Indian Institute of Technology Rajasthan

Application Form for Admission to M.Tech. Programme

Web Advertisement No.: IITJ/ ACAD/ 2011/ 02, dated 30-03-2011

For office use : Sl. No. ACAD/MTech/2011/

Demand Draft Amount:Draft. No.......................Draft Date:................ Drawn in Bank:...................................................................

the back side of the draft) (Write Name of the Applicant on

1.(a) Name:........................................................... (b) Father/ Guardians Name: .......................................................................... (c) Addresses:

Affix passport size Photograph

i) For correspondence ............................................................................ ............... ............................................................................ ............... ............................................................................ ............... ............................................................................ ............... Email: Fax:
..

ii) Permanent ............................................................ ............................................................ ............................................................ ............................................................ Phone:

(b) Age (as on 20-04-2011): (d) Marital Status: (f) Category:

2. (a) Date of Birth (dd/mm/yyyy): .. (c) Gender (Male / Female): ................................. (e) Nationality:.... ...

Please specify category GENERAL / OBC (Creamy layer) / OBC(Non-creamy layer) / SC / ST / PD (Person with Disability) (In case of OBC(Non-creamy layer), SC/ ST/ PD, Enclose attested copies of necessary certificate)

3.(a) Centre(s) of Excellence to which the M.Tech. admission is sought by the candidate: . . .. (b) Are you applying to M.Tech.. programme in other Centre of Excellence in IIT Rajasthan? YES / NO If yes, write the name of other CoE(s) to which applied M.Tech.: (c) Student Status: Regular and Full Time

(d) Your Qualifying Degree with Discipline:

4. Details of Universities/Institutions attended (from 10th standard onwards) (Attested copies of certificates and mark sheets/grade cards must be attached) Degree/ Exam (with discipline) 10th Class 12th Class University/College/ Board Year % Marks/ CGPA/ CPI* Class Obtai ned Subjects taken

* If final year qualifying degree examination results are awaited, please indicate average percentage of marks or CPI of examinations up to the last year (in case of system with annual examination)/last semester (in case of semester system). Final Results Expected by...

5. a) GATE Qualification (Attested copy of certificate must be enclosed. Also, fill-in the required information by going through the prescribed eligibility criteria): Subject GATE Score GATE Marks* All India Rank Valid up to

GATE cut-off qualifying =

marks

for GN:

OBC:

SC/ST:

* GATE marks above cut-off shall only be considered.

b) Any other source for fellowship/ scholarship:

6. a) Professional Experience (Teaching/ Research/ Industrial) if any ( proof to be attached). Name of Organization Period (i) (ii) Position held Type of work

(b)List of publications/projects if any: (Attach a separate sheet with details, if required)

7. Names and addresses (including Email and Phone Number) of two referees who are familiar with your academic background and credentials: (i) (ii )

8. Enclosures

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 promise to abide by the rules and regulations of the Institute. I note that the decision of the Institute is final in regard to selection for admission and assignment to a particular CoE/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 any information furnished by me is incorrect. Place: Date: Signature of the Applicant Note:. The completed application form with all necessary enclosures and along with the processing fee of Rs.300/- for General/ OBC candidates and Rs.150/- for SC/ ST / Person with Disability (PD) candidates in the form of demand draft drawn in favour of Director, IIT Rajasthan payable at Jodhpur should be submitted to Convener M.Tech Admissions Centre of Excellence in . Indian Institute of Technology Rajasthan 4

Old Residency Road, Ratanada Jodhpur 342 011, Rajasthan