Indian Institute of Technology Guwahati

Application Form for Admission to MTech and MDes Programmes

For office use Sl. No. ACAD/MTech/MDes/11/ For Department’s use Reg. No. M/
GATE/CEED
Demand Draft No......................dated.........................drawn in Bank.........................................................
Marks:

1.(a) Name: Mr/Ms/Mrs.............................................................………………………… Affix passport size

Photograph
(b) Father/Husband/Guardian ...........................................................................

(c) Addresses:

i) For correspondence ii) Permanent

................................................................................... ...........................................................................
................................................................................... ...........................................................................
.................................................................................. ...........................................................................

Email: Phone: Fax:

2. (a) Date of Birth (dd/mm/yyyy):……….......................... (c) Marital Status:……….................................

(b) Nationality:………….………......... (d) Category: GEN/OBC(Non-creamy layer)/SC/ST/PD: ………………..
(Please specify category, and enclose attested copies of necessary certificates)

3. (a) Department to which the candidate seeks admission :....................................................................

(b) Are you also applying to any other Department? Yes/No.
If yes, list the other Department(s):
(c) Category : ( Tick
)

Regular Sponsored IITG’s Project Staff Part-Time

(Full-Time)

(d) Choice for area of specialisation, in order of preference (if given in the advertisement) :
(i)
(ii)
(iii)
(iv)
(v)
(vi)
th
4. Details of Universities/Institutions attended (from 10 standard onwards)#
(attested copies of certificates and mark sheets/grade cards must be attached)
University/College/ Degree obtained Year % Marks/ Class Subjects taken
Board (with discipline) CGPA/ CPI obtained

# (a) Candidates still to appear in their qualifying degree examinations may also apply, provided they appear in all their
qualifying degree examinations and complete all requirements for their degrees before 19-07-2011. If selected, such
candidates shall be admitted provisionally, and they will have to furnish the results of their qualifying degree
examinations latest by 02-09-2011, failure to which their admissions shall stand automatically cancelled.
(b) 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).
 5. a) GATE/CEED Qualification (Attested copy of certificate must be enclosed. Also, fill-in the required
information by going through the prescribed eligibility criteria):

Subject GATE/CEED GATE All India Rank Valid up to

Score Marks*

* 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 organisation Position held Type of work Period

(i)

(ii)

(iii)

(b) List of publications/projects if any:

(Attach a separate sheet with details, if required)

7. List of 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 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
Please note:
Application fee of Rs. 150/- (for Gen/OBC candidates) and Rs. 75/- (ST/SC/PD candidates) must be
sent with this application by a demand draft drawn in favour of IIT Guwahati and payable at
Guwahati.
 Form I - Sponsorship Letter
(This should be typed on the letterhead of the sponsoring organisation)

Ref. No.:
Date:
To,
The Director,
Indian Institute of Technology Guwahati

Sub: Sponsoring an Employee for Mtech/MDes Programme.

Dear Sir,

We hereby sponsor the candidature of Mr./Ms.________________________________ who is an

employee in our organisation, for joining MTech/MDes programme in
_____________________________________ at your Institute as a full-time student.

It is certified that he/she has completed 2(Two) years of service in our organisation/institute as
a regular employee.

We shall relieve him/her of his/her duties in the organisation during the two years of the MTech/MDes
programme.

Signature and Seal of the

Sponsoring Authority.

Form II – No Objection Certificate for Part-Time Students

(This should be typed on the letterhead of the sponsoring organisation)

Ref. No.:
To, Date:
The Director,
Indian Institute of Technology Guwahati

Sub: No - Objection Certificate

Dear Sir,

We have no objection if Mr./Ms. ____________________________________________, an employee in

our organisation, is admitted to MTech/MDes programme in
_____________________________________ at your Institute as a part-time student.

It is certified that he/she has completed 2(Two) years of service in our organisation/institute as
a regular employee.

We shall give him/her leave of absence to attend classes/research work at IIT Guwahati during the two
years of the MTech/MDes programme.

Signature and Seal of the

Sponsoring Authority.
 Form III – No Objection Certificate for IIT Guwahati’s Project Staff
(This should be typed on the letter head of the R&D Section of IIT Guwahati)

Ref. No.:
To, Date:
The Director,
Indian Institute of Technology Guwahati

Sub: No Objection Certificate for IIT Guwahati’s Project Staff

Dear Sir,

The R&D Section of IIT Guwahati, has no objection if Mr./Ms./Mrs. ______________________, a

project employee in the project ________________________________________ under
_______________________________ department, is admitted to the MTech/MDes programme in
____________________________________ .

