APPLICATION FORM FOR ADMISSION TO Ph.D / M.

S PROGRAMME
INDIAN INSTITUTE OF TECHNOLOGY MADRAS

Ph.D M.S

Department : Area of Research : ... (Please see the Research Admission Brochure) 1. Name : . (In Capitals) Date of Birth (DD/MM/YY) : Age : Address for Communication: .. .. .. Pincode : ... Phone No: .. Mobile No: Personal E-mail ID : . 2. Type of Registration : HTRA Sponsored Permanent Address :

PHOTOGRAPH Affix Recent Passport Size Photo

... .... .... Pincode : . Phone No: ... Mobile No: .. . Personal E-mail ID : . . Non - HTRA IIT Project External Staff CSIR Part-Time

Details of University/ Institution Studied (Bachelor's level and above) Degree(*) (a) (b) (c) (d) .. Discipline . . . . University/College Year Average Marks/CGPA . Class

(*) please mention whether the degree obtained thro Regular or Distance education mode

4. Whether any degree was obtained thro' correspondence course /distance education mode : Yes/No 5. Examination Results: a) Bachelor's Degree : Semester % of marks obtained I II III IV V VI VII Branch : .. VIII IX X Aggregate /Grade Class

b) Master's Degree: Semester % of marks/ Grade obtained I II III IV

Branch : Aggregate / Grade Class

c) Additional Qualifying Examination (1) GATE Score : (2) CSIR/UGC/DAE/(JEST)/Others-JRF/Lecturship/NBHM Date of Exam : .

Valid upto : .

Valid upto

: .

6. Professional Experience (Teaching/ Research / Industrial )if any: Period Name of Organization Designation From To

Nature of Work

7. Personal Information:
(a) (b) (c) (d) Mother's Name Fathers/Husbands Name Father's/Husband's occupation Place of Birth : : : : (g) (h) (i) (j) (k) (e) Mother Tongue : Annual Income of parents : State to which the applicant belongs : Martial Status Gender : :

Married Male Unmarried Un Female

Category : SC ST OBC PH OTHERS (enclose attested copy of certificate issued as applicable) Name of the Caste/Sub-Caste .. Blood Group :

(f)

Nationality

(l)

8.List of enclosures: a) Demand Draft b) Attested copy of Marksheets/Grade card c) Attested copy of Community Certificate d) Attested copy of Doctors Certificate(in case of PH) e) Attested copy of GATE score/NET/etc ( ( ( ( ( ) ) ) ) ) f) Employers Certificate for External/Part-time ( g) Sponsorship Certificate for MS sponsored programmes h) project Co-ordinators certificate in the case of project staff i) Four passport Size photographs j) Six address slips ( ( ( ( ) ) ) ) )

k) If any others (Please specify)

Note : (i) (ii) If any one wants to apply more than one dept. he/she should apply separately for each department. Academic Profile include the following information: (a) Details of publications/Conference papers (b) Awards, patents, prizes etc., (c) Other activities If the candidate is employed, relief certificate from the employer should be produced at the time of admission.

(iii)

DECLARATION
I hereby declare that I have carefully read the instructions and particulars supplied to me and that the entries made in this application form are correct to the best of my knowledge and belief. I understand that association (active or passive) with any lawful organization is forbidden. If selected for admission, I promise to abide by the rules and discipline 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 expel me from the Institute at any time after my admission, provided it is satisfied that I was admitted on false particulars furnished by me or my antecedents prove that my continuance in the Institute is not desirable. I agree that I shall abide by the decision of the Institute, which shall be final.

Place :

Date : .

Signature of Applicant :

DATA SHEET FOR Ph.D / M.S ADMISSION

(TO BE FILLED BY CANDIDATES)
mark)

Ph. D M.S
(Please put a tick ()

1. Name

(If the boxes provided are not sufficient, Shorten your name) 2. Category Applied for 3. Department 4. Age as of last date of the receipt of Application form in IITM 7. B.Tech./B.E/B.Sc.(Engg)/M.A./ M.Com./ M.Sc./AMIE. Etc., (a) University (Shorten the name if boxes are not sufficient) (b) Year of passing (c) point) (d) point) (e) UGC-JRF-Lectureship/CSIR Fellowship holder (state validity date) 8. Category SC / ST/ GN / PH /OBC 8.1 Name of the Sub-caste 9. M.Tech/M.Sc.(Engg.)/M.E/M.Sc./ M.S./M.A./M.Com./M.B.A / M.C.A (a) University (Shorten the name if boxes are not sufficient) (b) (Provide one Box also for point) (d) If result awaited fill up the boxes as R A Year of passing (c) Aggregate Marks SC ST GN PH OBC GATE Score (Provide one Box also for Aggregate Marks (Provide one Box also for HTR A NonHTRA Extern al Proje ct Sta ff Sponsor ed CSI R PartTime

5. Date of Birth 6. Email ID: :

10. Experience in years as of April /Oct.

11. No. of Publications

To be filled in by office :

Reg. No: .

