Doctor of Philosophy (PhD) Joint Program

Application Form A

Name:

IIT Bombay

PhD Application

Office Use Only Stu ent !D: """"""""""""""""

Section A # $o %e complete %y the applicant

&' Personal etails

Please place in appropriate %o(es

Title: Family Name: Given Names: Gender: Date of Birth: Permanent Address: Address that formal mail should be sent to during your andidature

Mr

Mrs

Ms

Dr

Other

Male Day Month

Female Year

Dates this address !ill be a""li able for: from: Day Month #ome: Year to: Day $or%: Month Year

Tele"hone No: &'mail address:

Please indi ate your iti(enshi" status: )ndian iti(en Australian or Ne! *ealand iti(en or Australian "ermanent resident and "ass"ort number: Other

)f other+ "lease state your ountry of iti(enshi":

Disclosure of )riminal )on*iction for an Applicant Please indi ate if there is anything in your "ast that !ould "revent you from gaining a visa to Australia or other ountry, -this may in lude "rior riminal onvi tions. Please refer to: htt"://!!!,immi,gov,au/media/fa t' sheets/01 hara ter,htm for more information Please in lude details -N)2 if there are none.:

All applicants shoul attach a copy (scanne copy for email su%mission) of their passport+ %irth or citi,enship certificate+ or of a ocument relating to their resi ency status'

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Propose enrolment etails

Day Month Year

-'& Pro"osed andidature ommen ement date:

Please in icate the first ate .hen you .ill %e a*aila%le to /oin'

-'- Pro/ect )hoices: You will need to select up to 4 Project Choices online when submitting this form at The Academy Form A Online Application System AFO!S"# which a$ailable at% http%&&www'iitbmonash'org&application(process& Please rea these points carefully:
)t is not necessary that you ha$e to choose 4 projects on the online system' On the online system# each of the projects that you ha$e selected will ha$e a set of *ideal+ or *re,uired+ capabilities' You will need to indicate how your bac-ground satisfies these re,uired capabilities' )f you are not able to demonstrate these capabilities# you may want to choose another project' There is li-ely to be a change to the list of projects pro$ided on the Academy )nternet website and the online system'

-'0 )apa%ility a.areness #ave you read the "ro3e t des ri"tions for the "ro3e ts you have hosen -Y/N.4 For Pro3e t Des ri"tions li % on the relevant "ro3e t numbers on the 5esear h Pro3e ts "age on the !ebsite: !!!,iitbmonash,org/resear h'"ro3e tsv6 #ave you filled in your res"onses to the a"ability re7uirements for the "ro3e ts you have hosen -Y/N.4

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$ertiary e ucational recor an moti*ation

8tatement-s. of your full tertiary aca emic history must accompany this application , Scans of the original a ademi trans ri"ts an be submitted, )f you are invited to intervie! you are e9"e ted to bring the original trans ri"ts to the intervie!, A""li ants !ho submit do uments in a language other than &nglish must "rovide an offi ially ertified translation+ together !ith the original do ument, Original a ademi trans ri"ts for verifi ation are to be "rodu ed to the De"uty 5egistrar+ A ademi + at ))TB and Monash 5esear h Graduate 8 hool at Monash :niversity at the time of enrolment+ after admission, Do not "rovide grades su h as ;Distin tion; or ;First <lass;, Provide your a tual <P)+ <GPA or grades+ li%e =,10/>? or ==,@A+ et ,
Degree or other 7ualifi ations held A!arding institution Year om"leted Ma3or or dis i"line #onours/Final grade

Fill in as much of this table as possible' Although completion of these e.ams is not a prerequisite for entry to the program# it would be an ad$antage to ha$e done so'

$ype of 1(am GAT& -if available. G5& 8 ore -if available. TO&F2 8 ore -if available. BAM: N&T Other' > -say <AT+ et . Other' 6 Other' C

Score

2an3

4ear of 1(am

Please note that the more detail you pro$ide in this section# the greater your chances of success'

5ain Su%/ects Stu ie :

Provide a des ri"tion here of the main sub3e ts that you undertoo% in your studies !hi h !ould be most relevant to the su essful om"letion of the "ro3e t-s. you have hosen online

5oti*ation:
In 200 words or less, tell us why you think The Academy should select you as a PhD Candidate?

6' Scholarship etails

Do you hold any s holarshi"s or other a!ards+ or are you s"onsored by an outside body eg industry or government' s"onsored a!ards4 No Yes

Give name of s holarshi"s+ a!ards or s"onsoring body:

<ategory -TA/TP/5A/PA/8F/8$/P8/<8)5/:G</FADet .

