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Indian Institute of Technology Hyderabad

Academic Section
Convocation Registration Form
Convocation Date: 08- Aug- 2014


Roll No. :

Full Name (in English) : _________________________________________________________
(Block Letters)

Full Name (in Hindi) : ______________________________________________________________
Program: _____________ Dept. (with stream)______________Year of Completion: _____________
Contact Details : _______________________________________________________________
_______________________________________________________________
_______________________________Phone:_________________________
Mobile No. ____________________________________E-mail id: ____________________________










Please indicate the number of persons accompanying: _____________________________
(with name & relationship, not more than 2) :______________________________
Fee Paid Details: Challan Journal No. / Unique ID: ___________________________________


Select one of the following options
Yes, I shall attend the convocation and receive the degree in person.
A Challan for Rs. 300/- is enclosed herewith as fee for receiving the degree in
person.

No, I shall not be attending the convocation. A Challan for Rs. 300/- is
enclosed herewith as fee for receiving the degree in absentia.
I will come and collect the Degree certificate in person at IITH.
Please send the Degree Certificate to my following address.
_________________________________________________________
_________________________________________________________

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Instructions to Students:
Please ensure that you have cleared all the institute dues.
It is mandatory to attend the convocation rehearsal scheduled on 07
th
Aug 2014.
Please collect your gowns before rehearsal on payment basis.
Submit this form along with Accounts copy of the challan/e-receipt, either in
person/by speed post/ by email (convocation2014@iith.ac.in ) latest by 16
th
July,
2014 to the following address:
The Dean Academic Program
Academic Section, Indian Institute of Technology Hyderabad
ODF Estate, Yeddumailaram
Medak Dt. Telangana. Pin: 502 205
Please note that due to limited infrastructural facilities, no accommodation
facility is available on Yeddumailaram campus. Inconvenience caused is
regretted.
For any queries please contact Academic Section Phone No.- (040) 2301 6026
(or) email to (convocation2014@iith.ac.in )

Date: ____________________ Signature of the student
Name:
To be filled by PG students only
Thesis Title:
Name of the Supervisor:
Name of the Co-Supervisor:
Date of Joining the Institute:
Date of Thesis/Dissertation submission:
Date of Defense:
Date of Conversion (for Dual Degree):