Beruflich Dokumente
Kultur Dokumente
CATEGORY:______
GIPEDIAPPLICATIONFORM
BATCH:
Year:
____(1/2/3/4)
Mode:
EARLYDECISION
REGULARDECISION
FromTable3
oFemale?
GENDER
Name:
FIRSTNAME
MIDDLENAME
SURNAME
Mailing
PHOTOWITHWHITE
BACKGROUNDWEARING
WHITEORLIGHTCOLORED
CLOTHING(pleasewriteyour
nameontheback)
Address:
(____)
Tel#:
Mobile:
_ _ / _ _ / _ _ _ _
D D
M M Y Y Y Y
DATEOFBIRTH
email(s):
OFFICIALEMAILADDRESSFIRST;ALTERNATIVEFREEEMAILADDRESSESALSOMAYBEGIVENASSECONDEMAIL
Discipline
CURRENTINSTITUTE:
ACADEMICPROFILE(ONLYSTATEMARKSOBTAINED;DONOT ENCLOSECOPIESORORIGINALSOFANYCERTIFICATE)
Class10:
LANGUAGE1
SCIENCE
MATHS
PHYSICS
CHEMISTRY
BIO
MATHS
SEM1
SEM2
SEM3
SEM4
SEM1
SEM2
SEM3
SEM4
LANGUAGE2
AGGREGATE
RANK,IFANY
OTHER: LANGUAGE1
AGGREGATE
RANK,IFANY
AGGREGATE
RANK,IFANY
SST
Class12:
BACHELORS
SEM5
SEM6
SEM7
MASTERS
RANK,IFANY
PROPOSED TOPIC OF
INTERNSHIP (ONE
ONLY):
IhaveattachedmyStatementofPurposeseparately(StatementofPurpose:Pleaseattachseparatelyseepage20(maximum1
pagetypedinsinglespace12ptfont).
Ihaveattacheddescriptionsofmyprojectsdonesofar(Attachseparately(maximum1typedpage)seepage21givingdetailsof
teamsize,yourspecificcontributions,thedeliverables,significanceofwhatyoudidandhighlightingobjectivesmet.)
CONCURRENCEOFFACULTYMENTORINIITDELHI(OPTIONAL[seeFAQ2.10]/ONLYNEEDEDIFYOUALREADYHAVEA
MENTOR'SCONSENTdonotfillanameifyouhavenotobtainedaprioragreementinwritingfromtheproposedFacultyMentor ):
Signature:
FACULTYMENTORINIITD:
OfficeTel:
IITDemail:
Date:
(BeforeconsentingtobecomeFacultyMentors,FacultyareadvisedtoseeGUIDELINESFORSELECTINGSTUDENTSavailableat
http://sites.google.com/site/gipediinterns/guidelinesforfacilitators)
IhavereadtheGUIDELINESFORSELECTINGSTUDENTS(FacultyMentormustfillthisbox)
IhavefilledandsignedtheFacultyConsentForminPartBandenclosedit(FacultyMentormustfillthisbox)
LOCALADDRESS(REQUIREDONLYFORAPPLICANTSWHOARENOTAPPLYINGUNDERANYMoU
SUCHASIASc,KVPY,etc)
I state that I have a local address to stay in Delhi / NCR and, if selected, will make my own
arrangements for stay and travel to IIT Delhi as per Internship timings without any pre-conditions
INSTITUTIONALCONSENT(FROMTPO):
Iforwardthisapplication,havingreadand
agreeingtocomplywithalltermsand
conditionsoftheGIPEDI.
LOCAL
Address:
Signature
Tel#:
(____)
Mobile:
NAME:
email(s):
Seal:
OFFICIALEMAILADDRESSFIRST;ALTERNATIVEEMAILADDRESSESALSOMAYBEGIVENASSECONDEMAIL
DECLARATIONBYTHEAPPLICANT
1 Iherebycertifythatbysigningandsubmittingthisapplication,Icertifytheabovefactstobetrue.
NAME:
2 IalsoagreethatifIapplyforanyBatchotherthanaupcomingBatch(i.e.anybatchforwhichtheapplicationisnotbeing
advertised),theapplicationfeesshallbeforfeitedandmyapplicationshallnotbeprocessedfurtherunlessIhaveappliedunder
theEarlyDecisionScheme.
