HOW TO APPLY The candidate is required to download Bank Challan Proforma along with the application form from

www.iitr.ernet.in/admissions and then deposit the requisite fee of Rs. 200/- in any branch of Punjab National Bank throughout the country. The Bank Challan will be printed in triplicate. It is only available on Institute website and pay the fees through it. Bank will retain a copy and will return two copies to you. In those two copies, retain the Candidates copy with you and attach the IITRs copy with the application form.

OR
In case Punjab National Bank Branch is not available at his/her place or nearby place, then send the demand draft of Rs.200/- in favour of Chairman PG Admission, IIT Roorkee payable at Roorkee. The completed application form should be sent to Chairman, PG Admission-2012, IIT Roorkee in A4 size envelop only. Note:- Separate application be sent for separate departments/centres and for each department/centre separate fees will be required with each completed application form.

BANK COPY
Punjab National Bank (Challan Form) Ph.D. Admission for Spring Semester 2011-12 session I.I.T. Roorkee, Roorkee

CANDIDATES COPY
Punjab National Bank (Challan Form) Ph.D. Admission for Spring Semester 2011-12 session I.I.T. Roorkee, Roorkee

I.I.T.R. COPY
Punjab National Bank (Challan Form) Ph.D. Admission for Spring Semester 2011-12 session I.I.T. Roorkee, Roorkee (To be enclosed by the applicant with his/her application)

Account No.
IFSC CODE:

4044000100112597
PUNB0404400

Account No.
IFSC CODE:

4044000100112597
PUNB0404400

Account No.
IFSC CODE:

4044000100112597
PUNB0404400

Date Name of Candidate Fathers Name : City : : Rs. 200/Rs. 10/Total Rs. 210/:

Date Name of Candidate Fathers Name : City : : Rs. 200/Rs. 10/Total Rs. 210/:

Date Name of Candidate Fathers Name : City : : Rs. 200/Rs. 10/Total Rs. 210/:

Department Applied for Application Fee

Department Applied for Application Fee

Department Applied for Application Fee

Branch Transaction Charges :

(Transaction charges if any are to be borne by the candidates)

Branch Transaction Charges :

(Transaction charges if any are to be borne by the candidates)

Branch Transaction Charges :

(Transaction charges if any are to be borne by the candidates)

Signature of the Depositor Address

Signature of the Depositor Address

Signature of the Depositor Address

Phone No. :

Phone No. :

Phone No. :

Authorized Signatory Stamp

Authorized Signatory Stamp

Authorized Signatory Stamp

Application No.
(Not to be filled by the Candidate)

INDIAN INSTITUTE OF TECHNOLOGY ROORKEE

ROORKEE-247 667, Uttarakhand, India APPLICATION FORM FOR ADMISSION TO Ph.D. PROGRAMMES FOR SPRING SEMESTER -2011-12 1. Separate Application Form should be used for each Department/Centre. Latest 2. Enclose attested copies of all certificates with this Form. Bring original certificates at Photograph the time of Interview/Test and Admission. 3. Giving false information will lead to cancellation of Admission. (Not to be 4. No column should be left blank. Write Not Applicable against a column if the same attested) does not apply to you. 5. Tick ( ) the relevant box wherever provided. 6. Application incomplete in any respect, is liable to be rejected. 7. Candidates who are in the final year of their qualifying examination can be considered for admission only if they complete the requirement of their final examination including Viva-Voce before the registration date.

Name of Department/Centre in which admission is sought :

Details of Fee Paid : Challan Ref./DD No. __________ Dated __________ Amount ________ Bank Name________ Note: IITR Copy of Bank Challan/ Demand Draft must be attached with the application form.

Proposed Status If PART TIME

Full Time

Part Time

Sponsored

Self Financed

a) Whether working in a project at IIT Roorkee? Yes / No b) Are you an employee of IIT Roorkee? Yes / No c) Are you working in a Org./Univ./Inst. Approved by IIT Roorkee as Research Centre? Yes / No

NAME : (in block letters, as given in the qualifying degree certificate) (IN ENGLISH) Sex Date of Birth Fathers Name Mothers Name Address for Correspondence Male Female Nationality

Pin Code Fax No.with STD Code ______________________ Mobile No. __________________________ Category : GEN OBC SC Telephone No. with STD Code : E-mail address : ST Yes / No Foreigner NRI

Do you belong to person with disability (PD) category ?

(Candidates belonging to OBC category must submit Xeroxed copy of category certificate as per GOI, the format of the same is also available on the Institute website, OBC Non-creamy layer certificate should have been issued after 31.03.2011 by a competent authority and duly attested by Gazetted Officer.)