The Principal Investigator of the concerned project has agreed to allow him/her to attend
classes/research works during the MTech/MDes programme.

Signature and Seal of the

Dean(R&D),IIT Guwahati
 ANNEXURE-I

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES

APPLYING FOR ADMISSION TO CENTRAL EDUCATIONAL INSTITUTIONS (CEIS)
UNDER THE GOVERNMENT OF INDIA

This is to certify that Shri/Smt./Kum..……………………………………………Son/daughter

of Shri/Smt..…………......…………...................................Village………..................…………
District/Division…………………………..........……in……………….............…….State, belongs
to……………………………………………………………community which is recognized as a
backward class under

(i) Resolution No. 12011/68/93-BCC(C) dated 10/09/93 published in the Gazette of India
Extraordinary Part I Section I No.186 dated 13/09/03.
(ii) Resolution No. 12011/9/94-BCC dated 19/10/94 published in the Gazette of India Extraordinary
Part I Section I No.163 dated 20/10/94.
(iii) Resolution No. 12011/7/95-BCC dated 24/05/95 published in the Gazette of India Extraordinary
Part I Section I No. 88 dated 25/05/95.
(iv) Resolution No. 12011/96/94-BCC dated 9/03/96.
(v) Resolution No. 12011/44/96-BCC dated 6/12/96 published in the Gazette of India Extraordinary
Part I Section I No.210 dated 11/12/96.
(vi) Resolution No. 12011/13/97-BCC dated 03/12/97.
(vii) Resolution No. 12011/99/94-BCC dated 11/12/97.
(viii) Resolution No. 12011/68/98-BCC dated 27/10/99.
(ix) Resolution No. 12011/88/98-BCC dated 6/12/99 published in the Gazette of India Extraordinary
Part I Section I No.270 dated 06/12/99.
(x) Resolution No. 12011/36/99-BCC dated 04/04/2000 published in the Gazette of India
Extraordinary Part I Section I No.71 dated 04/04/2000.
(xi) Resolution No. 12011/44/99-BCC dated 21/09/2000 published in the Gazette of India
Extraordinary Part I Section I No.210 dated 21/09/2000.
(xii) Resolution No. 12015/9/2000-BCC dated 06/09/2001.
(xiii) Resolution No. 12011/1/2001-BCC dated 19/06/2003.
(xiv) Resolution No. 12011/4/2002-BCC dated 13/01/2004.
(xv) Resolution No. 12011/9/2004-BCC dated 16/01/2006 published in the Gazette of India
Extraordinary Part I Section I No.210 dated 16/01/2006.

Shri/Smt./Kum. _____________________________________ and/or his family ordinarily

reside(s) in the _______________________ District/Division of _______________________
State. This is also to certify that he/she does not belong to the persons/sections (Creamy
Layer) mentioned in Column 3 of the Schedule to the Government of India, Department of
Personnel & Training O.M. No. 36012/22/93-Estt.(SCT), dated 08/09/93, and as revised
from time to time.

Dated:
District Magistrate/Dy Commissioner etc.,
NOTE: (a) The term “Ordinarily resides” used here will have the same meaning as in Section 20 of the
Representation of the Peoples Act, 1950.
(b) The Authorities competent to issue caste certificates are indicated below:
(i) The District Magistrate/Additional Magistrate/Collector/ Deputy Commissioner/Additional Deputy
Commissioner/ Deputy Collector/First Class Stipendiary Magistrate/ Sub- Magistrate/Extra Assistant
Commissioner (not below the Rank of First Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
(iii) Revenue Officer not below the rank of Tehsildar; and
(iv) Sub-Divisional Officer of the area where the candidate and/or his family resides.
 ANNEXURE-II

Declaration / Undertaking – for OBC Candidates only

I, Shri/Smt./Kum. ____________________________________, son / daughter of Shri/Smt.

_____________________________________, resident of village/town/city

__________________, district ___________________State __________________, hereby

declare that I belong to the ______________________Community which is recognized as a

backward class by the Government of India for the purpose of reservation in admission in

Central Educational Institutions as per orders contained in Department of Personnel and

Training Office Memorandum No. 36012/22/93-Estt.(SCT), dated 8/9/1993. It is also

declared that I do not belong to persons/sections (Creamy Layer) Mentioned in Column 3 of

the Schedule to the above referred Office Memorandum, dated 08.09.1993, and as revised

from time to time.

Signature of the Candidate

Place:…………………………

Date: …………………………

Declaration/undertaking not signed by candidate will be rejected