3 Indemnity:Ialsotakefullresponsibilityforanyaccident/lossandagreetoinsuremyselfagainstanysuchaccident/lossoflife/
disabilitytomyselfarisingdirectlyorindirectlydueto/duringtheinternship.IagreethatFITTorIITDelhiwillNOTbeheld
responsibleorliableforcompensationinanymannerforanysuchaccident/lossoflife/disabilitytomyself.
oEDAPPFEEs
PAYMENTDETAILS EXEMPT
DATE:
PLACE:
DD#:
Signature
Rs:
BANK:
Pleasesendthecompletedapplicationto:GIPEDIProgram,FITT(Attn:Prof.SubratKar/Mr.K.K.Roy),IITDelhi,HauzKhas,NewDelhi110016India
PARTA
GIPEDIAPPLICATIONFORM
CATEGORY:______
FromTable3
STATEMENTOFPURPOSE:Ifyouneedtoincluderichmediaormatterwhichcannotbeenclosedastextsuchasvideo,images,
audiopleasefeelfreetogiveaweblinkbelowwherethemediacanbefound.PleaseuseaURLshorteningservicesuchas
bitly.comortinyurl.com.
Ihavemoreinformationwhichcanbefoundat:
http://
Pleasesendthecompletedapplicationto:GIPEDIProgram,FITT(Attn:Prof.SubratKar/Mr.K.K.Roy),IITDelhi,HauzKhas,NewDelhi110016India
PARTA
GIPEDIAPPLICATIONFORM
CATEGORY:______
FromTable3
StatementofProjectAbstracts/WorkExperience(Foreachproject,pleasegivethetitle,teamsize,yourrole,scopeofwhat
youdid,significanceofwhatyoudid,approximatemandays,anyreferee(s)andtheircontactemailandphone) Ifyouneedto
includerichmediaormatterwhichcannotbeenclosedastextsuchasvideo,images,audiopleasefeelfreetogiveaweblink
belowwherethemediacanbefound.PleaseuseaURLshorteningservicesuchasbitly.comortinyurl.com.
Ihavemoreinformationwhichcanbefoundat:
http://
Pleasesendthecompletedapplicationto:GIPEDIProgram,FITT(Attn:Prof.SubratKar/Mr.K.K.Roy),IITDelhi,HauzKhas,NewDelhi110016India
PARTA
GIPEDIAPPLICATIONFORM
CATEGORY:______
FromTable3
TellusaboutyourselfintheformofanessayaboutwhatyouexpecttoachieveasanIntern( highlightanythingspecialwhich
youthinkwillallowyoutocontributetothecommunityhereatIITDelhi ).Ifyouneedtoincluderichmediaormatterwhich
cannotbeenclosedastextsuchasvideo,images,audiopleasefeelfreetogiveaweblinkattheendwherethemediacanbe
found.PleaseuseaURLshorteningservicesuchasbitly.comortinyurl.com.
Ihavemoreinformationwhichcanbefoundat:
http://
APPLICANT RECOMMENDATION FORM (please photocopy this blank form if you need more LoRs)
Pleasesendthecompletedapplicationto:GIPEDIProgram,FITT(Attn:Prof.SubratKar/Mr.K.K.Roy),IITDelhi,HauzKhas,NewDelhi110016India
PARTA
CATEGORY:______
GIPEDIAPPLICATIONFORM
FromTable3
(please ensure that you print or photocopy both pages of this form on the two sides of the same sheet of paper, not on separate sheets)
Please answer the following questions (no box should be left unfilled in this table as that will disqualify the recommendation ) :
(FITT/IITD OFFICE to insert) the Handling # here :
Respondent Referee's Name
Title (Prof. / Dr. / Mr. / Ms.)
Applicant Name:
Designation
Year / Discipline:
Institution/Employer
Phone number:
(Areacode)
Good
Superior
Outstanding
Analytical Ability
Research Ability
Ability to master academic work
Fundamental knowledge in field
Skill/originality of research work
Lab / hands-on skills
Research productivity (papers
published/ talks given etc)
Ability in oral expression
Ability to write
Motivation towards a career
Initiative
Emotional stability and maturity
Self-reliance and independence
Ability to work with others
Ability to work in multicultural
environment
Leadership potential
Integrity
Creative or innovative talent
Imagination / Original thought
Potential for success in chosen
area
Growth observed during period
OVERALL RATING
OVERALL RANKING
Best student this year Best student in . Years Top .% of students this year Unable to rank
Pleasesendthecompletedapplicationto:GIPEDIProgram,FITT(Attn:Prof.SubratKar/Mr.K.K.Roy),IITDelhi,HauzKhas,NewDelhi110016India
PARTA
CATEGORY:______
GIPEDIAPPLICATIONFORM
FromTable3
Against which group are you rating the applicant ? For example, all under-graduate students I have taught in the past four years.
