INDIAN INSTITUTE OF TECHNOLOGY KANPUR
Application Form For Admissions To Post Graduate 2015-2016
Date:20-APR-2015
Reference No:
IITK/2015-16-I/PG/10717
Application Date:
13-APR-2015
Application Status:
Submitted
1. General Information
Full Name
abhishek singh
DOB
Place of Birth
gorakhpur
Father's Name
gorakh prasad
Address for Corres.
af 45
Sex
Male
14-JUL-1989
Marital Status
Single
Nationality
Indian
Uttaranchal
PinCode
Mobile
7505471957
jawahr bhawan
iit roorkee
State
E-Mail
abhisitm2012@gmail.com
Phone
NA
247667
2. Demand Draft Details
DD No.
818795
Amount Rs.
Issued by Bank Name
200.0
DD Date
06-APR-2015
STATE BANK OF INDIA
Branch Code(Drawee)
01069
Student Status
Full Time
3. Applied Department/Programme Details and Category
Department
Civil Engg.
Admission for Degree
PhD
Appling directly PhD after BE/BTech from Centrally Funded Technical Institute
Financial Status
Sponsored
Category
No
SC
Phy. Handicapped
No
Areas of specialization in the Department/Programme
Pref. 1. Structural Engineering
Pref. 2.
Pref. 3.
Pref. 4.
4. Academic Information/Work Experience
A. GATE,ICMR-JRF,ICAR,DBT-JRF,CEED,CSIR-JRF/LS,UGC-JRF/LS,Other Fellowship Details
Exam Name
Exam Discipline
Score
Rank
Exam Year
GATE
Civil Engg.
359.0
3623
2012
B. Qualifying Degree already obtained or in Progress
University Name
Uni Address 1
IIT roorkee
IIT roorkee
Uni Address 2
Rank in University
Total Student in Uni
NA
NA
Institute Code
Institute Name & Place
Centrally Funded Technical Inst. (Only applicable Rank in Institute
for direct PhD after BE/BTech)
UK018
Indian Institute of Technology, Roorkee
No
Degree
Discipline
Final Result expected by Min. Pass Marks
Max. Marks
M.Tech.
Earthquake engineering
2015
4.0
10.0
% Marks or Grade
Average
Sem. I
Sem. II
Sem. III
Sem. IV
6.0
5.8
9.0
0.0
Overall/Current grade
average
Sem. V
Sem. VI
Sem. VII
Sem. VIII
6.05
0.0
0.0
0.0
0.0
NA
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C. Other Degrees Obtained after 10+2(Do not include the degree listed in 4B)
Degree
Discipline
University Name & Address
Institute Name & Address
Marks or
CPI
Completion
Year
B.E.
civil engineering
BIT mesra BIT mesra ranchi
Bit Mesra ranchi Jharkhand
6.97
2012
D. Working Experiences
Duration
Employer
Position
Nature of work
E. Number of Technical Papers(Provide details separately)
Papers Published in Journals
Presented in Conference
5. Names and addresses of two referees from whom letters of reference have been obtaioned(For Ph.D Only)
1. Dr. Amita Sinvhal
2. Dr. Y Singh
Address: IIT roorkee
Address: IIT roorkee
Earthquake dept
earthquake dept
Email: amitafeq@iitr.ac.in
Email: yogenfeq@iitr.ac.in
Declaration by the Applicant
Certified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any wilful misrepresentation of facts
will result in my dismissal from the institute. If admitted, I shall abide by all the rules and regulations of the institute.
Date:
Signature:
Checklist (Send self attested photocopies(Not Original) and mention reference no. on each of the document)
1. Date of Birth (DOB) Certificate or High School (Class 10) Certificate with
DOB
2. SC/ST/OBC Certificate if applicable
3. Certificate of Physical Disability (Type of disability to be attached)
4. Sponsorship Certificate for Sponsored Candidate
5. GATE/CSIR/UGC/ICMR/CEED/Other Fellow Exam Score card (If you have 6. Photocopies of qualifying degree marks/grade sheets
not received GATE score card then please send printout of the online GATE
score card.)
7. The application fee of Rs.400/ for candidates in General/OBC and Rs.200/ for 8. Printed copy of your Online filled application form (If photograph is not
SC/ST/PD must be paid through demand draft payable to The Registrar IIT
loaded, then write reference no at back of self attested passport size photograph
Kanpur at Kanpur.(Note: Send original)
and staple it.).
9. No Objection/relieving Certificate from Employer (For employed candidates 10. Two letters of reference (For Ph.D. applicants only)
at the time of admission)
11. For applicants to the PhD programme of the ME Department, please see http://www.iitk.ac.in/me/admission/phd2014.htm for additional mandatory
requirements
Mailing Address for Applications:
The Convenor, DPGC
Department/Programme of _________________________
(Kindly mentioned the Department name where you are seeking your admission)
Indian Institute of Technology, Kanpur
Kanpur-208016 U.P.
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SPEED POST
APPLICATION REF NO: IITK/2015-16-I/PG/10717
PROGRAM: PhD
To,
The Convenor, DPGC
Department/Programme of Civil Engg.(CE)
Indian Institute of Technology, Kanpur
Kanpur-208016 U.P.
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