INDIAN INSTITUTE OFTECHNOLOGYKANPUR

APPLICATIONFFORADMISSION TOPOST-GRADUATEPROGRAMME

(Forfilling thisapplication form, please see instructions overleaf)

1.Full Name :


Paste your photograph here

2.Date of Birth: 3.Place of Birth: 4.Gender: Male/Female

5.Marital Status:6. Nationality :

7.Father’s Name:

8.Address of Correspondence:

State: Pin Code:

9. Contact Details:

Phone No. : Mobile No. :

E-mail address :

10. Details of DemandDraft


CodesforItems11-15aregivenoverleaf

11. Department/Programme

12. Admission forDegree

13. Student Status

14. Financial Status

15. Category

16. Physically DisabledYes / No

a) Amount Rs. ……………………………………..… No.…………………..……….. Date………………………….………

b) Issued by(Bank Name & Branch) …………….…………………….…………….……….……………………………………..

17.Academic Record/Work Experience

A. GATE/CSIR/UGC, otherfellowship exam details

Exam Name / Exam discipline / GATE Score/CSIR/UGC Rank / ExamYear

B. Qualifying Degree alreadyobtained or inprogress

Institute/ College
(Name &Address) / University
(Name &Address) / Discipline / Degree / Exam Date / Final results expected by / Pass Marks % orGrade Average
% Marks or
Grade Average / Sem. I / Sem. II / Sem. III / Sem. IV / Overall% or
GradeAverage
(if degree completed)
Sem. V / Sem. VI / Sem. VII / Sem. VIII

C. Other Degrees obtained after 10+2 (Do not include the degree listed in 17 B)

Institute/ College
(Name &Address) / University
(Name &Address) / Discipline / Degree / Marks or
CPI / Date of completion

D. Working Experience

Dates (from-to) / Employer / Position / Nature ofWork

E. Numberof Technical Papers:Publishedin JournalsPresented in Conferences

Providedetailsseparately

18. Areasof specialization inthe Department/Programme (See InformationBrochure)

Pref. 1Pref. 2

Pref. 3Pref. 4

19. Names and addresses of two referees from whom lettersofreference have been obtained (For Ph.D. applicants only)

1.2.

20. Declaration bythe applicant:

Certified,thatallinformationprovidedbymeonthisformiscorrecttothebestofmyknowledgeandbelief. Iunderstandthatany willfulmisrepresentationoffactswillresultinmydismissalfromtheinstitute. Ifadmitted,Ishallabidebyalltherulesandregulationsofthe institute.

Date :Signature :

INSTRUCTIONS FOR FILLING THIS FORM

1.This form is to be used for applying to all Departments and IDPs,

2.EitherTYPE or WRITEthe entrieson the form neatly.

3.Go through the codesforItems 11-15 given below, and fill them carefully inthe boxes onPage 1.

CODES(FORITEMS11-15)

Item 11:Department/ProgrammeCodes:{AerospaceEngg.=AE},{CivilEngg.=CE},{ComputerScienceEngg.=CSE},{Earth Sciences = ES}, {ElectricalEngg.=EE},{IndustrialManagementEngg.=IME}{Mechanical Engg. = ME}, {Materials Science Engg. = MSE} {Chemistry = CHM}, {Mathematics and Statistics = MTS}, {HumanitiesSocialSciences=HSS},{MaterialsScienceProgramme=MSP},{Nuclear Engg.Technology=NET},{Photonics Science & Engg.=PSE},{BiologicalSciencesandBio-Engineering =BSBE}.

Item 12: PH =Ph.D.MT = M.Tech. DS = Design, MS= MS(Research) only in (Chemical Engg. = CHE, Civil Engg. = CE, Electrical Engg. = EE, Mechanical Engg. = ME, Photonics Science & Engg. = PSE)

Item 13: Student Status:Full Time = FT; Part-Time= PT, External= EXT; Foreign National = FN

Item 14: Financial Status:

Sponsored = SD; InstituteAssistantship requested= IA;Fellowship(if CSIR/UGC/DBT/ICAR/ICMR) = FEL;

Other(exceptional case which is other than these three)= OTH

Item 15: Category:

SC=Scheduled Caste (certificate required); ST=Scheduled Tribe (certificate required);

OBC=Other Backward Class (Non-creamy layer); GN=General;FN=Foreign Nationals;

CHECKLIST (CIRCLETHEENCLOSEDDOCUMENTS). Send OnlySelf-attested Copies.

(Original certificates must be produced at the time of admission).

1.Date of Birth(DOB) CertificateorHigh School(ClassTen) Certificate with DOB

2.SC/ST/OBC(NCL)Certificate,if applicable(Item 15). Certificate format is given on the website.

3.Certificate of PhysicalDisability, if applicable (Item 16). Certificate format is given on the website.

4.Sponsorship certificate for sponsored candidates. (Item 14)

5.GATE/CSIR/UGC score card (Item 17A) (Computer generated printout is also accepted)

6.Copies of mark/gradesheets of qualifying degree or higher (Items 17B & 17C)

7.Two letters of reference (forPh.D.applicants only)

MailingAddress forSubmission ofApplications:

The Joint Registrar

Dean, Academic Affairs

Room No. 211, PG Section

Indian Institute of Technology Kanpur

Kanpur – 208 016 U.P., India