INDIAN INSTITUTE OF TECHNOLOGY, BOMBAY
M.TECH. ADMISSIONS 2005-2006
Sr. No.
1. Name in full: (as in qualifying degree certificate)
Paste (do not pin) passport
size photograph in this
space and get it attested by
Principal/Head of College/
University last attended or
a Gazetted Officer
2. (a) GATE records: (Attach copy of GATE score card)
Reg. No.
Year
GATE Percentile
.s
AIR
(b) Other Competitive (All India) Exams Score, if any
(Like NCST (D Level), AIIMS/ MCI/ GIPMER/ PGI Chandigarh/ AFMCPune)
Name of competitive exam: _____________ Year:
3. (a) Address of the candidate for communication
Score:
.s
_______________________________________
(b) Name & Address of Parent/ Guardian
(i.e. Permanent Address)
_____________________________________
_______________________________________
_____________________________________
_______________________________________
_____________________________________
City ____________________________
City ______________________________
State _____________Pin
State ____________Pin
4. Telephone: (with STD code) ____________________ E-mail: _______________________________
5. Date of Birth:
6. Sex:
D D
8. Marital Status:
9. Qualifying Degree:
M M
7. GN/SC/ST/PD:
Y Y
(Write M for Married/ S for Single)
10. Qualifying Discipline:
12. No. of years of Experience: a) Teaching :
11. Status of Examination:
b) Industry :
(attach experience certificate)
13. Details of Academic Record of Qualifying Examination:
Institute/University
Examination Passed
Year of Passing
Class/Division
Average % of
Marks/ Grade
14. * Departments/Interdisciplinary Groups/Centre and Schools applied for: Candidate can fill in any
three Departments/Interdisciplinary groups/Centre/Schools (in column I) in order of preference (from
the codes listed below at *). Write specialization of your interest (if any) against the Departments you
have applied for in column II (under 1 to 5). For list of specialization refer to brochure.
II Specializations
I
Department/Interdisciplinary groups/
Centre/Schools
(i)
(ii)
(iii)
15. # Categories under which you want to apply: (write in order of preference)
16. Papers published, if any: (Please attach extract)
No. of Papers: Published --
Under publication --
17. Declaration:
I certify that the information given above is correct and I am aware that providing incorrect information in
the application form will result in cancellation of the admission.
Place:
Date:
Signature of the Applicant
* Departments/Interdisciplinary Groups/Centre/Schools
AE
CH
CE
CS
GS
EE
ME
MM
Departments
Aerospace Engineering
Chemical Engineering
Civil Engineering
Computer Sc. & Engg.
Earth Sciences
Electrical Engineering
Mechanical Engineering
Metallurgical Engg. &
Materials Science
Interdisciplinary Groups
CO Corrosion Sc. & Engg.
EN Energy Systems Engg.
IO IE & OR
RE Reliability Engineering
SC Systems & Control Engg.
Centre
EV
IT
BM
Environmental Sc. & Engg.
Schools
School of Information
Technology
School of Biosciences &
Bioengineering
(Biomedical Engg.)
# Categories: TAInstitute Teaching Assistantship, TAPTeaching Assistantship through Project, RA
Institute Research Assistantship, PAProject Research Assistantship, PSProject Staff, ISInstitute Staff,
SFSelf-financed, SWSponsored candidates
Details of Demand Draft
Demand Draft No.: ___________________ Demand Draft Date: _______________________________
Amount: ___________________________ Bankers Name: ____________________________________