Doctor of Philosophy (PhD) Joint Program

Application Form A

Name:
IIT Bombay

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PhD Application Office Use Only – Student ID: ________________

Section A - To be completed by the applicant

1. Personal details

Please place  in appropriate boxes

Title: Mr Mrs Ms Dr Other

Family Name:

Given Names:

Gender: Male Female

Date of Birth: Day Month Year

Permanent
Address:

Address that
formal mail
should be sent to
during your
candidature

Dates this address will be applicable for:

from: Day Month Year to: Day Month Year

Telephone No: Home: Work:

E-mail address:

Please indicate your citizenship status:

Indian citizen Australian or New Zealand citizen Other

or Australian permanent resident

If other, please state your and passport number:
country of citizenship:

Disclosure of Criminal Conviction for an Applicant

Please indicate if there is anything in your past that would prevent you from gaining a visa to Australia or other
country. (this may include prior criminal convictions) Please refer to: http://www.immi.gov.au/media/fact-
sheets/79character.htm for more information
Please include details (NIL if
there are none):

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All applicants should attach a copy (scanned copy for email submission) of their passport, birth or
citizenship certificate, or of a document relating to their residency status.

2. Proposed enrolment details

2.1 Proposed candidature commencement date: Day Month Year

Please indicate the first date when you will be available to join.

2.2 Project Choices: You will need to select up to 4 Project Choices online when submitting this form at The
Academy Form A Online Application System (AFORS), which available at:
http://www.iitbmonash.org/application-process/

Please read these points carefully:

 It is not necessary that you have to choose 4 projects on the online system.
 On the online system, each of the projects that you have selected will have a set of “ideal” or “required” capabilities. You will need to
indicate how your background satisfies these required capabilities. If you are not able to demonstrate these capabilities, you may want to
choose another project.
 There is likely to be a change to the list of projects provided on the Academy Internet website and the online system.

2.3 Capability awareness

Have you read the project descriptions for the projects you have chosen (Y/N)?

For Project Descriptions click on the relevant project numbers on the Research Projects page on the website:
www.iitbmonash.org/research-projectsv2

Have you filled in your responses to the capability requirements for the projects you have chosen (Y/N)?

3. Tertiary educational record and motivation

Statement(s) of your full tertiary academic history must accompany this application. Scans of the original
academic transcripts can be submitted.
If you are invited to interview you are expected to bring the original transcripts to the interview. Applicants who
submit documents in a language other than English must provide an officially certified translation, together with the
original document.
Original academic transcripts for verification are to be produced to the Deputy Registrar, Academic, at IITB and
Monash Research Graduate School at Monash University at the time of enrolment, after admission. Do not provide
grades such as 'Distinction' or 'First Class'. Provide your actual CPI, CGPA or grades, like 8.97/10 or 88.5%, etc.

Degree or other qualifications held Awarding institution Year completed Major or discipline Honours/Final grade

Fill in as much of this table as possible. Although completion of these exams is not a prerequisite for entry to the
program, it would be an advantage to have done so.

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Type of Exam
GATE (if available)
GRE Score (if available)
TOEFL Score (if available)
Score Rank Year of Exam Please note that the
more detail you
provide in this
section, the greater
your chances of
success.

JAM:

NET

IELTS

Other- 1 (say CAT, etc)

Other- 2

Main Subjects Studied:

Provide a description
here of the main
subjects that you
undertook in your
studies which would be
most relevant to the
successful completion
of the project(s) you
have chosen online

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FOR HUMANITIES AND SOCIAL SCIENCES STUDENTS ONLY

PLEASE NOTE THAT AS PART OF THE ENTRY REQUIREMENTS OF THE PROGRAM YOUR
Bachelor, Honours or Masters Degree must have had a research/thesis component. Please supply
details below.

THESIS / DISSERTATION

Please list at least one Bachelor, Honours or Masters thesis/dissertation.(Please note you will be asked
to submit a copy of your dissertation through the online application portal)

Title

Language used:

Word Count

Mark or grade received

Which degree this thesis/dissertation was for

Please describe the requirements of the

thesis/dissertation including the period of
research project, the required length of thesis/
dissertation, how it was examined, etc. The more
details are the better. If these details are
available online, please provide the web
address.

