INDIAN INSTITUTE OF TECHNOLOGY GANDHINAGAR

Application Form for Admission to Doctoral Programme

Ph.D. Program in: Disciplines: Chemical Engineering, Chemistry, Civil Engineering, Cognitive Science, Computer Science and Engineering, Electrical Engineering, English, Mechanical Engineering, Materials Science & Engineering, Mathematics, Physics, Philosophy, Psychology, Sociology Research Areas of Interest: (Please refer to Faculty Research Profiles at www.iitgn.ac.in/phd.htm) Paste passport size photograph

Name (as in qualifying degree certificate) Paste passport First Name size photograph Middle Name Last Name Contact details Address for communication:

Permanent Address:

City: State: Telephone Number Date of Birth

Pin Code Mobile Number Nationality

City: State: Email Address: Alternate Email Address: Gender

Pin Code

Category: GN/OBC/SC/ST/PD

Category under which you want to apply (Please check appropriate box) Regular (RR): Fulltime residential researcher candidate Start Early (RR): Fulltime residential researcher candidate* External (ET): Candidates serving in research institution/Industry** Faculty Development Program (FDP): Candidates serving in educational Institutions only**

*All Start early (RR) applications must include signed letter/certificate from head of department indicating rank of the candidate at the end of 6 semesters **All ET/FDP applications must include employers support/sponsorship letter

Rank in your discipline after 6 semesters in BTech/BE programme (For Start Early (RR) category)
Must be supported by a signed letter/certificate from the head of the department stating the rank of the candidate

GATE/UGC-NET/CSIR-UGC performance Name of Examination Year Score Percentile All India Rank (AIR)

Details of academic record (From 12th onwards for Start early (RR) and Bachelors onwards for Regular (RR), ET and FDP) Degree Subject College University/ Institute Year of Passing Class/ Division % of Marks/Grade /CGPA

Details of Any Research/Professional Experience or Publication

Details of any past employment Organization Designation Duration From To

Declaration: 1. I have carefully read the web-advertisement and the faculty research profiles uploaded on the web 2. The SOP submitted with the application form was written only by me. 3. I hereby declare that the information given above is correct to the best of my knowledge and belief. I am also aware that providing incorrect information in the application form can result in the cancellation of my admission at any stage. Place: Date: Signature of the Applicant

Please send the completed application form to the following address with PhD Application written on the envelop Assistant Registrar (Academics) Indian Institute of Technology Gandhinagar VGEC Campus, Chandkheda Ahmedabad 382424 Phone: 09328474222, Fax: 07923972324 E-mail: academics@iitgn.ac.in

Check List for Enclosures: Copy of Mark sheets / Grade cards (From 12th onwards for start early and Bachelors onwards for RR,ET

and FDP) Statement of purpose Copy of GATE score/UGC-NET/CSIR-UGC (if applicable) Copy of Certificate of SC/ST/OBC (if applicable) Signed letter/certificate from head of department indicating rank of the candidate at the end of 6 semesters (in case of Start early Program candidates) Employers support/sponsorship letter (in case of External/Faculty Development Program candidates)