INDIAN INSTITUTE OF TECHNOLOGY KANPUR

Application Form For Admissions To Post Graduate 2016-2017

Date:11-APR-2016
Reference No:

IITK/2016-17-I/PG/6992

Application Date:

03-APR-2016

Application Status:

Applied

1. General Information
Full Name

CHETANYA DEV BHARADWAJ

DOB

Place of Birth

SASNI

Father's Name

VIJAY KUMAR SHARMA

Sex

Address for Corres.

BASANT VIHAR ,PALTAN ,SASNI

Male

HATHRAS
E-Mail

er.chetanyadev@gmail.com

Category

General

01-JUL-1992

Marital Status

State
Phone

NA

Person with Disability (PwD)

No

Single
Nationality

Indian

Uttar Pradesh

PinCode

Mobile

NA

Religion

Hindu

204216

2. Applied Department/Programme Details

Department

Mechanical Engineering

Admission for Degree

Appling directly PhD after BE/BTech from Centrally Funded Technical Institute
Financial Status

Institute Asst. Required

MTech

NA
Student Status

Full Time

Areas of specialization in the Department/Programme

Pref. 1. Solid Mechanics and Design

Pref. 2. Fluid Mechanics and Thermal Sciences

Pref. 3. Manufacturing Science

Pref. 4.

3. 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

Mechanical Engg.

780.0

870

2016

B. Qualifying Degree already obtained or in Progress

University Name

Uni Address 1

DR.A.P.J.ABDUL KALAM
TECHNICAL UNIVERSITY

IET CAMPUS ,LUCKNOW

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)

other

government engineering college

NA

Degree

Discipline

Final Result expected by Min. Pass Marks

Max. Marks

B.Tech.

Mechanical Engineering

2016

30.0

100.0

% Marks or Grade
Average

Sem. I

Sem. II

Sem. III

Sem. IV

Sem. V

73.2

78.6

71.7

72.5

78.2

Sem. VI

Sem. VII

Sem. VIII

Sem. IX

Sem. X

77.3

80.6

0.0

0.0

0.0

NA

Overall Marks in % or Grade Average 76.0

Page 1 of 2

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

D. Working Experiences
Duration

Employer

Position

Nature of work

E. Number of Technical Papers(Provide details separately)

Papers Published in Journals

Presented in Conference

4. Names and addresses of two referees from whom letters of reference have been obtaioned(For Ph.D Only)
Sr No Referee Name

Designation/Position

Address

Email ID

5. Application Fee Payment Details

Receipt Number : 14494319
Bank Name : State Bank of India

Bank Transaction ID : IG0BULLKR5

Transaction Status : OK

Transaction Amount : 400

Transaction Date : 11-04-2016 16:26:51

Payment Gateway : AXIS

Payment Mode : Net Banking

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: 03-APR-2016

Signature:

Checklist of Uploaded Documents

1. Applicant Photograph
2. Applicant Signature
3. Date of Birth (DOB) Certificate or High School (Class 10) Certificate with DOB
4. GATE Score Card

Page 2 of 2