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Application No (to be filled by office).

: __________

INDIAN INSTITUTE OF SPACE SCIENCE AND TECHNOLOGY


(Declared as Deemed to be University under section 3 of the UGC act 1956)
Government of India, Department of Space, Thiruvananthapuram – 695547

Application Form – February 2011 Admission


Department Code for which applying (Refer to the website)
Research Areas in which interested (Refer to the website):

1. Name : ______________________________________________________ Affix a self-attested


recent passport size
2. Address for correspondence: _____________________________________ photograph
_____________________________________________________________

____________________________________ Pin _____________________

E-mail _______________________________________________________

Telephone No. ________ ______________ Mobile (if any) ___________________

3. Date of Birth (DD-MM-YY) (Please attach proof of age): ________________________

4. Father’s Name: _____________________________Mother’s Name:________________________________

5. Gender: _________________________

6. Marital Status: ____________________

7. Whether you belong to: SC/ST/OBC _______________________________________

8. Qualifying Degree _________________________

University ____________________________________ College __________________________________

Year of passing ________

Aggregate Marks________% or CGPA__________out of __________

Class /Grade _________

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9. Details of academic record (Attested copies of mark sheets/certificates to be enclosed):

Remarks
Degree / Name of Year of % of marks/
Level Subjects /Distinction
Certificate Board/University passing GPA obtained
/Division
Secondary

Higher
Secondary
Bachelor

Master

Other (if any)

10. Whether Qualified any National Eligilibity Test: ____________________________________________


(UGC/CSIR/GATE/JEST/ICMR/DBT/NBHM,etc. Attach proof)

11. Professional Experience / Other achievements / List of Publications if any:_______________________


(Attach separate sheet)

12. Areas of interests along with a statement of purpose and research experience (if any) in about 150 words.
(Attach separate sheet)

13. Demand Draft No._____________________________________

Declaration

I declare that all information provided by me in the application is true to the best of my knowledge and belief. I
understand that I am liable for prosecution if any of the information is found to be false at anytime in future.

Date: _______________________________

Place: (Signature of the candidate)

List of Enclosures:

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