Indian Institute of Technology Indore

IET Campus: IET-DAVV Campus, Khandwa Road, Indore 452 017 (M.P.) Ph.: 0731-2438719, Fax: 0731-2364182 (for Basic Sciences & HSS) PACL Campus: 113/2-B (Opp. to Veterinary College), Village Hernia Khedi, MHOW Road, Indore 453 446 (M.P.) Ph.: 07324-240701 (for Engineering) Application Form for Admission

IIT Indore

A. Admission for the Year:

Semester:

Autumn (

) or Spring (

Paste (do not pin) passport size

B. Registration No.: (To be filled in by the Office) C. Programme.: (Please tick) M.Tech ( ) or M.Tech + Ph.d. Dual Degree ( ) )

photograph in this space

Communication & Signal Processing ( ) M.Sc. ( ) or M.Sc.+ Ph.D. Dual Degree ( Chemistry ( Ph.D. ( ) ) )

Production & Industrial Engineering ( ) )

Physics (

Computer Science Engineering ( Chemistry ( Psychology ( Philosophy ( ) ) )

Electrical Engineering ( Mathematics ( Sociology ( English ( ) ) )

Mechanical Engineering ( Physics ( )

Bioscience and Bioengineering (

1. Full Name in Capital Letters: (as mentioned in the qualifying degree certificate)
Type or Write Legibly in English Keep one block blank between the two words

2. Date of Birth: (as per matriculation or equivalent certificate): (Original Certificate should be produced at the time of interview) (DD/MM/YYYY)

3a. Category GN/OBC-NC/SC/ST (Original Certificate should be produced at the time of interview)

3b. Physically Disabled (Yes/No)

3c. Marital Status (Single (S)/ Married (M))

3d. Hostel Accommodation required (Yes/No)

4. Sex (M/F)

5. Nationality

6. Contact details*: (a) Address for Correspondence:

(b) Permanent Address:

City: State:

Pin Code

City: State:

Pin Code

Telephone Number (with STD code)

Mobile No

E-mail Address(s)

* It is the responsibility of the candidate to intimate change of address. 7. Category of PhD admissionunder which you want to apply: (in order of preference) At present the Institute admits PhD students as Full Time categories of: Full-Time Scholars CategoriesA. Teaching Assistantship (TA) # B. Govt./ Semi-Govt. Fellowship Awardees (FA) (CSIR, UGC, DAE, DBT, NBHM, Commonwealth, Nehru Memorial Doctoral Fellowship, etc.)
# As per MHRD Directives, candidate selected under TA category cannot accept or hold any appointment paid or otherwise or receive any emoluments, salary, stipend from any source during the tenure of TA ship. Hence, candidates selected as TA and having employment with or without pay with any organization/institution/establishment/project etc. must leave the job and submit relieving certificate before joining the Ph.D. programme under TA category.

1)

2)

For Institute Fellowship i.e. Teaching Assistantship (Except students with ME/M.Tech./M.Phil degree) all candidates should have qualified GATE or CSIR-JRF or CSIR -NET or UGC-JRF or UGC-NET. 8. Details of Educational Qualifications from Matriculation onwards (Original Certificates should be produced at the time of interview) Degree/ Branch/Subject University/ Institute Examination Passed

Month & Year of Entering

Month & Year of Passing

% of Marks or CPI/CGPA

Class/ Division

9. Details of qualifying examination like GATE, CSIR-NET, UGC-NET, or any other equivalent examination (Original Certificates should be produced at the time of interview) Name of Examination Year of Passing Validity Period Number of Candidates Marks AIR Rank Appeared Obtained

Score/Percentile