M.Tech.

(Closing Date 14 April, 2011)

Paste your
INDIAN INSTITUTE OF TECHNOLOGY DELHI Unattested
Application Form for Admission to M.Tech. Programme Photograph
Please read the instructions given in the Information Brochure Before you fill up the form

Visit : http://www.iitd.ac.in/pgadmission for details

Application Number : 00037611

Institution : Indian Institute of Technology
Academic Program : M.Tech.(Master of Technology)
Admission Type : Full-Time
Mode of Support : Assistantship

Personal Information

Name : SHALU JAIN

Gender : Female
Category : General
Date of Birth : 27-JUL-1983
Father Name : HARISHCHANDRAJAIN
Mother Name : MADHUBALAJAIN

Correspondence Address : FLAT NO 2/318,GITA MANDIR GALI

JAWAHAR NAGAR
JAIPUR,RJ
IND -302004
shalujai@gmail.com
0141~653584

Permanent Address : FLAT NO 2/318,GITA MANDIR GALI

JAWAHAR NAGAR
JAIPUR,RJ
IND -302004
shalujai@gmail.com
0141~653584

Academic Program Details

Department : Inter-Disciplinary Programme

Academic Plan : Optoelectronics and Optical Communication JOP Option : 1

Test Details

Test Year Registration ID Discipline Score Percentage/

Percentile
GATE 2011 3146523 Elec and Comm./Telecomm Engg.448 37.33

Education Information

Career Data
Qualifying Exam/Degree : Undergraduate Degree : Bachelor of Technology
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 M.Tech.
(Closing Date 14 April, 2011)

INDIAN INSTITUTE OF TECHNOLOGY DELHI

Application Form for Admission to M.Tech. Programme
Please read the instructions given in the Information Brochure Before you fill up the form

Visit : http://www.iitd.ac.in/pgadmission for details

Country : India Discipline : ELECTRONICS AND COMMUNICATION

City : AJMER University/Board : RAJASTHAN UNIVERSITY

Institute : ENGINEERING COLLEGE AJMER Year of Admit : 2002
Evaluation Pattern : Full Year Pattern Year of Passing : 2006
Result Status : Received

Year/Overall Semester/Year GPA Type GPA/Percentage Max Marks Rank in

Aggregate/CGPA Marks Obtained Class/University

Overall Aggregate % 74.7 0 0 NA

Year 1 Year % 75.6 0 0 NA

Year 2 Semester 1 % 75 0 0 NA

Year 2 Semester 2 % 78.4 0 0 NA

Year 3 Semester 1 % 73.7 0 0 NA

Year 3 Semester 2 % 69.5 0 0 NA

Year 4 Semester 1 % 74.4 0 0 NA

Year 4 Semester 2 % 76.4 0 0 NA

Have you ever studied and discontinued your studies at IIT Delhi ? No
Work Experience Details

Payment Information

Bank Draft Number : 206685 Date : 12-APR-2011

Drawn on : ICICI BANK
Amount Rs : 200

Date____________ (Signature of the Candidate)

Page 2 of 3
 M.Tech.
(Closing Date 14 April, 2011)

INDIAN INSTITUTE OF TECHNOLOGY DELHI

Application Form for Admission to M.Tech. Programme
Please read the instructions given in the Information Brochure Before you fill up the form

Visit : http://www.iitd.ac.in/pgadmission for details

FOR DEPARTMENT/CENTRES USE

FOR P.G. SECTION USE ONLY

(Recommendations/observations of the office)

The candidate may be provisionally admitted/not admitted subject to the following :

1) Submission of attested copies of the qualifying degree certificate and marks sheet showing the required

% of marks/CGPA by 21.7.2011/ 31.10.2011.

2) Submission of proof from the University/Head of the Institution of having appeared/passed in the qualifying

Degree Examination by 21.7.2011.

3) Submission of GATE Score Card (in original) by 21.7.2011.

4) Submission of relieving certificate from Employer by 21.7.2011.

______________________________________________________________________________________________________________________________

DR/AR (PGS&R) Signature of OS (PGS&R)

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