7' 8or3 e(perience

)ndi ate years of rele*ant e9"erien e in tea hing and / or resear h and / or industry,

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2esearch:pu%lications

Provide details of any original resear h and/or "ubli ations, For "ubli ations/abstra ts+ indi ate the "er entage of your ontribution+ eg sole ->??A.+ 3oint -@?A.+ multi authorshi" -6?A.+ and the nature and standing of the 3ournal/ onferen e, Also indi ate !hether in "ress -a e"ted for "ubli ation. or "ublished, -Atta h additional sheet if ne essary.

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1nglish proficiency
First language is &nglish An overall band s ore of not less than F,@ on the )&2T8 test ondu ted by )DP and the British <oun il, )n addition+ a s ore of at least F,? is re7uired for ea h band s ore and a""li ants must underta%e the a ademi module in regard to reading and !riting, The follo!ing s ores a hieved in the Ameri an Test of &nglish as a Foreign 2anguage -TO&F2.: A minimum total s ore of @00 together !ith a s ore of @ or more on the TO&F2 Test of $ritten &nglish -T$&. -"a"er based s ore.G A minimum total s ore of 6CC together !ith a s ore of @ or more on the &ssay 5ating -&5. - om"uter'based s ore.G or A minimum total s ore of 1> -internet based s ore. together !ith a minimum s ore of 6@ in the !ritten test and a minimum s ore of 66 in ea h of the reading+ s"ea%ing and listening tests,

Please "la e E in the bo9 indi ating ho! you have satisfied the &nglish language re7uirements for admission,

8u essful om"letion of a ourse of tertiary studies of at least t!o yearsH duration ondu ted entirely in &nglish and involving formal assessment of !ritten !or%+ in a ountry !here &nglish is the offi ial language, &viden e in the form of a letter or ertifi ate issued by the university 5egistrarHs offi e !ill need to be "rovided, 8tudies must be om"leted !ithin the five year "eriod "rior to a""li ation,

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2eferees

)n lude the name of at least 6 a ademi referees in the table belo!, P=1AS1 uploa referee reports to the applications portal' $e may onta t them to se ure their feedba % on you, Note that you are !el ome to in lude more than 6 referees:
Name of 5eferee <onta t details in luding "hone and email #o! do you %no! this referee4

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Declaration %y applicant

Note: The information on this form is olle ted for the "rimary "ur"ose of assessing your a""li ation for admission to PhD andidature, Other "ur"oses of olle tion in lude the reation of an enrolment re ord on the student database+ attending to administrative matters+ orres"onding !ith you and statisti al analyses, )f you hoose not to om"lete all the 7uestions on this form+ it !ill not be "ossible for us to assess your a""li ation, Personal information may also be dis losed to the relevant bodies for the verifi ation of your 7ualifi ations and it may be dis losed to government agen ies as re7uired by legislation, You have a right to a ess "ersonal information !e hold about you+ sub3e t to any e9 e"tions in relevant legislation, )f you !ish to see% a ess to your "ersonal information or in7uire about the handling of your "ersonal information+ "lease onta t the :niversity Priva y Offi er on F>'C' 11?@ F?>> -at Monash :niversity. and De"uty 5egistrar -A ad,. at 1>'66'6@0F 0?I> -at ))T Bombay., Please note that the re7uirements of the PhD "rogram at The A ademy means that you !ill not be able to arry out any "art time !or% and you !ould need to abide by the additional em"loyment onditions relating to ea h institution,

D1)=A2A$!ON: ! eclare that ) have read the instru tions on this a""li ation form and that the information "rovided by me is true and om"lete, ) re ognise that it is my res"onsibility to "rovide all ne essary do umentation to su""ort my a""li ation and ) authorise the )nstitute/:niversity to obtain offi ial student re ords from any edu ational institutionG or to verify my "ast and urrent em"loyment for the "ur"ose of ma%ing an informed de ision about the a""li ation or matters that on ern my admission and enrolment in this ourse, ! accept that do umentation "rovided by me !ill be ome the "ro"erty of ))T Bombay/Monash :niversity and made available to om"etent authorities !hen re7uired, ) have read and understood the above onditions and a e"t them fully, ! ac3no.le ge that ))TB/Monash :niversity reserves the right to vary or reverse any de ision regarding admission or enrolment made on the basis of in orre t or in om"lete information, ) have read and understand the above onditions and am "re"ared to a e"t them in full, $hen you are submitting this form ele troni ally "lease send it !ithout a signature+ but "rint your name as !ell as the ate you filled the form in, By inserting your name and date you are asserting that all of the information on this form is true+ om"lete and a urate, Any Form A which is su!mitted without a name and date on it may not !e considered"

8ignature:

Date:

Please see the instructions at the front of this form as .ell as the FA? on the .e%site (...'iit%monash'org) for etails on su%mitting your application