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Indian Institute of Technology Rajasthan

Application Form for Admission to M.Tech. Programme

Web Advertisement No.: IITJ/ ACAD/ 2011/ 02,


dated 30-03-2011 For office use : Sl. No. ACAD/MTech/2011/

Demand Draft Amount:…………………Draft. No..................…….....Draft Date:......……..........

Drawn in Bank:................................................................... (Write Name of the Applicant on


the back side of the draft)

1.(a) Name:……...........................................................………………………… Affix


passport
(b) Father/ Guardian’s size
Name: ..........................................................................
Photograph
(c) Addresses:

i) For correspondence ii) Permanent


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Email: Phone:
Fax:
2. (a) Date of Birth (dd/mm/yyyy): …………………………..…… (b) Age (as on 20-04-2011):
…………………..
(c) Gender (Male / Female): …………………………………… (d) Marital Status:
……….................................
(e) Nationality:……………..….…….… (f) Category:
………………………………..….
Please specify category GENERAL / OBC (Creamy layer) / OBC(Non-creamy layer) / SC / ST / PD (Person
with Disability)
(In case of OBC(Non-creamy layer), SC/ ST/ PD, Enclose attested copies of necessary certificate)

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3.(a) Centre(s) of Excellence to which the M.Tech. admission is sought by the
candidate:

………….
………………………………………………………………………………………………………….
……..
(b) Are you applying to M.Tech.. programme in other Centre of Excellence in IIT
Rajasthan? YES / NO
If yes, write the name of other CoE(s) to which applied M.Tech.:
…………………………………………………

(c) Student Status: Regular and Full Time

(d) Your Qualifying Degree with Discipline:

4. Details of Universities/Institutions attended (from 10th standard onwards)


(Attested copies of certificates and mark sheets/grade cards must be attached)
Degree/ University/College/ Year % Class Subjects taken
Exam (with Board Marks/ Obtai
discipline) CGPA/ ned
CPI*
10th Class
12th Class

* If final year qualifying degree examination results are awaited, please indicate average percentage of marks or
CPI of examinations up to the last year (in case of system with annual examination)/last semester (in case of
semester system). Final Results Expected by…..………………………….

5. a) GATE Qualification (Attested copy of certificate must be enclosed. Also, fill-in the required
information by going through the prescribed eligibility criteria):

Subject GATE GATE All India Valid up to


Score Marks* Rank

GATE cut-off marks for GN: OBC: SC/ST:


qualifying =
* GATE marks above cut-off shall only be considered.

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b) Any other source for fellowship/ scholarship:

6. a) Professional Experience (Teaching/ Research/ Industrial) if any ( proof to be


attached).

Name of Organization Position held Type of work


Period

(i)

(ii)

(b)List of publications/projects if any:


(Attach a separate sheet with details, if required)

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7. Names and addresses (including Email and Phone Number) of two referees who
are familiar with your academic background and credentials:

(i) (ii
)

8. Enclosures

Declaration

I hereby declare that the entries made in this application form


are correct to the best of my knowledge and belief. If selected for admission, I
promise to abide by the rules and regulations of the Institute.

I note that the decision of the Institute is final in regard to


selection for admission and assignment to a particular CoE/Department and
field of study. The Institute shall have the right to take any action it deems fit,
including expulsion, against me at any time after my admission, if it is found
that any information furnished by me is incorrect.

Place:

Date: Signature of the


Applicant
Note:. The completed application form with all necessary enclosures
and along with the processing fee of Rs.300/- for General/ OBC
candidates and Rs.150/- for SC/ ST / Person with Disability (PD)
candidates in the form of demand draft drawn in favour of “Director, IIT
Rajasthan” payable at Jodhpur should be submitted to
Convener – M.Tech Admissions
Centre of Excellence in
…………………………………………….
Indian Institute of Technology Rajasthan
4
Old Residency Road, Ratanada
Jodhpur – 342 011, Rajasthan