years and
As As Research Advisor
months
As Course Advisor
NO
NO
YES
UnNot
Fairly
Not Applicable
enthusiastical
recommended
strongly
ly
YES
YES
Strongly
Enthusiastically
, without
reservation
Please type your name, understanding that it is legally equivalent to your signature (if this recommendation is sent by electronic means) and constitutes your
certification that your responses and assessments are accurate and fair to the best of your knowledge.
Full Address of respondent (in
capitals)
(Name)
(Line1)
(Line2)
(City)PIN
State:
Signature of Respondent
Date
Place
PLEASESIGN,SEALSECURELYINAENVELOPEANDRETURNTOAPPLICANT.
ThecontentsofthisletterareCONFIDENTIALandmustNOTbeshowntotheApplicant.
ThelettermustbefilledinbytheRefereeinhis/herownhandwriting.
TherecommendationisonlyacceptableinthisformataseparateLetteronyourLetterheadisnotacceptable.
Thankyouforyourtime.
PARTA
CATEGORY:______
GIPEDIAPPLICATIONFORM
FromTable3
Please answer the following questions (no box should be left unfilled in this table as that will disqualify the recommendation ) :
Respondent Referee's Name
(FITT/IITD OFFICE to insert) the Handling # here :
Title (Prof. / Dr. / Mr. / Ms.)
Applicant Name:
Designation
Year / Discipline:
Institution/Employer
Phone number:
(Areacode)
Good
Superior
Outstanding
Analytical Ability
Research Ability
Ability to master academic work
Fundamental knowledge in field
Skill/originality of research work
Lab / hands-on skills
Research productivity (papers
published/ talks given etc)
Ability in oral expression
Ability to write
Motivation towards a career
Initiative
Emotional stability and maturity
Self-reliance and independence
Ability to work with others
Ability to work in multicultural
environment
Leadership potential
Integrity
Creative or innovative talent
Imagination / Original thought
Potential for success in chosen
area
Growth observed during period
OVERALL RATING
OVERALL RANKING
Best student this year Best student in . Years Top .% of students this year Unable to rank
Pleasesendthecompletedapplicationto:GIPEDIProgram,FITT(Attn:Prof.SubratKar/Mr.K.K.Roy),IITDelhi,HauzKhas,NewDelhi110016India
PARTA
CATEGORY:______
GIPEDIAPPLICATIONFORM
FromTable3
Against which group are you rating the applicant ? For example, all under-graduate students I have taught in the past four years.
years and
As As Research Advisor
months
As Course Advisor
NO
Not
recommended
NO
YES
YES
YES
Enthusiastically,
without
reservation
Please type your name, understanding that it is legally equivalent to your signature (if this recommendation is sent by electronic means) and constitutes your
certification that your responses and assessments are accurate and fair to the best of your knowledge.
Full Address of respondent (in
capitals)
(Name)
(Line1)
(Line2)
(City)PIN
State:
Signature of Respondent
Date
Place
PLEASESIGN,SEALSECURELYINAENVELOPEANDRETURNTOAPPLICANT.
ThecontentsofthisletterareCONFIDENTIALandmustNOTbeshowntotheApplicant.
ThelettermustbefilledinbytheRefereeinhis/herownhandwriting.
TherecommendationisonlyacceptableinthisformataseparateLetteronyourLetterheadisnotacceptable.
Thankyouforyourtime.
Pleasesendthecompletedapplicationto:GIPEDIProgram,FITT(Attn:Prof.SubratKar/Mr.K.K.Roy),IITDelhi,HauzKhas,NewDelhi110016India
PARTA
GIPEDIAPPLICATIONFORM
CATEGORY:______
FromTable3
Pleasesendthecompletedapplicationto:GIPEDIProgram,FITT(Attn:Prof.SubratKar/Mr.K.K.Roy),IITDelhi,HauzKhas,NewDelhi110016India