For Office Use

Degree: Department: Date of Receipt Reg No.

raYT/Iya |aoooOVaooigakI saMsqaana Agartlaa

National Institute of Technology, Agartala

Application Form for Admission to Ph.D. Programme, July December, 2013 session

Barjala, Tripura - 799055

1. Name (In Block letter): ..

. Male Female P

2. Fathers / Husbands name: .. 3. Mothers name:.. 4. Address: (a) For correspondence (Including Mobile no) (b) Permanent

Stamp Size Photo

(c) Email: 5. (a) Date of Birth :. (b) Age on 01.07.2013: .

(d) Phone :

(e) Fax :

(e)Marital Status: (f) Nationality: ..

(c) Whether SC/ST/OBC (if yes, a certificate must be attached) 6. (a) Department to which the candidate seeks admission: (b) Category: ( Tick ) Regular Part-time Sponsored Institute Staff Project Staff External

7. Details of Universities/Institutions attended (from 10th Standard onwards) (Attested copies of mark sheets/ grade cards of each examination passed must be attached).
University / College / Board Degree obtained (with discipline) Year % Marks / CGPA / CPI Class /Div Obtained Subjects taken

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

(I) GATE Subject

Score

Valid up to

(II) UGC/CSIR NET Date of qualifying

Valid up to

9. (a) Professional Experience (Teaching/Research/Industrial) if any (Documentary evidence to be attached).

Sl No
(i) (ii)

Name of organization

Position held

Type of work From

Period To

(b) Attach a list of publications/projects etc. separately, if any:

10. (a) If employed, name of the present employer: (b) Whether employers permission obtained?: Yes No (c) If yes, whether NOC in form-I/II/III is enclosed?: (d) Total period of service up to the date of application: 11. List of Enclosures: a c e g i b d f h j

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 undertake to abide by the rules and regulations of the Institute as exist and amended from time to time. 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 information furnished by me are false or incorrect. I shall abide by the decision of the Institute, which shall be final.

Signature of the applicant For office use only a. To be filled in by Departmental Admission Committee after verification and selection test i i % of B.Tech marks/Grade Performance of Selection Test ii % of M.Tech/M.Phil marks/ Grade ii Position in order of merit ii GATE/NET Score iii Category(General/SC/ST/OBC)
i

Place : Date :

Recommendation for admission (with / without scholarship):

Signature of member Signature of member Signature of member Departmental PG Admission Committee

Chairman,

b. To be filled in by Central Admission Committee: (i) Verified and found suitable and recommended to Chairman, Senate for admission (ii) Recommended/ Not recommended for Ph.D Assistantship (iii) Not recommended for admission .. (Signature of members): ..........

.......................................................... c. Admitted on approval from Chairman, Senate.

Date:

Dean (Academic)

Sponsorship Letter
(This should be typed on the letter head of the sponsoring organization) To, Reference No. The Director National Institute of Technology, Agartala. Sub: Sponsoring an Employee for PhD Programme Dear Sir, We hereby sponsor the candidature of Mr./Mrs./Ms. ____________________ ____________________________ time student. It is certified that he/she has completed 1(one) year of service in our organization/institute as a regular employee. We shall relieve him/her from his/her duties in the organization during the first three years of the Ph.D. Programme. who is an employee in our organization, for joining PhD programme in __________________________at your institute as a full-

Date:

Signature and Seal of the Sponsoring Authority.

No-Objection Certificate for Part-Time Students (This should be typed on the letter head of the sponsoring organization) To, Reference No. The Director National Institute of Technology, Agartala. Sub: No-Objection Certificate Dear Sir, We have no objection if Mr./Mrs./Ms. ___________________________ ________________________________ an employee in our organization, is admitted to the Ph.D. Programme in __________________________ at your institute as a PART-TIME student. It is certified that he/she has completed 1(one) year of service in our organization/institute as a regular employee. We shall grant him/her leave of absence to attend classes/research works at NIT Agartala during the Ph.D. Programme. Date:

Signature and Seal of the Sponsoring Authority.

Sponsorship Certificate of External Registration (This should be typed on the letter head of the sponsoring organization) To, The Director National Institute of Technology, Agartala. Sub: Sponsoring an Employee for PhD Programme for External Registration. 1. Name of the sponsoring organization: 2. Address: 3. Designation of the applicant: 4. Present status of the applicant: 5. List of Division/Section where research work is proposed to be done: 6. List of available local supervisor(s): (Bio-Data of local supervisor(s) to be enclosed giving details of designation, qualification, research experience with area of research etc. along with their consent for research guidance) 7. Details of relevant facilities which will be made available to the candidate: It is certified that he/she has completed 1(one) year of service in our organization/institute as a regular employee. If Mr./Mrs./Ms. ______________________________________ is admitted to the Ph.D. programme, we agree to relieve him/her to enable him/her to be available at NIT Agartala to attend classes for completion of his/her course works relating to the Ph.D. programme. Mr./Mrs./Ms. ____________________________________________________ will be permitted to carry out research leading to the Ph.D. degree at our organization under the guidance of selected local supervisor. The necessary facilities will be provided for the purpose. Reference No. Date:

Signature and Seal of the Sponsoring Authority.