APPLICATION FORM FOR 

Post Doctoral Fellowship of IITM for Women 

Department :………………………………………………………

(To get the names of the Departments visit : http://www.iitm.ac.in/departments)

1. Name :
PHOTOGRAPH 
Date of Birth (DD/MM/YY) : Age :
Affix Recent 
Address for Communication: Permanent Address : Passport Size 
Photo

Pincode : Pincode :
Phone No: Phone No:
Mobile No.: Fax No. :
Email :

2. Details of University/ Institution Studied (Bachelor's level and above)

Sl. Class & Average
Degree Discipline University/College Class
No. Year Marks/CGPA

3. Whether any degree was obtained thro' Correspondence course / distance education mode
(Tick the relevant) Yes q No q (If yes give the details)
…………………………………………………………………………………………………………………………………………………..

4. Personal Information:
(a) Father's /
Husband's Name (g) Annual Income :
Father's/Husband's (h) State to which the
(b)
occupation applicant belongs :
(c) Mother's Name (i) Martial Status :

(d) Place of Birth (j) Gender : Male q Female q

(k) Whether SC/ST /OBC : Yes / No
(e) Mother tongue
(If yes, enclose the relevant copy of the certificate)
(l) Whether Persons with Disability: Yes / No
(f) Nationality
(If yes, briefly describe its nature) 
 DECLARATION

I hereby declare that I have carefully read the instructions and particulars supplied to me and that the entries made in this
application form are correct to the best of my knowledge and belief. I understand that association (active or passive) with
any unlawful organization is forbidden. If selected, I promise to abide by the rules and discipline of the Institute.

Place :

Date : Signature of Applicant

………………………………………………………………………………………………………………………………………………………

Note :

1) The filled up application form should have the following enclosures:

a) Photocopies of the Rank certificates, Abstract of the Ph.D thesis, details of papers
presented, design contests participated, projects executed, any other
awards/distinctions obtained, Caste certificate if belongs to SC/ST/OBC, Medical
Certificate if Person with Disability etc.
b) A two page write‐up on the intended project work at IITM.
c) No objection certificate from the present employer (if currently employed)
2) The applications should be sent (through proper channels in case the candidates are
employed) to the following address:

The Deputy Registrar (Academic)

Indian Institute of Technology Madras
Chennai ‐ 600 036

3) All correspondence regarding this scheme are also to be addressed to the respective Heads
of department as indicated above.
(Names of the Departments visit : http://www.iitm.ac.in/departments).