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(For office use)

Examination Roll No.

Application No.

INDIRA GANDHI INSTITUTE OF DEVELOPMENT RESEARCH


An Advanced Research Institute Established by Reserve Bank of India
A Deemed University
Reaccredited with A Grade by NAAC
(Silver Jubilee Year 2012-2013)
Gen.A.K. Vaidya Marg, (Film City Road), Goregaon (E), Mumbai - 400 065

APPLICATION FOR M.Sc. /M.Phil. /Ph.D. PROGRAMME


General Instructions:
i. Completed application form should reach the Admissions Office by March 23, 2012.
ii. Referee report sheets (For M.Phil./Ph.D. candidates only) attached herewith are to be handed over
to the referees. The completed reports duly signed and sealed by the referee in an official envelope
must be collected by the applicant and mailed along with the completed application form.
iii. Candidates will appear for the written test at their own cost.
iv. "Information Handout" including sample tests will be sent along with the Call Letter.
v. Application forms downloaded from the website should reach the Admissions Office by March
23, 2012 along with the application fee of Rs.500/Examination Centres: (Circle your preference for the Centre)
1.. 1. Ahmedabad
2. Allahabad
1. 3. Chandigarh
2. 4. Bangalore
3. 5. Bhopal
4. 6. Bhubaneshwar
5. 7. Chennai
6. 8. Guwahati

7. 9.Hyderabad
8. 10.Jaipur
9. 11.Kolkata
12.Lucknow
13.Mumbai
14.Nagpur
15.New Delhi
16.Thiruvananthapuram

AFFIX
YOUR RECENT
PASSPORT SIZE
PHOTOGRAPH

1.

Name of Programme

2.

Name of Candidate (in block letters) : .............................................................................................


(First)
(Middle)
(Surname)

3.

Sex

M.Sc.

M.Phil/Ph.D

Male/Female

2
4.

Date of Birth

: .........................................................................
Date
Month
Year

5.

Marital Status

6.

Nationality

7.

Address for Communication

Mailing Address

Permanent Address@

State

State

Pin Code

Pin Code

Telephone No.:

Telephone No.:

Fax No.:
Email:

Fax No.:
Email:
@

To be provided, if different from the mailing


address, for travel reimbursement after interview
8. Highest Degree obtained:

........................................

9.Academic Awards:

........................................

10.Work/Research Experience:

Yes/No

If yes, provide details, accounting breaks, if any.


From

To

10.

Job Profile

Name of Employer

Will you be sponsored by your employer for the programme?


If yes, provide details.

Last salary drawn

Yes/No

Educational History
11.

Fill in all details from and including S.S.C. or equivalent examination to your present degree. In case you have not completed your present
degree, mention all the marks/grades obtained till now. Also mention scores from GATE, GRE, UGC Fellowship or equivalent exams if you
have appeared in any of these exams. If your result is in terms of grades, also provide the equivalent conversion in percentage terms.

Examination
Passed

Year of passing

Institution/
University

Period

From

Subjects:
Main and
Ancillary

% in aggregate
and division

Rank if any

To

Note: Originals of mark sheets, rank certificates, etc. must be produced at the time of interview.
Geographic Location of Under graduate college:

Date:

Name:....................................................Signature:.......................................................................

4
12.

Have you applied for this Programme in the past?


If yes, in which year(s)?
If you were selected, give the year(s) of selection and
brief reasons for not joining the Programme.

13.

Background information:

Yes/No

(i)Name and Educational Qualification:


Father:
Mother:..
(ii)Do you belong to Scheduled Caste/Tribe Category/OBC?

Yes/No

(iii)Are you physically disabled?

Yes/No

SC/ST/OBC

14.

Where did you see the advertisement?:........................................................................

15.

Name and address with phone number of two referees of whom at least one should be an
academician. (For M.Phil./Ph.D. candidates only)

(i)

Name:....................................................................................................
Designation:..........................................................................................
Address:..................................................................................................
Pincode:..................................................
Tel: ..................................................(O)...............................................(R)

(ii)

Name:......................................................................................................
Designation:............................................................................................
Address:...................................................................................................
Pincode:.......................................................
Tel:.....................................................(O)...............................................(R)

16.

Any other information that you think will help us to better assess your performance and
potential (use separate sheet, if necessary).

Declaration: I hereby certify that the statements made by me above are, to the best of my
knowledge, true, correct and complete. I understand that any incorrect information or material
omission on my part renders me liable to termination without any notice or compensation.
Date

(Signature of the Candidate)

Statement of Purpose
(For M.Phil./Ph.D. Candidates only)
Write your statement of purpose in not more than 200 words indicating why you want to join the
M.Phil. /Ph.D. Programme at the IGIDR and what your future research plans are.

Indira Gandhi Institute of Development Research


(A Deemed University)
(To be detached by the candidate and handed over to the Referee. The applicant should collect the
completed recommendation duly signed and sealed by the referee in an official envelope and mail it
along with the completed application form.)

Referee's Report
(For M.Phil./Ph.D. Candidates only)
Application No._______________
Candidate's Name: ................................................................................................................
(In Block Letters)
(First)
(Middle)
(Surname)

Name of the Referee: .....................................................................................................


(In Block Letters)
Address:
.................................................................................................................
................................................................................................................
........................................................Telephone No.........
How long and in what capacity have you known him/her and how do you rate him/her compared to
an average post-graduate student in terms of intelligence, academic achievements and abilities?
Please give your assessment below. You may use additional sheet, if necessary. Kindly mail this
form directly to the Institute using the enclosed envelope. We thank you in advance for your
assistance in evaluating the applicant.
______________________________________________________________________________

Date:________________

Signature____________________

Indira Gandhi Institute of Development Research


(A Deemed University)
(To be detached by the candidate and handed over to the Referee. The applicant should collect the
completed recommendation duly signed and sealed by the referee in an official envelope and mail it
along with the completed application form.)

Referee's Report
(For M.Phil./Ph.D. Candidates only)
Application No._______________
Candidate's Name: ................................................................................................................
(In Block Letters)
(First)
(Middle)
(Surname)

Name of the Referee: .....................................................................................................


(In Block Letters)
Address:
.................................................................................................................
................................................................................................................
........................................................Telephone No.........
How long and in what capacity have you known him/her and how do you rate him/her compared to an
average post-graduate student in terms of intelligence, academic achievements and abilities? Please give
your assessment below. You may use additional sheet, if necessary. Kindly mail this form directly to the
Institute using the enclosed envelope. We thank you in advance for your assistance in evaluating the
applicant.
____________________________________________________________________________________

Date:________________

Signature____________________