Application No: PHD120375

INDIAN INSTITUTE OF TECHNOLOGY ROORKEE

APPLICATION FOR ADMISSION TO Ph.D. PROGRAMMES
FOR SPRING SEMESTER 2012-13
1. Separate Application should be used for each Department/Centre. 2. Enclose attested copies of all certificates with this Application. Bring original certificates at the time of Interview/Test and Admission. 3. Giving false information will lead to cancellation of Admission. 4. Application incomplete in any respect, is liable to be rejected. 5. 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 VivaVoce before the registration date.

A Passport Size Photograph should be pasted in this space

Name of Department/Centre in which admission is sought : PHD - Physics Proposed Status: Full Time Approved Research Centre: If PART TIME a) Whether working in a project at IIT Roorkee? b) Are you an employee of IIT Roorkee? c) Are you working in a Org./Univ./Inst. Approved by IIT Roorkee as Research Centre? : No : No : No

NAME : PURNA CHANDRA PATRA Gender : Male Nationality : Indian Fathers Name : BISHNU MOHAN PATRA Mothers Name : MINATI LATA PATRA Address for Correspondence : UGC-DAE CSR HOSTEL NEAR SHIVMANDIR INDRAPURI COLONY INDORE MADHYA PRADESH Pin Code : 452001 Mobile No. : 8962521515 Fax No. : Category :GEN Telephone No.: e-mail address : purnaphy@gmail.com Person with disability (PD) : No Date of Birth : 24-Jul-1989

ACADEMIC RECORD
Details of marks/grades secured in the examinations passed. Exam Passed 10th Standard 12th Standard Duration Subjects Institute/Universit Year of Passing 2004 Marks Obtained 522.00 Max % of Marks Marks 750.00 69.60

1 2

GENERAL PHY,CHEM,MA TH,BIO PHYSICS SOLID STATE PHYSICS

B.SC M.SC

3 2

BANIA HIGH SCHOOL CHARAMPA COLLEGE,BHAD RAK FAKIR MOHAN UNIVERSITY UTKAL UNIVERSITY

2006

587.00

900.00

65.22

2009 2011

1,448.00 1,800.00 790.00 1,000.00 0.00 0.00

80.44 79.00 0.00

Details of Marks/ Grade Point Average secured in the Qualifying Degree Examinations

Name of the qualifying Degree Programme: M.Sc. Discipline/ Specialization of Qualifying Degree: SOLID STATE PHYSICS Whether qualifying degree examination Passed: Yes Year of passing: 2011 Name of the University/Institute: UTKAL UNIVERSITY
Semester/Year First Fourth Second Third Marks/CGPA Obtained Max Marks/Scale Semester/Yearly System

186.000 201.000 198.000 205.000

250.000 250.000 250.000 250.000

Semester System Semester System Semester System Semester System

GPA/ CGPA / Marks Obtained 790.000 Out of 1000.000 point scale/Max.Marks Medium of Instruction at Qualifying Examination level : English Relevant National Level examination qualified : GATE Year appeared 2012 Valid Upto 15 MARCH 2014 GATE / Other score 410.00 Discipline Chosen in GATE/NET/CEED: PHYSICS Awards and Scholarships, if any : I got a scholarship when i was in m.sc.

Any other relevant information which you want to furnish : Research Experience Years 0 No. of papers published 0 Teaching Experience (UG/PG Level) Years 0, 0 (Attach list giving details) Professional Experience Years 0 Whether you were a student at IIT Roorkee previously and discontinued studies? 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 :solid state physics Give Sub-Areas of Proposed research priority wise : 1. material science 2. nanotechnology 3. 4. paragraph on how your qualifications/ experience etc. are relevant to the proposed field of your research I have solid state physics as my special paper in m.sc. I am very much interested in superconductivity. Employment Record :

Organisation

Post

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Nature of Duties

Presently Working

Employed candidates seeking admission as full time / part time / sponsored category must submit Application 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. PURNA CHANDRA PATRA 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, PURNA CHANDRA PATRA S/o, /D/o
BISHNU MOHAN PATRA 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) Attested copies of the qualifying degree/ certificate and marks sheet showing the required % of marks/CGPA. ii) Proof from the University/Head of the Institution of having appeared/passed in the qualifying Degree Exam. iii) Attested Copy of GATE Score Card and its Admit Card /Equivalent National Test certificate. iv) Attested Copy of SC/ST/OBC/PD certificate. v) 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.