Ph.D

M.S

HOW TO APPLY
(a) (b) (c)

If a candidate desires to apply for admission to more than one department, he/ she should use separate application form for each department. He/She should indicate clearly the Department and area of research in the space provided in the application form. Application from candidates who are currently employed must be routed through their employers. The following documents are to be sent along with completed application form:

(a) (b) (c) (d) (e) (f) (g)

(h) (i) (j)

(k) (l)

A Demand Draft for Rs.250/-(Rs.125/- in the case of SC/ST/PD/Female candidates ) drawn in favour of IIT Madras payable at Chennai (only for downloaded application form). Attested Copy of SSLC first page / 10th class or Matriculation certificate. Attested copies of all Mark sheets / grade cards, degree certificates beginning from first degree towards proof of qualification. [Original certificates should not be enclosed]. Attested copy of Community Certificate in the case of SC/ST/OBC(Non- creamy layer) students issued by the respective State Government. Attested copy of authorised Doctors Certificate with disability descriptions in the case of PH candidates. Attested copy of GATE score or NET (UGC-JRF/Lectureship/CSIR/ DAE-JEST) or other fellowship award. Employers Certificate in the prescribed format in the case of candidates applying for Ph.D/M.S i. under external scheme and a copy of the degree certificate of Co-guide. ii. under part-time scheme. Sponsorship certificate from the employer as per format in the case of candidates who apply for M.S. (sponsored) programme Project Co-ordinators certificate in the prescribed format and a copy of project appointment letter from Dean IC & SR of IITM in the case of project staff if already appointed. At the time of joining the Institute, the specified minimum residential requirement period of the candidates selected under External / Sponsored schemes, to produce required period of leave should be properly mentioned in the relieving order for the candidates offered admission to Ph.D/M.S programme, by the Sponsoring Organisations/Institutions. Four passport size photographs. Six address slips neatly typed with Pincode, e-mail and phone number. Applications received without DD and the above said certificates will not be considered for admission to Ph.D/M.S programme under any circumstances and no correspondence thereof will be entertained. Application form can be downloaded form our website www.iitm.ac.in. Filled in forms with all enclosures superscribed as Application Form for Ph.D/M.S Programme should be addressed to
The Deputy Registrar (Academic) Indian Institute of Technology Madras Chennai 600 036

Candidates seeking admission to Biotechnology, Chemistry, Electrical Engineering and Mechanical Engineering Departments must apply online following the instructions given therein through the respective Website and send the application to the concerned departments. http://www.biotech.iitm.ac.in/msphd http://www.chem.iitm.ac.in/msphd http://www.ee.iitm.ac.in/msphd http://www.mech.iitm.ac.in/msphd Such candidates have to send the Demand Draft for Rs. 250/- (Rs. 125/- in the case of SC/ST/PD/ Female +++ +Candidates) along with a hard copy of the application form and other enclosures.

Admission to Ph.D/M.S programme under External Registration Scheme at IIT Madras

Proforma for Relief Certificate

Shri / Smt / Kumari .. employed as . is granted leave for 20 weeks (140 days) commencing from to and is relieved of his/her duties with effect from to .. to enable him/her to pursue M.S/Ph.D. Research programme under External Registration Scheme in July / Jan. .. semester at the Indian Institute of Technology Madras, Chennai - 600036 as per their offer of admission letter No. dated ..

Date :

Signature of the Officer with name and address of the Organisation

Office Seal

Admission to Ph.D / M.S programme under Part-Time Scheme at IIT Madras

Proforma for Relief Certificate

Shri / Smt / Kumari .. employed as . is granted leave for 20 weeks (140 days) commencing from to and is relieved of his/her duties with effect from to .. to enable him/her to pursue M.S/Ph.D. Research programme under PartTime Scheme in July / Jan... semester at the Indian Institute of Technology Madras, Chennai - 600036 as per their offer of admission letter No. dated ..

Date :

Signature of the Officer with name and address of the Organisation

Office Seal

Certificate from the Employing Organisation

Form-1

For external registration of their employees in Ph.D / M.S programme of IIT Madras --------------------------------------------------------------------------------------------------------------------------The application of ..... working as .... . .. in .. since ..

