IIT


Application Form for Admission


Admission for the year Academic Year 2017-18
(NOTE: AT IIT-Indore, the AUTUMN Semester begins in July; while the SPRING semester begins in January.)
Program *
Discipline/Specialization * (NOTE: If applying for multiple disciplines submit separate applications for each discipline.)


Don't use these characters { ' ; --} and don't use Copy / Paste.

Please specify the Order-of-preference of Broad-areas of Specialization in the chosen discipline: *
NOTE: It is recommended that you explore the areas of research available with each discipline before filling this section. However, you are free to choose other areas as well.

Preference 1:   

Preference 2:   

Preference 3:   

Name * (as mentioned in the qualifying degree certificate)
Date Of Birth * (as per matriculation or equivalent certificate)
Father / Spouse Name *
Category *
Physically Disabled *
Marital Status *
Hostel Accommodation required * (Only Bachelor Hostel Available)
Gender *
Blood Group *
Nationality *

Permanent Address * Address for Correspondence *
Address *
City *
State *
Pin Code *
Address *
City *
State *
Pin Code *
* It is the responsibility of the candidate to intimate us about change in address if any.

Email Id *
Your Phone No *
Father / Spouse Phone No *


State Bank Collect ref. no.*
Date*
Amount* (use only numerical)


Category of Admission * (Note: Please read the information below)


Category of PhD admission under which you want to apply:
At present the Institute admits Ph.D. students under the following categories:
Full Time Scholars Categories-
TA (Teaching Assistantship): Teaching Assistantship with scholarship as per MHRD guidelines.#
FA (Fellowship Awardee): Fellowship Awardees from the agencies such as CSIR, UGC, NBHM, etc. OR JRF/SRF project staff working in a Sponsored Research Project under a faculty member (PI of the project) of IIT Indore. The scholarship will as per the rules/guidelines of the concerned funding agency.
SW (Sponsored WITHOUT Institute scholarship): Sponsored from a reputed Industrial or Research organization. (Full time)
IS: Institute staff (part time) WITHOUT any scholarship from the Institute.
EC: External Category Candidates from the central services and central government employees.
DF: Serving personnel in the defense forces WITHOUT any scholarship from the Institute.

#    
As per MHRD Directives, TA category Ph.D. student cannot accept or hold an appointment paid or otherwise or receive emoluments, salary, stipend from any other source during the tenure of TA ship. Candidates holding employment with or without pay with any organization/institution/establishment/project etc. if selected under the TA category must resign the job and submit the relieving certificate before joining the Ph.D. programme.
   

For Institute Fellowship Under TA category ALL candidates (Except students with ME / M.Tech. / M.Phil/MS from the accredited foreign university) should have qualified GATE.


Details of Education Qualification from Matriculation onwards: *
(Original Certificates should be produced at the time of interview)
Examination Degree/Examination Passed Branch/Subject University/ Institute Month & Year of Entering Month & Year of Passing % of Marks or CPI/CGPA out of 10 Class/Division


Details of qualifying examination like GATE, CSIR-JRF, UGC-JRF, CSIR-NET-LS, UGC-NET-LS or any other equivalent examination: *
(Original Certificates should be produced at the time of interview)
Name of
Examination
Subject of
Examination
Year of Passing Validity Period Number of Candidate
Appeared
Marks
Obtained
AIR
Rank
Score Percentile


Details of Professional / Work Experience:
Organization Designation Date-From Date-To Nature of Responsibilities


Present Employment status: *
If employed, details of the employer:
(Postal address, email, phone, fax, name of contact person and designation)


Details of the Bachelors and masters project / thesis / dissertation: *
Name of the University / Institute Year of submission Name of the supervisor Title


Details of the Research Experience* , if any (Details not more than 200 words.)



List of Publications *, if any (Details not more than 200 words.)
* mention in the order of giving name(s) of author(s), title of paper, details of the journal/conference, year, volume, page numbers.



Any other relevant information


Contact Details of the Referees:
(The referees may be contacted telephonically or through email to comment on you academic or professional capabilities:
In detail name,designation, organization,office address,office telephone(with STD code), email. )
Ref.1*:
Ref.2*:


Number of Enclosures attached with this application form:*


List of Enclosures:
(List of enclosures to be submitted along with the hard copy of this application.)