Professional Documents
Culture Documents
Application Form Walk in
Application Form Walk in
7. Father’s Name:
Codes for Items 11-15 are given overleaf
8. Address of Correspondence:
11. Department/Programme
C. Other Degrees obtained after 10+2 (Do not include the degree listed in 17 B)
Pref. 1 Pref. 2
Pref. 3 Pref. 4
19. Names and addresses of two referees from whom letters of reference have been obtained (For Ph.D. applicants only)
1. 2.
Certified, that all information provided by me on this form is correct to the best of my knowledge and belief. I understand that any
willful 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 :
INSTRUCTIONS FOR F ILLING THIS FORM
3. Go through the codes for Items 11-15 given below, and fill them carefully in the boxes on Page 1.
4. The application fee of Rs. 400/- for candidates in General/OBC and Rs. 200/- for SC/ST/PD must be paid through demand draft
payable to The Registrar I I T Kanpur at Kanpur
Item 11: Department/Programme Codes: {A erospace Engg. = AE}, {Civil Engg. = CE}, {Computer Science & Engg. = CSE}, {Earth
Sciences = ES}, {Electrical Engg. = EE}, {Industrial & Management Engg. = IME} {Mechanical Engg. = ME}, {Materials
Science & Engg. = MSE} {Chemistry = CHM}, {Mathematics and Statistics = MTS}, {Humanities & Social Sciences =
HSS}, {Materials Science Programme = MSP}, {Nuclear Engg. & Technology = N ET}, {Photonics Science & Engg. = PSE},
{Biological Sciences and Bio - Engineering = BSBE}.
Item 12: PH = Ph.D. MT = M.Tech. DS = Design
Item 13: Student Status: Full Time = FT; Part-Time = PT, External = EXT; Foreign National = FN
Sponsored = SD; Institute Assistantship requested = IA; Fellowship (if CSIR/UGC/DBT/ICAR/ICMR) = FEL;
1. Date of Birth (DOB) Certificate or High School (Class Te n) Certificate with DOB
2. SC/ST/OBC(NCL) Certificate, if applicable (Item 15). Certificate format is given on the website.
3. Certificate of Physical Disability, if applicable (Item 16). Certificate format is given on the website.
7. No Objection Certificate from employer (only for part-time/external) (Item 13). Full time students currently working must
produce NOC or Relieving Certificate from the employer at the time of admission.
8. The Demand draft for the application fee of Rs. 400/- or Rs. 200/- as applicable