.. is herewith recommended and forwarded for admission under External Registration Scheme of the Indian Institute of Technology Madras for Ph.D/M.S Research programme in the Department of
1. This organization has adequate facilities for carrying out the research indicated by the applicant and if he/she is selected, these will be made available to him/her during regular working hours till the completion of the programme. The applicant will be deputed/given leave for duration of his/her residence period at IIT Madras. Facilities will be made available to the Co-guide to supervise the work of the applicant and to attend the meetings at IIT Madras when necessary. Till the completion of his/her research programme, the applicant will not ordinarily be transferred to another unit or place which may impede his/her work under the scheme. If such a transfer is necessary, IIT Madras will be informed within a month of such transfer. We understand that continuing of registration will depend on IITs decision in this regard, taking into account all relevant factors. We note that the facilities of the Institute will be made available to him/her for carrying out the work and that there will be no separate charge (other than tuition fees payable by the candidate) for the use of laboratory, library and other facilities. No part of the work carried out in fulfillment of the Research programme will be utilized commercially or for applying for a Patent without the approval of Indian Institute of Technology Madras and other than on terms mutually agreed to by IIT Madras and this organization.

2. 3. 4.

5.

6.

Date: Seal of the organization/ Institution

Signature of the Officer : Name and Designation : Postal address of the Organisation :

Form-2 Certificate from the reputed University / Institution/ Organization sponsoring their employees For Ph.D / M.S programme of IIT Madras-Part-time scheme --------------------------------------------------------------------------------------------------------------------------The application of ..... working as .... . .. in .. since ..

.. is herewith recommended and forwarded for admission under External Registration Scheme of the Indian Institute of Technology Madras for Ph.D/M.S Research programme in the Department of
1. The applicant has 2 year / 5 year(in the case of management area) experience in the organization.

2. We note that facilities of the IITM will be made available to him/ her for carrying out the research work under the supervision of a guide and he/ she has to pay full fees every semester for the use of laboratory, library and other facilities of the Institute. 3. 4. This organization facility will also be made available to him/ her in the case of selection. The applicant will be deputed/given leave for duration of his/her residence period at IIT Madras.

5. Till the completion of his/her research programme, the applicant will not ordinarily be transferred to another unit or place which may impede his/her work under the scheme. If such a transfer is necessary, IIT Madras will be informed within a month of such transfer. We understand that continuing of registration will depend on IITMs decision in this regard, taking into account all relevant factors. 6. No part of the work carried out fulfillment of the Research programme will be utilized commercially or for applying for a Patent without the approval of Indian Institute of Technology Madras and other than on terms mutually agreed to by IIT Madras and this organization. Date: Seal of the organization/ Institution Signature of the Officer : Name and Designation : Postal address of the Organisation :

Particulars of Co-guide for external Registration Scheme

In addition to being in a position to ensure technical and logistic support to the scholar in his/her research work in the organization, the Co-guide must have a minimum academic qualification of a Masters degree in Engineering/Management or Ph.D. in Science and adequate professional experience in the relevant field. The Co-guide should not himself be a scholar working for any higher degree of any university. He will be an invitee to the Doctoral Committee/General Test Committee meetings at IIT Madras. (1) Name of proposed Co-guide (in block letters) Academic qualifications of Co-guide :

(2)

(3)

Membership of Professional Societies of Co-guide

(4)

Designation of Co-guide

Certificate of Co-guide
This is to state that in the event of Mr/Ms. ________________________________________ of this organization being selected for Ph.D / M.S programme in the Department of

________________________________________________ under the External Registration Scheme of IIT Madras, I agree to be his/her Co-guide and shall extend all possible facilities to enable him to carry out his research programme towards the submission of thesis.

Date:

Signature of Co-guide

Admission to Ph.D / M.S programme under Project Scheme at IIT Madras Certificate from the Project Co-ordinator
I have noted the conditions stated below concerning the registration of project staff for Ph.D / M.S programme.

This is to certify that Sri/Smt/Kum ________________________________ is working in the project title _______________________________________________ since ______________ as

_____________________________________. The candidate is eligible to continue in the project for a minimum period of one more year from the date of his/her joining the research programme (Ph.D / M.S) even though his/her appointment is up to ________________ as per his/her appointment order. The actual duration of the project is up to _________________.
Conditions:

1.

For a person employed on a project to be eligible for Ph.D/M.S registration, there should

be a minimum residual period of one years service in the project from the date of registration. 2. Where qualification in an All-India Examination like CSIR/UGC/GATE is also a

requirement for registration, persons who are employed on projects and who do not satisfy this requirement on the date of application, can be considered for provisional registration for Ph.D / M.S programme provided, they have at least 2 years residual service on the project.

Date:

Signature and name of the Project Coordinator Department of__________________________ Countersigned:

Date:

Head of the Department of ________________