INDIAN INSTITUTE OF TECHNOLOGY ROORKEE

APPLICATION FOR ADMISSION TO Ph.D. PROGRAMMES

FOR AUTUMN SEMESTER 2017-18

A Passport Size
1. Separate Application should be used for each Department /Centre.
2. Enclose self attested copies of all certificates with this Application . Bring original certificates Photograph
at the time of Interview/Test and Admission. should be
3. Giving false information will lead to cancellation of Admission . pasted in this
4. Application incomplete in any respect, is liable to be rejected. space
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 Viva -
Voce before the registration date.

Application No: ESD17203978

Name of Department/Centre in which admission is sought : ESD - Earth Sciences

Proposed Status: Full Time

Approved Research Centre: -

Working Status: No Job Status: Not Applicable

If PART TIME a) Whether working in a project at IIT Roorkee? : No

b) Are you an employee of IIT Roorkee? : No
c) Are you working in a Org./Univ./Inst. Approved
by IIT Roorkee as Research Centre? : No

NAME : MONIKA RANI

Gender : Female Date of Birth : 15-Aug-1993

Nationality : Indian

Fathers Name : SALINDER KUMAR

Mothers Name : REETA DEVI

Address for Correspondence : V.P.O:BABAIN

NEAR VIVEK SIKSHA NIKATAIN SCHOOL
DIST. KURUKSHETRA
HARYANA
State : Haryana City: KURUKSHETRA Aadhar Card No.: 398676743939

Pin Code : 136156

Mobile No. : 9729892854 Telephone No.:

Fax No. : e-mail address : monikagood4u@gmail.com

Category :GEN Person with disability (PD) : No

Maths at 10+2 Level: Yes Maths at UG Level: Yes

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Application No: ESD17203978

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Application No: ESD17203978

INDIAN INSTITUTE OF TECHNOLOGY ROORKEE

APPLICATION FOR ADMISSION TO Ph.D. PROGRAMMES
FOR AUTUMN SEMESTER 2017-18

A Passport Size
1. Separate Application should be used for each Department /Centre.
2. Enclose self attested copies of all certificates with this Application . Bring original certificates Photograph
at the time of Interview/Test and Admission. should be
3. Giving false information will lead to cancellation of Admission . pasted in this
4. Application incomplete in any respect, is liable to be rejected. space
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 Viva -
Voce before the registration date.

Name of Department/Centre in which admission is sought : ESD - Earth Sciences

Proposed Status: Full Time

Approved Research Centre: -

If PART TIME a) Whether working in a project at IIT Roorkee? : No

b) Are you an employee of IIT Roorkee? : No
c) Are you working in a Org./Univ./Inst. Approved
by IIT Roorkee as Research Centre? : No

Working Status: No Job Status: Not Applicable

NAME : MONIKA RANI

Gender : Female Date of Birth : 15-Aug-1993

Nationality : Indian Person with disability (PD) : No

Category :GEN Maths at UG Level: Yes

Maths at 10+2 Level: Yes

ACADEMIC RECORD
Details of marks/grades secured in the examinations passed.

Institute/ Year of Marks Max % of

Exam Passed Duration Subjects University Passing Obtained Marks Marks

10th Standard 1 year SCIENCE WITH H.B.S.E 2008 369.00 500.00 73.40
MATH
12th Standard 1 year PHYSICS, H.B.S.E 2010 404.00 500.00 81.00
MATH,CHEMIST
RY,HINDI,ENGL
ISH
B.SC 3 year PHYSICS, KUK 2013 2077.000 2,900.00 71.60
MATH,COMPUT
ER SCIENCE
3 year
M.TECH (Applied Geophysics) APPLIED KUK 2017 7.780 10.00 77.80
GEOPHYSICS
0.000 0.00 0.00

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Application No: ESD17203978
Details of Marks/ Grade Point Average secured in the Qualifying Degree Examinations

Name of the qualifying Degree Programme: M.Tech. (Sciences)

Discipline/ Specialization of Qualifying Degree: GEOPHYSICS

Whether qualifying degree examination Passed: No

Year of passing: 2017

Name of the University/Institute: KURUKSHETRA UNIVERSITY

Are you a Under Graduate Candidate from CFTIs including IITs and NITs having a CGPA exceeding 7.00: No
Name of CFTI:

Semester/Year Marks/CGPA Obtained Max Marks/Scale Semester/Yearly System

Fourth 7.78 10.00 Semester System

GPA/ CGPA / Marks Obtained 7.780 Out of 10.000 point scale/Max.Marks

Medium of Instruction at Qualifying Examination level : English

Relevant National Level examination qualified : GATE

Year appeared Valid Upto GATE / Other score 0.00

Discipline Chosen in GATE/NET/CEED/GPAT:

Awards and Scholarships, if any :

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 :GEOPHYSICS
Give Sub-Areas of Proposed research priority wise :
1. EXPLORATION GEOPHYSICS
2. SEISMOLOGY
3. SOLID EARTH GEOPHYSICS
4. GEOELECTRO-MAGNETISM
paragraph on how your qualifications/ experience etc. are relevant to the proposed field of your research
Respected Sir,
I am pursuing M. Tech. (Applied Geophysics) from Kurukshetra University in which I have studied Seismic Prospecting,
Magnetic and Gravity Prospecting, Electromagnetic and Magnetotelluric prospecting and Electrical Prospecting. Besides
these I also have studied Solid Earth Geophysics, Seismology, Geophysical Inversion, Computational Seismology etc. I also
have participated in Poster Presentation on the topic related to Analysis of time series using DSP tools in IGU -2015 held at
National Centre for Antarctic and Ocean Research, Goa. Along with this I have done compulsory training in the ONGC,
Vadodara for 15 days in exploration seismology. So these training and these studies build up my interest in field of
research. I have also done a minor project on seismology on topic Estimating the attenuation relation for Strong Ground
Motion in Delhi-NCR Region Using Empirical Relation of Different Region of World.
Employment Record :
Organisation Post From To Duration Pay Scale Nature of Duties Presently
Working

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Application No: ESD17203978

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. MONIKA RANI who is working in this organisation for the last ....... years
(from.................. to .....................) and is presently holding the rank/ position of ......................................... for pursuing
Ph.D. programme in the Department of ................................................................................................................ with
specialisation in the following areas
1. EXPLORATION GEOPHYSICS 2. SEISMOLOGY 3. SOLID EARTH GEOPHYSICS 4 .
GEOELECTRO-MAGNETISM

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.Our enterprise is registered in a stock exchange /had an annual turn over of over Rs. 5.0 crores in the past
two years (for candidates working in a Firm/Company/Industry).

Place : ............................................. Signature of the Head of the Institution/ Organisation with seal
Date : .............................................. Name ..........................................................................
Designation .....................................................................

UNDERTAKING

I, MONIKA RANI S/o, /D/o SALINDER KUMAR 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 / Equivalent National Test certificate.
iv) Attested Copy of SC/ST/OBC/PD certificate. Candidates belonging to OBC category must submit xeroxed copy of
category certificate on GOI format. OBC Certificate should have been issued after 31.03.2016 by competent authority.
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.