Phd Form July2012

8/2/2019 Phd Form July2012

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Indian Institute of Technology Patna

For Office Use:Sl. No.: IITP/ACAD/PhD/2012/01/_____________

For Dept. Use:App. No.:_______________________________

(Fill the details of the Demand Draft drawn in favour of IIT Patna Payable at Patna for the Application Fee)Amount: Rs. Draft

No.:Dated: Drawn in

Bank:

1. Full Name of the Applicant:Affix yourRecent

Passport sizePhotograph

2. Fathers/ Guardians/Spouses Name:

3. Date of Birth (dd-mm-yyyy): 4. Nationality:

5. Gender: 6. Marital Status:

7. Category: General / OBC (including OBC Minorities) (Non-Creamy Layer) / SC / ST(In case of SC/ ST/ OBC (Non-Creamy Layer), enclose the attested copy of certificate for the proof of category)

8. Are you a Person with Disability (PD)? Yes / No

(If yes, enclose the attested copy of certificate from Govt. Medical Practitioner stating the type and percentage of physical disability)

9 (a). Contact Address: 9(b). Permanent Address:

9(c). Contact Phone Number:

(In case of landline, write STD code also. Your Mobile phone number is preferable)

9(d). Contact Email Address:


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13. Choices for Area of Research for Ph.D. (See: Detailed Advertisement available on the website), in order of preference1st Pref: 2nd Pref:

3rd

Pref: 4th

Pref:

14. Details of Academic Record (Attach attested copies of certificates, mark sheets, etc)Qualifying Degree already obtained or in progress:

Degree Discipline Name & Place of Institution/ University Year ofPassing

Final Resultsexpected by

Minimum Passing %of Marks or GradeAverage for theaward of degree

Overall Percentageof Marks obtained orFinal GradeAverage*

Semester Sem - I Sem II / Year - I Sem - III Sem IV / Year- II Sem - V Sem VI / Year - III

Percentage ofMarks or GradeAverage ObtainedSemester Sem - VII Sem VIII / Year - IV Sem - IX Sem X / Year - VPercentage ofMarks or GradeAverage Obtained

* If degree is not obtained, write the percentage of marks obtained or final Grade Average up to the pre-final semester/ year.Write the details of the academic record of 10 th, 12th classes and the Degrees obtained other than Qualifying Degree mentioned above.

Degree/Examination

Name of Institution/ Exam Board Year ofPassing

Percentage ofMarks/ Final

Grade Average

Class/Division

Obtained

Subjects Taken

10th Class

12th Class

(other degree)

15. Professional examination (GATE/ UGC or CSIR NET/ NBHM/DBT-JRF/ other fellowship exams) passed:Exam Name Exam Discipline Exam Score &

RankExam Passing

YearValid upto

16. Professional Experience, if any. (Attach attested copy of the proof).Name of Organization Position held Nature/ Type of Work Period (From To)


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18. List of Enclosures

Declaration

I hereby declare that the entries made in this application form are correct to the best of my knowledge andbelief. If selected for admission, I promise to abide by the rules and regulations of the Institute. TheInstitute 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. I note that the decision of theInstitute is final in regard to selection for admission and assignment to a particular department and field ofstudy.

Place:

Date: Signature of the Applicant

Please note:For complete details (Areas of Research, etc) on Ph.D. admission, visit the website: http://www.iitp.ac.in.

Application Fee of Rs. 300/- (for Gen/OBC candidates) and Rs.150/- (for ST/SC/PD candidates) must besent with this application by a demand draft drawn in favour of Indian Institute of Technology Patna andpayable at Patna.

The completed application enclosed with the demand draft for application fee and attested copies of marksheets/certificates and with other necessary enclosures (if applicable) should be sent to the AssistantRegistrar(Academic), Indian Institute of Technology Patna, Patliputra Colony, Patna 800 013,Bihar, to reach on or before 30-04-2012. The words Application for PhD admission in the Department of______ should be written on the top of the envelope for sending the completed form.


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Form ISponsorship Letter

(This should be typed on the letter head of the sponsoring organization)

Reference No.Date:

To,The DirectorIndian Institute of Technology Patna

Sub: Sponsoring an Employee for PhD Programme

Dear Sir,

We hereby sponsor the candidature of Mr./Ms./Mrs. ________________________________ who is anemployee in our organization, for joining PhD programme in ____________________________ at yourInstitute as a full-time student.

