Indian Institute of Technology Guwahati

Application Form for Admission to MTech/MDes/PhD

Programme for FOREIGN APPLICANTS

For Department/Centre’s use: Reg. No.F/

1.(a) Name (as in qualifying degree certificate) : / Affix passport size Photograph
______
(b) Father/Husband/Guardian ______
(c) Addresses:
i) For correspondence / ii) Permanent
...... / ......
...... / ......
...... / ......
Email: ______/ Phone No. (With ISD Code) ______
Mobile No. ______/ Skype id: ______
(It is the responsibility of the candidate to intimate change of address, if any to the Dean of Alumni Affairs & External Relations,
IIT Guwahati at )
2. (a) Date of Birth : date …… month ……….year…….. / (b) Marital Status:………......
(b) Nationality: ...... / (d) Passport No. ………………………………..
(e) Passport valid up to ______/ (f) Date & Place of issue:______
(attach photocopy of the Passport)

(g) Are you a self –financed student (Yes/No): ______(in case of ‘yes’ 1 & 2 to be completed)

1. A signed statement certifying that you will bear all the charges including the tuition fees, accommodation, food charges and all other incidental charges along with an updated bank statement showing sufficient balances to pay fees and other charges during the stay at IITG.

2.  If you are from Afghanistan, China, Iran, Pakistan, Iraq, Sudan, foreigners of Pakistani origin and stateless persons you are hereby requested to forward your admission application from the Indian embassy in your country . Pl. see point 9 below.

3. M.Tech/M.Des/PhD programme in : (For M.Des and PhD(Design) kindly see the link http://www.iitg.ernet.in/design/ first )

(i)  ______

(ii)  ______

Areas of research interest (in order of preference):

(i)  ______

(ii)  ______

4. Details of Universities/Institutions attended (from 12th standard onwards) (attested copies of certificates and mark sheets/grade cards must be attached)

Name of degree or / Board/ / Duration of / Year of passing
Level of examination / Country / % Marks/ CGPA/ CPI **
certificate / University / programme

Equivalent to 10+2 level exam of CBSE or ICSE, India*

Graduate (Bachelors) level

Post-graduate (Masters) level

Other

* e.g. General Certificate Education (GCE) Examination (London/Cambridge/Sri Lanka) at the Advanced (A) level, or High School Certificate Examination of the Cambridge University, etc.

** Mention the grading scale also (e.g. 3.5 out of 4.0, etc.) if marks are not awarded

5. a) Professional Qualifying Examination passed (attested copy of certificate must be attached):

(1) GATE & CEED*** / (2) UGC/CSIR NET/Others***
Subject / Score / All / Valid / Subject / Date of / Valid up to
India / up to / Qualifying
Rank

***  Applicable, if the candidate was resident in India and appeared in such examinations

b)  Performance in Competitive Examination (Such as GRE, GMAT)

Name of the exam ______Year ______Score ______

6. a) Medium of instruction at Undergraduate/Graduate level: ______

b)  Knowledge of English: (If medium of instruction was not English, suitable proof about the proficiency in English should be submitted)

7. a) Professional Experience (Teaching/ Research/ Industrial) if any (proof to be attached).

Name of the / Period held / Nature of duties / Name of supervisor / Period
university/organisation/Industry / (with email id)

(b)  List of publications/projects if any:

(Attach a separate sheet with details, if required)

8. Employment details:

Name and address of the organization / Designation / Period / Total duration (in months)

From To

7. List of Enclosures :

8.  Referee (Name and address) :

(Please send a letter of reference in a sealed envelope from the Head of Department or a Professor of the Institute/University you last studied)

Name:

Designation/Position:

Address:

9.  No objection from Embassy for those students who belong to the country (Afghanistan, China, Iran, Pakistan, Iraq, Sudan, foreigners of Pakistani origin and stateless person) .

The admission application of Mr./Ms. ______belongs to ______

(Write the name of the country) is hereby forwarded to IITG for admission to M.Tech/M.Des/PhD.

Signature and Seal of the

Embassy officials

Declaration

I hereby declare that the entries made in this application form are correct to the best of my knowledge and belief. If selected for admission, I promise to abide by the rules and regulations of the Institute.

I note that the decision of the Institute is final in regard to selection for admission and assignment to a particular department and field of study. The Institute shall have the right to take any action it deems fit, including expulsion, against me at any time after my admission, if it is found that any information furnished by me is incorrect.

Place:

Date: Signature of the applicant

(To the Referee – In addition to responding to the items below, please comment specifically on the applicant’s strength and limitations for the proposed study and also proficiency in English. Please use the backside of this form or attach a letter. The referee is requested to put this form in a sealed envelope and sign across the seal before handing it over to the candidate.)

LETTER OF REFERENCE

For admission of foreign students in Indian Institute of Technology Guwahati, Guwahati, India

I have known Mr. /Ms./Mrs. ______, who intends to apply for the MTech/PhD

programme in Indian Institute of Technology Guwahati, for ____ years. I have known the applicant in my capacity as

(please tick √ where applicable):
instructor in one or more courses / supervisor
employer / other: / please / explain

The candidate ranked approximately ______in a class of about ______students.

The following are my ratings on his qualities (please tick):

Quality / Excellent / Good / Above / Average / Below / Unable to
average / average / judge
Background preparation
Analytical ability
Potential research ability
Motivation
Diligence
Oral Communication
Written Communication
Overall / evaluation
For the proposed study, I (please tick where appropriate)
highly recommend / recommend
recommend with some reservation / do not recommend the candidate.
Signature of the Referee: / Date :
Name of the Referee: / Position/Designation:
Address:
Telephone No. / Fax No. / e-mail address