IIT Roorkee as Research Centre? Yes / No

NAME : (in block letters, as given in the qualifying degree certificate)

(IN ENGLISH)

Sex Male Female

Date of Birth Nationality

Fathers Name

Mothers Name

Address for Correspondence

Pin Code

Fax No.with STD Code ______________________ Telephone No. with STD Code :

Mobile No. __________________________ E-mail address :

Category : GEN OBC SC ST Foreigner NRI

Do you belong to person with disability (PD) category ? Yes / No

(Candidates belonging to OBC category must submit Xeroxed copy of category certificate as per GOI, the

format of the same is also available on the Institute website, OBC Non-creamy layer certificate should havebeen issued after 31.03.2011 by a competent authority and duly attested by Gazetted Officer.)

Application No.

Latest

Photograph

(Not to be

attested)

(Not to be filled by the Candidate)


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ACADEMIC RECORD

Details of marks/grades secured in the examinations passed.

Examinations SUBJECTS INSTITUTE/ YEAR MARKS/CGPA % of MARKS/

Passed UNIVERSITY of CGPA/GPA

Passing Max. Obtained (Aggregate)

10th Standard

10+2

UG( B.E./B.Tech/

B.Sc./ B.A.)

PG(M.E./M.Tech/M.Sc./

M.A./MCA/MBA)

M. Phil.

Details of Marks/ Grade Point Average secured in the Qualifying Degree Examinations

Name of the qualifying Degree Programme

(M.Tech./M.Sc./B.Tech./B.Arch. etc)Discipline/ Specialization (e.g. Electrical, Mechanical etc.)

Whether qualifying degree examination Passed (Tick) Yes / No Year of passing _________________

Details of Qualifying Degree Examination : Name of the University/Institute_____________________________

In case of grade system: GPA/ CGPA _________________________ On a ________________ point scale

In case of marks system: Aggregate Marks Obtained _______ Out of ________ Aggregate percentage_______

Medium of Instruction at Qualifying Examination level : English Hindi Others(Tick )

Relevant National Level examination qualified GATE CSIR/UGC NET/DST CEED

Year appeared _________________ Valid Upto ________________ GATE / Other score ______________

Discipline Chosen in GATE/NET/CEED_______________________________________________________________

Awards and Scholarships, if any, _________________________________________________________________

Any other relevant information which you want Research Experience Years ____ No. of papers published_____

to furnish. Teaching Experience Years ____ (Attach list giving details)(UG/PG level)

Professional Experience Years ____

Whether you were a student at IIT Roorkee previously and discontinued studies? Yes No

If Yes, give particulars of the Name of Academic Programme & Department , Year(s) and the reasons for

discontinuing the programme___________________________________________________________________

Duration

of

Course

Max. Marks / Marks/ GradeGrade Secured

Ist Semester IInd Semester

Max. Marks/ Marks/ GradeGrade Secured

TotalMax. Marks / Marks/GradeGrade Secured

Yearly SystemSemester System

Year of Study

Ist Year

IInd Year

IIIrd Year

IVth Year


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Proposed Broad Area of Research (e.g. Civil, Electrical, Physics etc.) ______________________________________

Give Sub-Areas of Proposed research priority wise :

1. ____________________ 2. _____________________ 3. _______________________ 4. _____________________

Write a paragraph on how your qualifications/ experience etc. are relevant to the proposed field of your research.

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

Employment Record :

Name of Employer(s) Period of Employement Designation & Salary Nature of Duties

Employed candidates seeking admission as full time / part time / sponsored category must submit

Application Form through their employer on the proforma given below.

NO OBJECTION / SPONSORSHIP CERTIFICATE

(Required from Full Time / Part Time / Sponsored candidates only)

The undersigned is pleased to sponsor Mr./ Ms. ............................................................................................ who

is working in this organisation for the last ....................... years and is presently holding the rank/ position of

.............................................. for pursuing Ph.D. programme in the Department of

................................................................................................................... with specialisation in the following areas

1. .................................................... 2. .................................................... 3. ....................................................

His/ Her conduct and character is good.

The Institution/ Organisation would allow/relieve him/her immediately for joining the above course, if selected for admission.

The Institution/ Organisation also agrees to PAY/ NOT PAY the contingent/ all expenses stipulated by the Institute. This

is further certified that the sponsorship for admission will not be withdrawn midway till completion of the Ph.D. programme.

Place : ............................................. Signature of the Head of the Institution/ Organisation with seal

Date : . .. .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Name .... ... .. ... .. ... .. ... .. ... .. ... .. ... .. ... .. ... .. ... .. ... .. ... .. ... .. ... ..

Designation .....................................................................


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UNDERTAKING

I, ...................................................................S/o/D/o.....................................................................

hereby undertake to abide by rules and regulations in vogue from time to time, and shall not indulge in any

act of indiscipline. The factual information given by me are correct.If at any time the information provided by

me is found to be incorrect, my admission be cancelled.

Date Signature of Candidate

Check List

i) Attested copies of the qualifying degree/ certificate and marks sheet showing the required % of marks/CGPA.

ii) Proof from the University/Head of the Institution of having appeared/passed in the qualifying Degree Exam.

iii) Attested Copy of GATE Score Card and its Admit Card /Equivalent National Test certificate.

iv) Attested Copy of SC/ST/OBC/PD certificate.

v) Certificates pertaining to No Objection/ Sponsorship on the proforma of the Application Form.

Note : Original Certificates will be required for verification on at the time of registration by the Institute.

latest ph_d_ application form

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