APPLICATION NO. 15102761
INDIAN INSTITUTE OF TECHNOLOGY ROORKEEAPPLICATION FOR ADMISSION
TO
M.TECH./M.ARCH./M.U.R.P. PROGRAMMES-2015 A Passport
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EC33065S2059GATE REGISTRATION NO: Aadhaar Card No:
1. Name of the Candidate :GOURAV PRATEEK SHARMA
2. Fathers Name: RAJINDER KUMAR SHARMA 3. Mothers Name: NEETA
SHARMA
4. Date of Birth: 18-March-1994 5. Gender :
6. Nationality:
7. Category : GEN 8. Person with Different Ability:
9. Qualifying Exam Passed:
Any back paper(s)/ Supplementary(ies):
10. Percentage of Marks/CGPA: 8.260 Max.Marks/CGPA-Point Scale
10.000
11. Bachelors Degree from an IIT: If yes, Name of the IIT:
12. GATE Qualified: 13. GATE Discipline (Code): EC
14. GATE Marks Out of 100: 57.70 15. GATE Qualifying Year:
2015
16. Whether Sponsored Candidate: (for candidates already in
employement)
If Yes, Admission required :
18. Departments/Centres Applied
17. Maths at 10+2 Level:
Subject Name: (A candidate will be required to complete and have
passed/appeared the qualifying examination including back paper(s)
/supplementary(ies) examination by the date of registratrion)
Likly to Clear:
Maths at Graduation Level:
Female
Indian
No
No
No
No
Yes
No
Yes Yes
Qualifying Degree : B.Tech.
ECD 1 EED 2 NTC 3 PHD 4
19. Codes of Academic Programme, Preference wise (As per Table-2
of Information Brochure-15) Choices once given shall not be changed
for any reason after submission of online application.
29 1
31 2
30 3
26 4
28 5
46 6
47 7
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20. Amount of Application Fee including Fee for Additional
Deptts. Paid (Rs.400-700): Rs. 740.00
22. Complete Postal Address for CorrespondenceJ-50 NIT
SRINAGARHAZRATBALSRINAGARJAMMU AND KASHMIRPin Code: 190006Email:
[email protected] No. 9596863133Telephone No.
01923263115Fax No.
23. DECLARATION BY CANDIDATEI hereby declare that all the
particular stated by me in this application form are true to the
best of my knowledge and belief. I have read the Information
Brochure of PG Admission-2015, IIT Roorkee given on Institute
Website and I shall abide by the terms and conditions given
therein. It is entirely my responsibility, to prove my eligibility
for admission to the Programme(s) for which I am admitted and also,
in respect of qualifications and entitlement for admission against
reserved category, if claimed, to the satisfaction of the
Institute. Further, in the event of suppression or distortion of
any fact like category, educational qualifications, nationality,
etc., made in my application form, I understand that my admission,
if granted or degree /diploma acquired subsequently, is liable for
cancellation. I also understand that the decision of IIT Roorkee
regarding my admission, will be final and I shall abide by the
ordinances and regulations of IIT Roorkee, in vogue form time to
time. I have read Section 8.9 of the Information Brochure regarding
the institutions approach toward ragging and the punishments to
which I am liable if found guilty of ragging. Further, if admitted,
I promise to abide by the statutes, ordinances and regulations of
IIT Roorkee. I further declare that I have not taken admission and
registered for any Postgraduate programme at the Institute at the
level for which I am applying. I also clearly understand that I
have to complete and pass the qualifying examination including back
paper (s)/supplementary(ies), if any by the scheduled date of
registration to the programme. In the event I am granted admission
/registered to the programme and later on it is found that I have
appeared in the examination or for a back paper/supplementary(ies)
for any subject and passed it after the date of scheduled
registration to the programme my admission /registration shall
stand terminated and I will not be entitled to any claim from the
IIT Roorkee.
24. Full Signature of candidate
Place...............................
Date
Enclosures:1. IITR Copy of Challan2. Xerox / Downloaded copy of
GATE score card3. Copy of Final year marks sheet/Pre final year
marks sheet4. Proof of Mathematics at 10+2 or higher level marks
sheet (If applicable)5. Copy of Persons with Disability (PD)
certificate (If applicable)6. SC/ST candidates should attached
caste certificates from the competent authorities. Candidates
belonging to OBC category must submit Xeroxed copy of category
certificate on GOI format.Certificate should have been issued after
31.03.2014 by a competent authority.7. Annexure 1 / 2 / 3 / 4 / 5
as applicable.
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