NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKA, SURATHKAL

P.O. SRINIVASNAGAR, MANGALORE-575 025 Registration No. (for office use only)

Admission to Post-Graduate Programme M.Tech (SPONSORED SEAT/RESEARCH)

2012-13
Application for M.Tech. _______________________________________(SPONSORED SEAT/RESEARCH) (Write Name of the Programme) Name of the Dept. _____________________________________________________________________________ Particulars of D.D. drawn Name of the issuing Bank ______________________________ Drawn at ____________________________________________ D.D. No. ____________________ dated ___________________ Instructions: Rs. _______________ Category: OC / SC / ST / OBC / OM / PC (Tick mark the appropriate)

1. Fill in the application form and the index sheet completely. (Separate Application for each P.G Programme with required DD) 2. Fill your address in the address slips & Registration Memo. 3. Enclose attested photo copies of marks card and other documents.
4. Affix self attested recent Passport size photograph

Candidates who have appeared for the Final degree Examination of May/ June 2012 may also apply provided they can produce proof of their eligibility for admission at the time of interview. Late/incomplete/Applications without DD are liable to be rejected. Last date for submission of filled in application is 18.06.2012. 1. Name of the Candidate in full (in Block Letters as mentioned in the Degree marks card) 2. Address of the applicant (with pin code): a. Permanent:

5. 6.

b. Correspondence

c. Telephone with STD Code or contact number/ Mobile No. : d. email (if any): 3. Name and address of Father/Mother (or Guardian if the parents are not alive, state relationship of Guardian) 4. Occupation of Father/Mother/Guardian Annual Income

5. a. Religion of the Candidate: Caste/Subcaste

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

. Yes / No SC / ST / OBC / OM

b. Do you belong to Scheduled Caste/Tribe/OBC/OM ( Tick mark) If yes, enclose a copy of the Caste Certificate issued from Competent Authority c. Place of domicile d. Nationality
e.

Do Yes / No

you

belong

to

Physically Handicapped (PH) / Physically Challenged (PC) group? (if yes, enclose copy of a medical certificate from a DMO) (Tick mark the appropriate) 6. Date of Birth (Copy of the Supporting document to be enclosed) In Figures: In Words:
7.

Academic Record: a. i. Qualifying Examination Passed ii. Specialisation iii. Institute where he/she studied iv. Period of study v. University b. Engg. or Arch./M.Sc./AMIE, etc.): Year of Passing : : : : from __________________ to ________________ : Marks obtained in the Qualifying Examination (Bachelors Degree in B.E./B.Tech./B.Sc.(Engg.)/M.Sc./AMIE/ B.Arch./ AMITE, if any other mention it.

Marks/Grade obtained

Max. Marks

Percentage

Class/ Division

CGPA

I Sem II Sem III Sem II Year IV Sem V Sem III Year VI Sem VII Sem IV Year VIII Sem I Year
c. Total aggregate of percentile of marks (all semester): 8. GATE Score details (Enclose a Xerox Copy of the Score Card) Year of passing GATE Score GATE mark

9. Details of Practical Training under gone, if any, other than that required for graduate Course. Attach extra sheet if necessary. 10. Professional/research or other Experience (Enclose Copies of Certificates from Employer) Employer Post Held Period Salary

11. Are you a Sponsored candidate? (If yes, forward your application through your employer) Ref. No.15. 12. References (Give the names and addresses of two responsible persons well acquainted with your work and character) 1. 2.

13. DECLARATION OF CANDIDATE

I hereby declare that to the best of my knowledge, the particulars furnished in this application are correct. I am willing to forfeit the seat secured for any course, if any information provided by me is false. If selected for admission, I promise to abide by the conditions of admission and Rules of the Institute, and the Academic Regulations that govern the programme of study. I also promise to refund the entire Scholarship amount drawn by me in case I discontinue the course at any stage before completion. Place : Date : Signature of candidate

Photo copy of the following Documents to be enclosed. 1. Copy of the Marks Card of Qualifying Exam (all years) all Semesters. 2. Copy of the GATE score card. 3. S.S.L.C./ X Std. Marks Card (for date of birth). 4. Caste Certificate issued by Competent authority for SC/ST. 5. Physically Challenged Certificate, if applicable. 6. Sponsorship letter for deputed candidates. 7. OBC Certificate in the Central Govt. format issued by competent authority in case of OBC. 8. OM (Other Minority Category) certificate if applicable.

14. DECLARATION OF PARENT OR GUARDIAN

(Not applicable to M.Tech. candidates deputed on full salary by Institutions/ Industries) In case my son/daughter/ward discontinues the course at any stage before completion without obtaining permission from the Director and without repaying the scholarship amount drawn by him/her, I hereby undertake to repay the scholarship amount payable by my son/daughter/ward to the Institute.

Place: Date: In case declaration is signed by Guardian, indicate relationship with the candidate Signature of Parent or Guardian with Postal Address Name Relationship

15. FOR USE BY FORWARDING AUTHORITY (EMPLOYER) Sponsorship (Deputation) Certificate/

The applicant (name) .has been a permanent staff of this Institute/Organization from .. and has .. years of experience (teaching/R&D/industry). 1. Sponsorship/ (Deputation) certificate:

He/She is sponsored (deputed) with full/half/no salary, for full time study in National Institute of Technology Karnataka, Surathkal. 2. The candidate and his/her sponsorship (deputation)/ NOC will not be withdrawn before the completion of the course/programme. Office Seal Station: Date : Signature of the Employer Name:

Designation: (Note: Sponsorship certificate should be submitted in the same format as indicated in this application form duly signed by the Employer/ Sponsoring Institute Head and seal.)

N.I.T.K. SURATHKAL, SRINIVASNAGAR, MANGALORE 575 025 INDEX SHEET M.Tech (Sponsored Seats/Research)
(READ INSTRUCTIONS OVERLEAF BEFORE FILLING)

1. Full Name (as mentioned in the Degree Certificate)

2. Programme Code 3. Qualification

B.E. B.Tech. AMIE B.Sc.(Engg.) B.Arch. M.Sc. Other

4. Year of passing qualifying degree exam 5. Name of University :

6. Name of the Institution: 7. Have you obtained your final semester/ year marks sheet: 8. Percentage of marks obtained in final year of qualifying degree (Write R.A. if results are awaited) 9. Aggregate of percentage of marks (all semesters/years) of qualifying degree 10. Year of Passing GATE: 11. GATE Percentile 12. Reservation Category Code All India Rank GATE Score Score: YES NO

GM

SC

ST

OBC

OM

PC

13. Sponsorship Code 14. Experience (in years)

Teaching

Research

Field/Industry

All the above information are correct to the best of my knowledge.

Signature of the applicant

INSTRUCTIONS FOR FILLING INDEX SHEET

a. Give your full name as in Degree Certificate/Provisional pass certificate. Give blank columns to separate first and second name etc. b. Programme codes: (item 2 of the Index Sheet)
a) Department of Civil Engineering (CV) i. Structural Engineering ii. Geotechnical Engineering iii. Environmental Engineering iv. Transportation Engineering v. Construction Technology and Management b) Department of Applied Mechanics and Hydraulics (AM) vi. Marine Structures vii. Water Resources Engineering and Management viii. Remote Sensing & Geographic Information Systems c) Department of Mining Engineering (MN) ix. Rock Excavation Technology and Management d) Department of Computer Engineering (CO) x. Computer Science and Engineering xi. Computer Science and Engineering Information Security e) Department of Electronics and Communication Engineering (EC) xii. VLSI Design xiii. Communication Engineering f) Department of Electrical and Electronics Engineering (EE) xiv. Power and Energy Systems Department of Information Technology xv. Information Technology h) Department of Mechanical Engineering (ME) xvi. Thermal Engineering xvii. Manufacturing Engineering xviii. Mechatronics Engineering Department of Chemical Engineering (CH) xix. Chemical Plant Design xx. Industrial Pollution Control xxi. Industrial Bio-Technology j) Department of Metallurgical and Materials Engineering (MT) xxii. Process Metallurgy xxiii. Materials Engineering xxiv. Nanotechnology Department of Mathematical And Computational Sciences (MA) xxv. System Analysis and Computer Applications Program Code (ST) (GT) (EN) (TS) (CM) (MS) (WR) (RS) (RT) (CS) (IS) (VL) (CE) (PS) (IT) (TH) (MF) (MC) (PD) (PC) (IB) (PM) (ML) (NT) (SY)

g)

i)

k)

c) For Item 3 choose one of the codes corresponding to branch of Engg./Science in which you have passed your qualifying degree (s) and indicate the same in the appropriate box. Automobile Engg. Chemical Engg. Civil Engg Computer Science/Engineering Electrical Engg. Electrical and Electronics Engg. Electronics and Comm. Engg. Electronics & Instrumentation Electronics & Control Engg. Instrumentation Instrumentation Technology Industrial Engg. Production cum Plant Engg. Industrial Engg. and Management Transportation Engineering Environmental Engg. Structural Engg. Information Technology AM CH CV CS EL EE EC EI EO IN IS IL PP IM TR EN ST IT Manufacturing Engg. Mechanical Engg. Metallurgical Engg. Mining Engg. M.Sc. Applied Science Mathematics Physics Chemistry Electronics & Telecommunication GRAD IETE Instrumentation Engineering Industrial and Production Engg. Production Engg. Construction Management Architecture any other MF ME MT MN AS MA PH CY ET GI IE IP PR CM AR OO

d) Against item (5) give name of University/Autonomous institution awarding qualifying degree. Candidates who have passed AMIE may indicate Institution of Engineers
e) Against Item (8) give average of the Percentage of marks scored in final two semesters (eg: 77.88) Those awaiting final semester/year Mark list must leave the column blank.

Against Item (9) give the overall aggregate Percentage of marks obtained in all the semesters/ years of qualifying degree.
f) g) Sponsorship Code (item 13)

Not Sponsored Sponsored from: a. Central/State owned Colleges c. Private Colleges e. Private Organisations g. Govt. Organisations

NSP SGC SPC SPO SGO b. Aided Colleges SAC d. Research Institute SRD f. Public Sectors- Govt. Undertaking SPS

NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKA

SURATHKAL, POST SRINIVASNAGAR, MANGALORE- 575025, KARNATAKA STATE.

REGISTRATION MEMO.
Date:......... 2012 Ref: Application for admission to M.Tech. Programme (Sponsored seats/Research) The Registration No. assigned to your application for admission is noted below, which must be quoted in all correspondences connected with your application. No notice will be taken of any communication or document sent by you unless it bears your Registration Number. Registration Number:

M.Tech. ........../-2012 Dy. Registrar (Academic)

Affix Stamp Rs.6/To:

The Dy. Registrar (Academic), N.I.T.K., Surathkal Post Srinivasnagar MANGALORE - 575 025.

Mr./Ms. ________________________ ______________________________ _______________________________ _______________________________

(Write address of the candidate) To _____________________________ _____________________________ _____________________________ _____________________________ Pin Code ________ (__________ State) To: _____________________________ _____________________________ _____________________________ _____________________________ Pin Code ___________ (________State)

To _____________________________ _____________________________ _____________________________ _____________________________ Pin Code _________ (__________State)

To: _____________________________ _____________________________ _____________________________ _____________________________ Pin Code __________(__________State)

APPLICATION FOR

BY REGISTERED POST

ADMISSION 2012 Post Graduate Programme - M.Tech.(Sponsored seats/Research)

_____________________(Specify the Programme)

From:
____________________________ ____________________________ ____________________________ ____________________________ ____________________________

To:

The Dy. Registrar (Academic), N.I.T.K., Surathkal Post Srinivasnagar MANGALORE - 575 025.