sarc sre ever Rt Indian Institute of Technology Delhi fbr arg (ge) Academic Section (Undergraduate) ‘earaa/Self- Study areara crear % fery arte ————— APPLICATION FOR SELF-STUDY COURSE AOL VPA BRI ART oT Part- A To be completed by the Student 2, wf&fR Wy Entry No. H/ Name _ _ ‘endar/Programme 4, worden ahs/Programme code fer/Departmént wea mempfeathapMerascirs ward ¥ (gor we Ber crag) rear a Rey Request is for Self Study in (circle one) Ist/2™/Suramer semester of ses: areaamy fraw/Course details: aan ¥./ Course No. _ areregiue saraerftayL.T.P,____sBfe/Credits wea wr r/Conrse title ar He We H Piles ware 8 ae Gear Prats oe oH A wera POAT IT VT EI (ve We te aR) wire Is this course being offered as a regular course in the semester indicated at item 6 ? (Circle one) Yes/No aR ei, aa sim ga Praha wom & wr Paul El a Ba we? If yes, then why are you not taking it as a regular course? onted He Wi, 6 H fife Y Pratta comma ord (Gareaa a vreae wa oir Tou) Regular Course work in the semester indicated at item 6 above (all registered courses, except self study). = Wea T, wines ara we Course No. Title ' | Credits | Category EF | ga Peel wt sar frre Fay pe gee = Total credits registered for: * BASortell aftrat & ferpenaraar Usere SRT: Supporting documents required for further processing: ware ts ord ot atria verry & (ow der or) ars Photocopy of the most recent Semester Grade Card attached (circle one) Yes/No ore ew, 6 Paes wear wor tamer Res wiaret wl (Gem ET GTR) i/AEl Registration Record of the semester indicated at jtem 6 above attached —_-Yes/iNo (circle one) sre rere Gren eM SryPARRa REA omar wr Pt eet eA ahora are aereT ORL (Gas WT Ar IAT) Plan for completing degree requirements as dpproved by Course Adviser Yes/No Attached (circle one) Retar/Date____ pa & wanerySignature of Student_ ore ada: ora ath ann. a, a, aE Se SA any, ee are ap Se wT ea eo eT B ore wp erreme organ A wat BE Next Step: The student shoutd get parts B, C. D and E completed, and then submit this form toUG — Scetion within the first week of the semester. TPT wremann werreere at RrorRer Part-B Recommendation by Course Adviser ARN ontaral ah goh aed Ray Ora a cro ao aH eargles Ga ae A & ear ge FaTEATA a Reefer a oN eRe TA at wet & (car fewer wr we %) 1 J have carefully examined the student's course plan for completing degree requirements and this self-study is Recommended/Not recommended (strike out one option) ; ari/Name__ _ Reaer Wa aMdla/ Signature & date, _ APT aT yeberreres apHET are RTT ve arpa Part-C Verification and Clearance by UG Section , argh fag woe ee Boldface anser is a pre-requisite for clearance 10. a UTeRHH wereere B ahora we Aare fret Ase rar? Bip Plan discussed with Course Adviser? YesiNo 11, Sar vena eet (Bar *Tay/Self study done previously 7 BipteyYes/No 12, Ras totter & orarher ger area wo ear Se onderd gol gy urge ? are With current registration, will degree requirements be completed Yes/No with this self-study ? 13. Ray geht ward Aeanara qroumn & fay we ore des foat & ? are Yes/No Any other application for a self-study course in the sare semester?ayaa 14, Raft srdeny ot amet oF feng aa wh sa Rareara Tou Site ? Yes/No Is another self-study course required for completing degree requirements ? 15, war WeTAT eT Wars Supporting documents attached ? wyrey/YesiNo a ant Bt siftar & ferg orpater wart BH Mg Osrpatt wart vat at 1§ waif ae a Clearance granted for further processing Clearance not granted because of item No. oniier (q.L..) wRMTWSignature of Supdt.(UGS). ara ya &. wh ned & ferg pra at arre fear ore To be returned to the student for completing Parts D and E. rere BT wah BT a fore cteare wenrer were eB) EAT Part-D Concurrence of faculty member willing to teach the student Age ora at ere B wr eum a, wart Ferg ature & : ay Lam willing to teach course NG as Self-study to this student: Yes/No (a fare ame YStrike out one option) arm/Name, BRIER Ve aTEtw/Signatuie & date RrampdsyDeparmenviCentee sar ~ =, Reaee Rarer & arene verre a oe A rer creat @ ser Poareney/aexreaet _ RrorRer Part-E Recommendation by Head of Department/Center whose course is to be taken as Selt-Study. a eave rou fy are (ese Prat rT) Arrangement for this seif-stady course (Tick one) Q witgayAcceptable OQ andigr/Not acceptalbe ‘wearers Ya aTebe/Signature & date unt a greuer, 2s ea ichlereor & Rehr (Vm) Part-F Recommendation by Chairman, Grades & Regn, (UG) eave AG Sega (ar ae Prat arare) Renee ah ore CORrenter et ah eh a, Approval for self-study (tick one) Recommended Not Recommended because wren GH ameha/Signature & datewry Bw Mewrenezer, YA. BRT TTTT Part-G Approval by Dean, UGS creamer ren ore S/SRPARRE At Rear are ¢gar Parse wre 8) Self-Study is Approved/Not approved (Stike out on option) xh ra orga ah rift Foran rat aT We ata Forwarded to UG Section Signature & date aT ot Yet. argorr arr wrkars Part-H action by UG Section ate a AR a fT ware a i Entered by. on date__ TOM TE Bt at at, Pa yer wet a arth Ah Information, instruction, deadlines sent to course coordinator on. ‘Ura ey. atta eae, Péa cer wer vt at arta at gh Information, instructions and deadlines sent to student on. Notification issued on_