Title

Language used:

Word Count

Mark or grade received

Which degree this thesis/dissertation was for

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Motivation:

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

4. Scholarship details
Do you hold any scholarships or other awards, or are you sponsored by an outside body eg industry or
government-sponsored awards?
No Yes

Give name of scholarships, awards or sponsoring body:

Category (TA/TP/RA/PA/SF/SW/PS/CSIR/UGC/FA…etc)

5. Work experience

Indicate years of relevant experience in teaching and / or research and / or industry.

6. Research/publications
Provide details of any original research and/or publications. For publications/abstracts, indicate the percentage of
your contribution, eg sole (100%), joint (50%), multi authorship (20%), and the nature and standing of the
journal/conference. Also indicate whether in press (accepted for publication) or published. (Attach additional sheet if
necessary)
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7. English proficiency
Please place X in the box indicating how you have satisfied the English language requirements for admission.

First language is English

An overall band score of not less than 6.5 on the IELTS test conducted by IDP and the British Council.
In addition, a score of at least 6.0 is required for each band score and applicants must undertake the
academic module in regard to reading and writing.
For Humanities and Social Sciences Students: An overall score of not less than 7.0 on the IELTS test
(Academic), at least a score of 7.0 in the writing band and at least 6.0 for each other band.

The following scores achieved in the American Test of English as a Foreign Language (TOEFL):
 A minimum total score of 577 together with a score of 5 or more on the TOEFL Test of Written
English (TWE) (paper based score);
 A minimum total score of 233 together with a score of 5 or more on the Essay Rating (ER)
(computer-based score); or
 A minimum total score of 91 (internet based score) together with a minimum score of 25 in the
written test and a minimum score of 22 in each of the reading, speaking and listening tests.
For Humanities and Social Sciences Students:
 A minimum total score of 600 (TWE 5) (paper based); or
 A minimum total score of 100 with a minimum score of 25 in each of the written, reading, speaking
and listening tests (internet based test).

Successful completion of a course of tertiary studies of at least two years’ duration conducted entirely in
English and involving formal assessment of written work, in a country where English is the official language.
Evidence in the form of a letter or certificate issued by the university Registrar’s office will need to be
provided. Studies must be completed within the five year period prior to application. Applicants for
Humanities and Social Sciences should have completed the course of study within the two-year period
prior to application.

8. Referees

Include the name of at least 2 academic referees in the table below.

PLEASE upload referee reports to the applications portal. For HSS students: Supervisors of your thesis in
previous degrees are preferred.

We may contact them to secure their feedback on you.

Note that you are welcome to include more than 2 referees:

Name of Referee Contact details including phone and email How do you know this referee?

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9. Declaration by applicant
Note:
The information on this form is collected for the primary purpose of assessing your application for admission to PhD
candidature. Other purposes of collection include the creation of an enrolment record on the student database,
attending to administrative matters, corresponding with you and statistical analyses. If you choose not to complete
all the questions on this form, it will not be possible for us to assess your application. Personal information may
also be disclosed to the relevant bodies for the verification of your qualifications and it may be disclosed to
government agencies as required by legislation. You have a right to access personal information we hold about
you, subject to any exceptions in relevant legislation.

If you wish to seek access to your personal information or inquire about the handling of your personal information,
please contact the University Privacy Officer on 61-3- 9905 6011 (at Monash University) and Deputy Registrar
(Acad.) at 91-22-2576 7041 (at IIT Bombay).

Please note that the requirements of the PhD program at The Academy means that you will not be able to carry out
any part time work and you would need to abide by the additional employment conditions relating to each
institution.

DECLARATION:

I declare that I have read the instructions on this application form and that the information provided by me is true
and complete. I recognise that it is my responsibility to provide all necessary documentation to support my
application and I authorise the Institute/University to obtain official student records from any educational institution;
or to verify my past and current employment for the purpose of making an informed decision about the application
or matters that concern my admission and enrolment in this course.

I accept that documentation provided by me will become the property of IIT Bombay/Monash University and made
available to competent authorities when required. I have read and understood the above conditions and accept
them fully.

I acknowledge that IITB/Monash University reserves the right to vary or reverse any decision regarding admission
or enrolment made on the basis of incorrect or incomplete information. I have read and understand the above
conditions and am prepared to accept them in full.

When you are submitting this form electronically please send it without a signature, but print your name as well as
the date you filled the form in. By inserting your name and date you are asserting that all of the information on this
form is true, complete and accurate.

Any Form-A which is submitted without a name and date on it may not be considered.

Signature: Date:

Please see the instructions at the front of this form as well as the FAQ on the website
(www.iitbmonash.org) for details on submitting your application