8/13/2019 IITB Monash PhD Form a 2013-04-01 Application

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8/13/2019 IITB Monash PhD Form a 2013-04-01 Application

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IIT Bombay

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PhD Application Office Use Only Stuent !D: """"""""""""""""

Section A # $o %e complete %y the applicant

&' Personal etails

Please place in appropriate %oes

Title: Mr Mrs Ms Dr Other

Family Name:

Given Names:

Gender: Male Female

Date of Birth: Day Month Year

PermanentAddress:

Address thatformal mailshould be sent toduring yourandidature

Dates this address !ill be a""liable for:

from: Day Month Year to: Day Month Year

Tele"hone No: #ome: $or%:

&'mail address:

Please indiate your iti(enshi" status:

)ndian iti(en Australian or Ne! *ealand iti(enor Australian "ermanent resident

Other

)f other+ "lease state yourountry of iti(enshi":

and "ass"ort number:

Disclosure of riminal on*iction for an ApplicantPlease indiate if there is anything in your "ast that !ould "revent you from gaining a visa to Australia or otherountry, -this may inlude "rior riminal onvitions. Please refer to: htt"://!!!,immi,gov,au/media/fat'sheets/01harater,htmfor more information

Please inlude details -N)2 ifthere are none.:

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http://www.immi.gov.au/media/fact-sheets/79character.htmhttp://www.immi.gov.au/media/fact-sheets/79character.htmhttp://www.immi.gov.au/media/fact-sheets/79character.htmhttp://www.immi.gov.au/media/fact-sheets/79character.htm

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All applicants shoul attach a copy (scanne copy for email su%mission) of their passport+ %irth orciti,enship certificate+ or of a ocument relating to their resiency status'

-' Propose enrolment etails

-'&Pro"osed andidature ommenement date: Day Month Year

Please inicate the first ate .hen you .ill %e a*aila%le to /oin'

-'- Pro/ect hoices: You will need to select up to 4 ProjectChoices online when submitting this form at TheAcademy Form A Online Application System AFO!S"# which a$ailable at%http%&&www'iitbmonash'org&application(process&

Please rea these points carefully: )t is not necessary that you ha$e to choose 4 projects on the online system'

On the online system# each of the projects that you ha$e selected will ha$e a set of *ideal+ or *re,uired+ capabilities' You will need to

indicate how your bac-ground satisfies these re,uired capabilities' )f you are not able to demonstrate these capabilities# you may want tochoose another project'

There is li-ely to be a change to the list of projects pro$ided on the Academy )nternet website and the online system'

-'0 apa%ility a.areness

#ave you read the "ro3et desri"tions for the "ro3ets you have hosen -Y/N.4

For Pro3et Desri"tions li% on the relevant "ro3et numbers on the 5esearh Pro3ets "age on the !ebsite:!!!,iitbmonash,org/researh'"ro3etsv6

#ave you filled in your res"onses to the a"ability re7uirements for the "ro3ets you have hosen -Y/N.4

0' $ertiary eucational recor an moti*ation

8tatement-s. of your full tertiary acaemic history must accompany this application, Scans of the original

aademi transri"ts an be submitted,)f you are invited to intervie! you are e9"eted to bring the original transri"ts to the intervie!, A""liants !hosubmit douments in a language other than &nglish must "rovide an offiially ertified translation+ together !ith theoriginal doument,

Original aademi transri"ts for verifiation are to be "rodued to the De"uty 5egistrar+ Aademi+ at ))TB andMonash 5esearh Graduate 8hool at Monash niversity at the time of enrolment+ after admission, Do not "rovidegrades suh as ;Distintion; or ;First

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$ype of 1am Score 2an3 4ear of 1am Please note that themore detail you

pro$ide in thissection# the greateryour chances ofsuccess'

GAT& -if available.

G5& 8ore -if available.

TO&F2 8ore -if available.

AM:

N&T

Other' > -say

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6' Scholarship etails

Do you hold any sholarshi"s or other a!ards+ or are you s"onsored by an outside body eg industry or government's"onsored a!ards4

No Yes

Give name of sholarshi"s+ a!ards or s"onsoring body:

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;' 1nglish proficiency

Please "lae E in the bo9 indiating ho! you have satisfied the &nglish language re7uirements for admission,

First language is &nglish

An overall band sore of not less than ,@ on the )&2T8 test onduted by )DP and the British ' Declaration %y applicant

Note:The information on this form is olleted for the "rimary "ur"ose of assessing your a""liation for admission to PhDandidature, Other "ur"oses of olletion inlude the reation of an enrolment reord on the student database+attending to administrative matters+ orres"onding !ith you and statistial analyses, )f you hoose not to om"leteall the 7uestions on this form+ it !ill not be "ossible for us to assess your a""liation, Personal information mayalso be dislosed to the relevant bodies for the verifiation of your 7ualifiations and it may be dislosed togovernment agenies as re7uired by legislation, You have a right to aess "ersonal information !e hold aboutyou+ sub3et to any e9e"tions in relevant legislation,

)f you !ish to see% aess to your "ersonal information or in7uire about the handling of your "ersonal information+"lease ontat the niversity Privay Offier on >'C' 11?@ ?>> -at Monash niversity. and De"uty 5egistrar-Aad,. at 1>'66'6@0 0?I> -at ))T Bombay.,

Please note that the re7uirements of the PhD "rogram at The Aademy means that you !ill not be able to arry outany "art time !or% and you !ould need to abide by the additional em"loyment onditions relating to eahinstitution,

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D1=A2A$!ON:

! eclarethat ) have read the instrutions on this a""liation form and that the information "rovided by me is trueand om"lete, ) reognise that it is my res"onsibility to "rovide all neessary doumentation to su""ort mya""liation and ) authorise the )nstitute/niversity to obtain offiial student reords from any eduational institutionor to verify my "ast and urrent em"loyment for the "ur"ose of ma%ing an informed deision about the a""liationor matters that onern my admission and enrolment in this ourse,

! acceptthat doumentation "rovided by me !ill beome the "ro"erty of ))T Bombay/Monash niversity and made

available to om"etent authorities !hen re7uired, ) have read and understood the above onditions and ae"tthem fully,

! ac3no.legethat ))TB/Monash niversity reserves the right to vary or reverse any deision regarding admissionor enrolment made on the basis of inorret or inom"lete information, ) have read and understand the aboveonditions and am "re"ared to ae"t them in full,

$hen you are submitting this form eletronially "lease send it !ithout a signature+ but "rint your nameas !ell asthe ateyou filled the form in, By inserting your name and date you are asserting that all of the information on thisform is true+ om"lete and aurate,

Any FormA which is su!mitted without a name and date on it may not !e considered"

8ignature: Date:

Please see the instructions at the front of this form as .ell as the FA? on the .e%site(...'iit%monash'org) for etails on su%mitting your application

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http://www.iitbmonash.org/http://www.iitbmonash.org/