ACADEMIC RECORD
Details of marks/grades secured in the examinations passed.
Duration of Course

Examinations Passed

SUBJECTS

INSTITUTE/ UNIVERSITY

YEAR of Passing

MARKS/CGPA Max. Obtained

% of MARKS/ CGPA/GPA (Aggregate)

10th Standard 10+2 UG( B.E./B.Tech/ B.Sc./ B.A.) PG(M.E./M.Tech/M.Sc./ M.A./MCA/MBA) M. Phil. Details of Marks/ Grade Point Average secured in the Qualifying Degree Examinations Name of the qualifying Degree Programme (M.Tech./M.Sc./B.Tech./B.Arch. etc) Discipline/ Specialization (e.g. Electrical, Mechanical etc.) Whether qualifying degree examination Passed (Tick ) Yes / No Year of passing _________________

Details of Qualifying Degree Examination : Name of the University/Institute_____________________________ Year of Study Ist Year IInd Year IIIrd Year IVth Year In case of grade system: GPA/ CGPA _________________________ On a ________________ point scale In case of marks system: Aggregate Marks Obtained _______ Out of ________ Aggregate percentage_______ Medium of Instruction at Qualifying Examination level (Tick ) : English Hindi Others
Ist Semester Semester System IInd Semester

Yearly System
Total Max. Marks / Grade Marks/ Grade Secured

Max. Marks / Marks/Grade Max. Marks/ Marks/ Grade Grade Secured Grade Secured

Relevant National Level examination qualified

GATE

CSIR/UGC NET/DST

CEED

Year appeared _________________ Valid Upto ________________ GATE / Other score ______________ Discipline Chosen in GATE/NET/CEED_______________________________________________________________ Awards and Scholarships, if any, _________________________________________________________________ Any other relevant information which you want Research Experience to furnish. Teaching Experience (UG/PG level) Years ____ No. of papers published_____ Years ____
(Attach list giving details)

Professional Experience Years ____ Whether you were a student at IIT Roorkee previously and discontinued studies? Yes No

If Yes, give particulars of the Name of Academic Programme & Department , Year(s) and the reasons for discontinuing the programme___________________________________________________________________

Proposed Broad Area of Research (e.g. Civil, Electrical, Physics etc.) ______________________________________ Give Sub-Areas of Proposed research priority wise : 1. ____________________ 2. _____________________ 3. _______________________ 4. _____________________ Write a paragraph on how your qualifications/ experience etc. are relevant to the proposed field of your research. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________

Employment Record : Name of Employer(s) Period of Employement Designation & Salary Nature of Duties

Employed candidates seeking admission as full time / part time / sponsored category must submit Application Form through their employer on the proforma given below. NO OBJECTION / SPONSORSHIP CERTIFICATE (Required from Full Time / Part Time / Sponsored candidates only) The undersigned is pleased to sponsor Mr./ Ms. ............................................................................................ who is working in this organisation for the last ....................... years and is presently holding the rank/ position of .............................................. for pursuing Ph.D. programme in the Department of

................................................................................................................... with specialisation in the following areas 1. .................................................... 2. .................................................... 3. .................................................... His/ Her conduct and character is good. The Institution/ Organisation would allow/relieve him/her immediately for joining the above course, if selected for admission. The Institution/ Organisation also agrees to PAY/ NOT PAY the contingent/ all expenses stipulated by the Institute. This is further certified that the sponsorship for admission will not be withdrawn midway till completion of the Ph.D. programme.

Place : ............................................. Date : ..............................................

Signature of the Head of the Institution/ Organisation with seal Name .......................................................................... Designation .....................................................................

UNDERTAKING
I, ...................................................................S/o/D/o..................................................................... hereby undertake to abide by rules and regulations in vogue from time to time, and shall not indulge in any act of indiscipline. The factual information given by me are correct.If at any time the information provided by me is found to be incorrect, my admission be cancelled. Date Signature of Candidate

Check List
i) ii) iii) iv) v) Attested copies of the qualifying degree/ certificate and marks sheet showing the required % of marks/CGPA. Proof from the University/Head of the Institution of having appeared/passed in the qualifying Degree Exam. Attested Copy of GATE Score Card and its Admit Card /Equivalent National Test certificate. Attested Copy of SC/ST/OBC/PD certificate. Certificates pertaining to No Objection/ Sponsorship on the proforma of the Application Form.

Note : Original Certificates will be required for verification on at the time of registration by the Institute.