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Indian Institute of Technology GuwahatiApplication Form for Admission to MTech/MDes/PhD Programme

forFOR IG! APP"I#A!T$

For Department/Centres use: Reg. No.F/

1.(a) Name: Mr/Ms/Mrs.............................................................

(b) Father/Husband/Guardian .......... ........ ........ ........ ........ ....... ......... ........ ....... ..

(c) Addresses:

Affix passport size

Photograph

i) For correspondence ii) Permanent

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

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

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

Email: Phone: Fax:

. !a) Date o" #irth : date $$ month $$$.%ear$$.. !&) 'arital (tatus:$$$.................................

!&) Nationalit%: ............................. !d) Passport No. $$$$$$$$$$$$..

!attach photocop% o" Passport)

. !a) Department/Centre to *hich the candidate see+s admission:$$$$$$$$$$$$$$$$$$... !&) Programme !PhD) :

!c) ,ndicate research areas "or PhD in order o" pre"erence :!as gi-en in the ad-ertisement) :

!i)

!ii)

!iii)

. Details o" ni-ersities/,nstitutions attended !"rom 0 th standard on*ards)!attested copies o" certi"icates and mar+sheets/grade cards must &e attached)

"e%el of e&amination!ame of degree orcertificate

'oard/(ni%ersity

#ountryDuration ofprogramme

)ear of passing * Mar+s/ #GPA/#PI ,,

E1ui-alent to023 le-el examo" C#(E or ,C(E4,ndia5

6raduate!#achelors) le-el

Post7graduate!'asters) le-el

8ther

* e.g. General Certificate Education (GCE) Examination (London/Cambridge/Sri Lanka) at theAdvanced (A) level or !igh School Certificate Examination of the Cambridge "niver#it$ etc.** %ention the grading #cale al#o (e.g. &.' out of . etc.) if mark# are not a arded

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9. a) Pro"essional uali"%ing Examination passed !attested cop% o" certi"icate must &e attached): !0) 6A;E555 ! ) 6C/C(,R NE;/8thers555

(u&

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(To the Referee n addition to res!ondin" to the items be#o$% !#ease comment s!ecifica##& on the

a!!#icant's stren"th and #imitationsfor the !ro!osed stud& and a#so !roficienc& in n"#ish. #ease usethe bac*side of this form or attach a #etter. The referee is re+uested to !ut this form in a sea#ed

en,e#o!e and si"n across the sea# before handin" it o,er to the candidate.)

" TT R OF R F R !#For admission of foreign students in Indian Institute of Technology Guwahati- Guwahati- India

ha,e *no$n Mr. /Ms./Mrs. --------------------------------% $ho intends to a!!#&

for the h !ro"ramme in ndian nstitute of Techno#o"& Gu$ahati% for ---- &ears. ha,e

*no$n the a!!#icant in m& ca!acit& as ( please tick where applicable):

instructor in one or more courses su!er,isor

em!#o&er other: !#ease e !#ain

The candidate ran*ed a!!ro imate#& ------- in a c#ass of about ------ students.

The fo##o$in" are m& ratin"s on his +ua#ities (please tick):

0ua#it& ce##ent Good bo,e

a,era"e

,era"e 2e#o$

a,era"e

3nab#e to

4ud"e2ac*"round !re!aration

na#&tica# abi#it&otentia# research abi#it&Moti,ationi#i"ence5ra# 6ommunication7ritten 6ommunication5,era## e,a#uation

For the !ro!osed stud&% rror: Reference source not found (please tick where appropriate)

hi"h#& recommend recommend

recommend $ith some reser,ation do not recommend

the candidate.

8i"nature of the Referee: ate :

Name of the Referee: osition/ esi"nation:

ddress:

Te#e!hone No. Fa No. e9mai# address