We shall relieve him/her from his/her duties in the organization during the first three years of the PhDprogramme.

Signature and Seal of theSponsoring Authority

Form IINo-Objection Certificate for IIT Patnas Project Staff(This should be typed on the letterhead of the R&D Section of IIT Patna)

Reference No.Date:

To,The Director

Indian Institute of Technology Patna

Sub: No-Objection Certificate for IIT Patnas Project Staff

Dear Sir,

The R&D Section, of IIT Patna, has no objection if Mr./Ms./Mrs. ___________________________ aj l i h j d


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Form III

No-Objection Certificate for Part-Time Students(This should be typed on the letter head of the sponsoring organization)

Reference No.Date:

To,The DirectorIndian Institute of Technology Patna

Sub: No-Objection Certificate

Dear Sir,

We have no objection if Mr./Ms./Mrs. ________________________________________ an employeein our organization, is admitted to the PhD programme in _____________________________ at yourInstitute as a PART-TIME student.

It is certified that he/she has completed 1(one) year of service in our organization/institute as a regularemployee.

We shall grant him/her leave of absence to attend classes/research works at IIT Patna during

the PhD programme.

Signature and Seal of theSponsoring Authority


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ANNEXURE-I

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FORAPPOINTMENT TO POSTS / ADMISSION TO CENTRAL EDUCATIONAL INSTITUTIONS (CEIs), UNDER THE

GOVERNMENT OF INDIA

This is to certify that Shri/Smt./Kum. _____________________________ Son/Daughter of Shri/Smt.

__________________________________ of Village/Town ________________________________ District/Division

__________________________ in the _________________________ State belongs to the

________________________ Community which is recognized as a backward class under:

(i) Resolution No. 12011/68/93-BCC(C) dated 10/09/93 published in the Gazette ofIndia Extraordinary Part I Section I No. 186 dated 13/09/93.

(ii) Resolution No. 12011/9/94-BCC dated 19/10/94 published in the Gazette of IndiaExtraordinary 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.

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


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NOTE:

(a) The term Ordinarily used here will have the same meaning as in Section 20 of the Representation of thePeople Act, 1950.

(b) The authorities competent to issue Caste Certificates are indicated below:(i) District Magistrate / Additional Magistrate / Collector / Deputy Commissioner / Additional Deputy

Commissioner / Deputy Collector / Ist Class Stipendiary Magistrate / Sub-Divisional magistrate / TalukaMagistrate / Executive Magistrate / Extra Assistant Commissioner (not below the rank of Ist ClassStipendiary 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, __________________________ son/daughter of Shri ______________________ 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 services 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 8/9/1993, which is modified vide Department of Personnel and

Training Office Memorandum No.36033/3/2004 Estt.(Res.) dated 9/3/2004.

Signature of the CandidatePlace:


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Annexure- III

DECLARATION / UNDERTAKING BY OBC(NCL) - MINORITY

CATEGORY CANDIDATES ONLY

I, ________________________________ son / daughter of Shri

_________________________________ resident of________________________

village/town/city __________________________________ district

________________________ State _______________hereby declare that I belong to

OBC(NCL) MINORITY Category as notified by Central Government of India.

I also declare that the condition of status / annual income for Creamy Layer of my

parents is within prescribed limits as on financial year ending on March 31, 2012.Based on this declaration I request you to kindly consider me as OBC(NCL)

minority.

I will submit the attested copy of the certificate at the time of registration for the

course.

Signature of the Candidate

Roll No.

Place:

Date:

Signature of the Parent/Guardian

(Declaration / undertaking not signed by candidate and countersigned by parents will

be rejected)

Place:


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Page - 9

DATA SHEET FOR THE APPLICANT (NAME): .. DEPARTMENT OF: .

App.

No.

(For

Office

Use)

Name & Address

Category

Point 7

Application form

Topics of interest

Descending by preference

Academic Qualifications

Experiences (For

employed Candidates)

Remarks

(For Official

Use)Degree% of

marks

Year in

which

Completed

Name:

X

Mailing Address:

XII

Date of Birth

DD/MM/YYYY

B.E./ B.Tech/

B.Sc./ B.A.

PIN Code:

Gate score and

validity M.E./ M.Tech./

M.Sc./ M.A.

Phone and Mobile Number: M.Phil.

Email ID: Category in Which Applied:Point 12 Application form

Documents

Phd Form July2012