INDIAN INSTITUTE OF TECHNOLOGY GANDHINAGAR

ApplicationFormforAdmissiontoM.TechandD.IIT Programmes

Paste passport size photograph

Programme: (Please tick M.Tech. Discipline: (Please tick Chemical Engr. Electrical Engr.

in front of the programme you are applying for)

D.IIT

M.Tech. (part-time basis)

in front of the discipline you are applying for)

Civil Engr.

Mechanical Engr.

Material Science and Engr.

Name (as in qualifying degree certificate) First Name Middle Name Last Name Contact details Address for communication: Permanent Address:

City: State: Telephone Number

Pin Code Mobile Number

City: State: Email Address: Alternate Email Address:

Pin Code

Date of Birth dd/mm/year

Category: GN/OBC/SC/ST

Sex (M/F)

Nationality

GATE score Name of Examination Year Score/Percentile Validity Period (if applicable) All India Rank (AIR)

Details of academic record (From 12th Standard Onwards) Degree Subject College

[IMPORTANT: Please attach the attested copies of necessary documents]

University/ Institute

Year of Passing

Class/ Division

% of Marks/Grade /CGPA

Details of Any Research/Professional Experience or Publications

Details of Any Past Employment Duration Organization Designation From To

Declaration: I hereby declare that the information given above is correct to the best of my knowledge and belief. I am also aware that providing incorrect information in the application form can result in the cancellation of my admission at any stage. Place: Date: Signature of the Applicant

Please send the completed application form to the following address with MTech Application written on the envelope Assistant Registrar (Academics) Indian Institute of Technology Gandhinagar VGEC Campus, Visat-Gandhinagar Highway Chandkheda, Ahmedabad 382424 Email: academics@iitgn.ac.in Phone: +91 - 79 - 2397 2583; Fax: +91 - 79 - 2397 2586

Check List for Enclosures: Copy of Mark sheets/ grade cards (From 12th standard onwards) Copy of GATE score/UGC-NET/CSIR-UGC Copy of Certificate of SC/ST/OBC (if applicable)