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 in the PhD Programme A. PhD Admission for the Year: _____________________ Semester: _____________________ B. Department/Discipline: _________________________________________________________ C. Registration No.:_______________________________________________________________ (To be filled in by the Office)

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IIT Indore

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

5. Nationality

(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)

1)

2)

(CSIR, UGC, DAE, DBT, NBHM, Commonwealth, Nehru Memorial Doctoral Fellowship, etc.) C. Foreign Scholars (FS) *
# 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. Sponsored candidates have to submit letter of sponsorship based on Appendix I/ II/ III/ IV respectively depending on the category in which you seek admission.

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 Score/Percentile Appeared Obtained

10. Details of Professional/ Work Experience: (Original Certificate should be produced at the time of interview) Organization Designation From Date To Nature of Responsibilities

11. Present Employment status: (Employed /Not Employed) If employed, then details of the employer:

12. Details of the Research Experience:

12 (A). Details of the Bachelors and Masters project/ thesis/ dissertation Name of the University/ Institute Year of submission Name of the supervisor Title

12 (B). List of Publications*, if any (Attach a separate sheet if required) * mention in the order of giving name(s) of author(s), title of paper, details of the journal/conference, year, volume, page numbers.

13. Broad Area of Specialization in which intend to work in the PhD programme:

14. Any other relevant information (Attach a separate sheet) 15. Contact Details of the Referees: (The referees may be contacted telephonically or through email to comment on you academic or professional capabilities) Particulars Name Designation Organization Office Address Referee 1 Referee 2

Office Telephone (with STD code) Email 16. Number of Enclosures attached with this application form:

17. Declaration: I do hereby solemnly declare that the information given above is correct to the best of my knowledge and belief. I am fully aware that I must submit attested copies of my qualifying degree certificate / final transcripts, failing which, my admission will stand canceled. I am also aware that providing incorrect information in the application form can result in the cancellation of my admission at any stage.

Place:

Signature of the Applicant with date Name of the Applicant:

Please post ONLY the completed application form (no photocopies of certificates) to the following address in an envelope (27 cm x 20 cm) without folding the application materials. The envelope should be marked Application for Ph.D. admission in the Discipline of _________" and should be sent to the respective Head, of School or the Concerned Faculty to the respective address (IET campus for School of Sciences and School of HSS and PACL campus for the School of Engineering) To, The Head of School of -------------------- (or Concerned Faculty Name) Indian Institute of Technology Indore --------------------------------------------- (Address of the respective campus) Indore, MP, India Phone: 0731-2438719 (IET Campus); 0732-4240701 (PACL Campus) Website: www.iiti.ac.in

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 Science & HSS) PACL Campus: 113/2-B (Opp. Ti Veterinary College), Village Hernia Khedi, MHOW Road, Indore 453 446 (M.P.) Ph.: 07324-240701 (for Engineering)

IIT Indore

Statement of Purpose (Attach separate sheet for details, if required) Statement of Purpose (SoP) is an opportunity for the applicant seeking admission to the PhD programme at IIT Indore, to share your thoughts with the Admissions Committee about why you want to pursue PhD studies. While writing the SoP, please describe briefly about the past project / research work done by you. However, restrict yourself to 300-350 words. The personal SoP will aid the admission committee in evaluating your application.

Place:

Signature of the Applicant with date Name of the Applicant: