Application Form for Admission to MTech and MDes Programmes

For office use Sl. No. ACAD/MTech/MDes/11/ For Departments use Reg. No. M/ GATE/CEED Marks:

Indian Institute of Technology Guwahati

Demand Draft No......................dated.........................drawn in Bank......................................................... 1.(a) Name: Mr/Ms/Mrs............................................................. (b) Father/Husband/Guardian ........................................................................... (c) Addresses: i) For correspondence ................................................................................... ................................................................................... .................................................................................. Email: Phone: (c) ii) Permanent

Affix passport size Photograph

........................................................................... ........................................................................... ........................................................................... Fax: Marital Status:

2. (a) Date of Birth (dd/mm/yyyy):.......................... ................................. (b) Nationality:.......... ..

(d) Category: GEN/OBC(Non-creamy layer)/SC/ST/PD:

(Please specify category, and enclose attested copies of necessary

certificates)

3. (a) Department to which admission :.................................................................... (b) Are you also applying to any other Department? If yes, list the other Department(s): (c) Category Regular : ( Tick ) Sponsored (Full-Time) Yes/No.

the

candidate

seeks

IITGs Project Staff

Part-Time

(d) Choice for area of specialisation, in order of preference (if given in the advertisement) : (i) (ii) (iii) (iv) (v) (vi) 4. Details of Universities/Institutions attended (from 10th standard onwards)# (attested copies of certificates and mark sheets/grade cards must be attached) University/College/ Board Degree obtained (with discipline) Year % Marks/ CGPA/ CPI Class obtained Subjects taken

# (a) Candidates still to appear in their qualifying degree examinations may also apply, provided they appear in all their qualifying degree examinations and complete all requirements for their degrees before 19-07-2011. If selected, such

candidates shall be admitted provisionally, and they will have to furnish the results of their qualifying degree examinations latest by 02-09-2011, failure to which their admissions shall stand automatically cancelled. (b) 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).

5. a) GATE/CEED Qualification (Attested copy of certificate must be enclosed . Also, fill-in the required information by going through the prescribed eligibility criteria): Subject GATE/CEED Score GATE Marks* All India Rank Valid up to

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

b) Any other source for fellowship/ scholarship:

6. a) Professional Experience (Teaching/ Research/ Industrial) if any ( proof to be attached). Name of organisation Period (i) (ii) (iii) (b) List of publications/projects if any: (Attach a separate sheet with details, if required) Position held Type of work

7. List of 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 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:
Please note:

Signature of the applicant

Application fee of Rs. 150/- (for Gen/OBC candidates) and Rs. 75/- (ST/SC/PD candidates) must be sent with this application by a demand draft drawn in favour of IIT Guwahati and payable at Guwahati.

Form I - Sponsorship Letter (This should be typed on the letterhead of the sponsoring organisation) Ref. No.: Date: To, The Director, Indian Institute of Technology Guwahati Sub: Sponsoring an Employee for Mtech/MDes Programme. Dear Sir, We hereby sponsor the candidature of Mr./Ms.________________________________ who is an employee in our organisation, for joining MTech/MDes programme in _____________________________________ at your Institute as a full-time student. It is certified that he/she has completed 2(Two) years of service in our organisation/institute as a regular employee. We shall relieve him/her of his/her duties in the organisation during the two years of the MTech/MDes programme. Signature and Seal of the Sponsoring Authority.

Form II No Objection Certificate for Part-Time Students (This should be typed on the letterhead of the sponsoring organisation) To, The Director, Indian Institute of Technology Guwahati Sub: No - Objection Certificate Dear Sir, We have no objection if Mr./Ms. ____________________________________________, an employee in our organisation, is admitted to MTech/MDes programme in _____________________________________ at your Institute as a part-time student. It is certified that he/she has completed 2(Two) years of service in our organisation/institute as a regular employee. We shall give him/her leave of absence to attend classes/research work at IIT Guwahati during the two years of the MTech/MDes programme. Signature and Seal of the Sponsoring Authority. Ref. No.: Date:

Form III No Objection Certificate for IIT Guwahatis Project Staff

(This should be typed on the letter head of the R&D Section of IIT Guwahati) Ref. No.: Date: To, The Director, Indian Institute of Technology Guwahati Sub: No Objection Certificate for IIT Guwahatis Project Staff Dear Sir, The R&D Section of IIT Guwahati, has no objection if Mr./Ms./Mrs. ______________________, a project employee in the project ________________________________________ under _______________________________ department, is admitted to the MTech/MDes programme in ____________________________________ .

The Principal Investigator of the concerned project has agreed to allow him/her to attend classes/research works during the MTech/MDes programme.

Signature and Seal of the Dean(R&D),IIT Guwahati

ANNEXURE-I
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR ADMISSION TO CENTRAL EDUCATIONAL INSTITUTIONS (CEIS) UNDER THE GOVERNMENT OF INDIA This is to certify that Shri/Smt./Kum..Son/daughter of Shri/Smt...........................................Village.................. belongs District/Division..........in..............State, backward class under
(i) Resolution No. 12011/68/93-BCC(C) dated 10/09/93 published in the Gazette of India Extraordinary Part I Section I No.186 dated 13/09/03. (ii) Resolution No. 12011/9/94-BCC dated 19/10/94 published in the Gazette of India Extraordinary Part I Section I No.163 dated 20/10/94. (iii) Resolution No. 12011/7/95-BCC dated 24/05/95 published in the Gazette of India Extraordinary Part I Section I No. 88 dated 25/05/95. (iv) Resolution No. 12011/96/94-BCC dated 9/03/96. (v) Resolution No. 12011/44/96-BCC dated 6/12/96 published in the Gazette of India Extraordinary Part I Section I No.210 dated 11/12/96. (vi) Resolution No. 12011/13/97-BCC dated 03/12/97. (vii) Resolution No. 12011/99/94-BCC dated 11/12/97. (viii) Resolution No. 12011/68/98-BCC dated 27/10/99. (ix) Resolution No. 12011/88/98-BCC dated 6/12/99 published in the Gazette of India Extraordinary Part I Section I No.270 dated 06/12/99. (x) Resolution No. 12011/36/99-BCC dated 04/04/2000 published in the Gazette of India Extraordinary Part I Section I No.71 dated 04/04/2000. (xi) Resolution No. 12011/44/99-BCC dated 21/09/2000 published in the Gazette of India Extraordinary Part I Section I No.210 dated 21/09/2000. (xii) Resolution No. 12015/9/2000-BCC dated 06/09/2001. (xiii) Resolution No. 12011/1/2001-BCC dated 19/06/2003. (xiv) Resolution No. 12011/4/2002-BCC dated 13/01/2004. (xv) Resolution No. 12011/9/2004-BCC dated 16/01/2006 published in the Gazette of India Extraordinary Part I Section I No.210 dated 16/01/2006.

tocommunity which is recognized as a

Shri/Smt./Kum. _____________________________________ and/or his family ordinarily reside(s) in the _______________________ District/Division of _______________________ State. This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the Government of India, Department of Personnel & Training O.M. No. 36012/22/93-Estt.(SCT), dated 08/09/93, and as revised from time to time.

Dated: District Magistrate/Dy Commissioner etc.,

NOTE: (a) The term Ordinarily resides used here will have the same meaning as in Section 20 of the Representation of the Peoples Act, 1950. (b) The Authorities competent to issue caste certificates are indicated below: (i) The District Magistrate/Additional Magistrate/Collector/ Deputy Commissioner/Additional Deputy Commissioner/ Deputy Collector/First Class Stipendiary Magistrate/ Sub- Magistrate/Extra Assistant Commissioner (not below the Rank of First Class Stipendiary Magistrate). (ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate. (iii) Revenue Officer not below the rank of Tehsildar; and (iv) Sub-Divisional Officer of the area where the candidate and/or his family resides.

ANNEXURE-II

Declaration / Undertaking for OBC Candidates only

I, Shri/Smt./Kum. ____________________________________, son / daughter of Shri/Smt. _____________________________________, resident of village/town/city

__________________, district ___________________State __________________, hereby declare that I belong to the ______________________Community which is recognized as a backward class by the Government of India for the purpose of reservation in admission in Central Educational Institutions as per orders contained in Department of Personnel and Training Office Memorandum No. 36012/22/93-Estt.(SCT), dated 8/9/1993. It is also declared that I do not belong to persons/sections (Creamy Layer) Mentioned in Column 3 of the Schedule to the above referred Office Memorandum, dated 08.09.1993, and as revised from time to time.

Signature of the Candidate

Place:

Date:

Declaration/undertaking not signed by candidate will be rejected