T.No.

_______________

Indian Institute of Technology Hyderabad

Kandi, Sangereddy-502285 Telangana, INDIA

Registration Form for M.Tech.,

(2018 January)

Academic details:
Date of Registration: ______________ Application No.__________

Department _____________________ Affix Passport size

Photo

Program: _____________________

Specialization: _____________________

Duration of course: 2 year (TA) 3 year (RA)

Admission type : Regular External Self-sponsored Sponsored

Qualifying exam details:

GATE/CEED/UGC/NET/CSIR /Others (Pls.specify): ________ Year of qualifying
________
Regd. No______________ Rank __________________ AIR________________
Personal Details:
Name in Block letters (As per SSC/10th) ___________________________________________________

Father’s Name: ________________________________________________________________

Date of Birth: _____________________ Native Place:

____________________

Nationality: __________________ Category: (pl. mention): _______________

Personal Mobile No. 1): _______________________ 2):

____________________

Email id:_______________________________.

Address for Correspondence :

_________________________________________________________________________________

_________________________________________________________________________________

Permanent Address:
_________________________________________________________________________________

_________________________________________________________________________________

1
 ::2::

Educational details:
Year Medium
Name of the Name of the % of
Exam Duratio of of
course/Degr Board/Univer Marks/CGP
Passed n Passin Instructio
ee sity A
g n

10th /SSC

10+2/
Intermediate

Graduation
(Pl. Specify)
GATE/CEED/U
GC/NET/CSIR
/Others
Others(Pl.
Specify)

Other details:
Are you currently employed? If yes, pl. furnish the details of employer
_____________________________________________________________________________

Did you submit NOC/ Relieving Order? : Yes / No

Parent/ Guardian Details:

Name Phone No. Occupation
Father
Mother
Local guardian
(To contact in case of Emergency)

Mother Tongue: ____________ Other Languages Known:

_____________________

Blood Group: ____________

Are you physically challenged person? If yes,

pl. specify nature & percentage of disability _________________________________

Personal Identification Mark: ____________________________________________________

Signature of Student
Date: Name: