Application Number (for office use only): ..

Indian Institute of Information Technology Vadodara

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Application Form for Admission to PhD Programme-July, 2016

Full Time Assistantship

CATEGORY

Source of Assistantship
INSTITUTE

Employed Candidates
(No Assistantship)
CSIR

Master Degree
OR
GATE

Year

Details of GATE exam

Year Employer: .

Year of passing:...

UGC-JRF

Subject:.

Year

GATE Score/Percentile:..

Any Other

All India Rank.

Specify Experience in Years:.

UGC-NET

ECE
CSE
PHY/MS/NS&NT
(Select only one of the above)

CHOICE

Sponsored (Full-Time)

ECE: Electronics and Communication Engineering

CSE: Computer Science and Engineering
MS: Material Science
NS&NT: Nanoscience and Nanotechnology
HSS : Humanities and Social Sciences
STAT: Statistics

MAT/STAT

HSS

PHY: Physics
MAT: Mathematics

Proposed Area(s) of Research :...........

Name (in CAPITAL)

Gender

Male

Female
DD

Date of Birth

MM

YYYY

Fathers Name
Mothers Name

PERSONAL

Marital Status

Married

Unmarried

Address for
Correspondence
PIN:

Mobile:

Email:

Permanent Address
PIN:

Mobile:

QUALIFYING DEGREE

Email:

Qualifying Exam...Discipline
Year of Passing. University/Institute...
Obtained

Sem.I..
CPI/CGPA
/Marks
obtained

Out of

..

Sem.III.. ..

CPI/CGPA

Obtained

Sem.II..

Sem.IV..

OR Aggregate % of Marks

Out of

Exam/Degree

Discipline

Board/
Institute/University

Year of
Passing

% of Marks/
CGPA

PAYMENT

EXPERIENCE IF ANY

PREV. ACAD. REC.

10th
10+2/
Equivalent
B.Sc./B.A./
B.C.A.
B.Tech./B.E.
M.Sc./M.A./
M.C.A.
M.Tech./
M.E./M.Phil
Any other
Experience
(Reverse Chronological order)

Designation

Organization
(with Address)

Details of the Demand Draft

(Demand Draft of INR 1000, in the name of Indian Institute of Information
Technology Vadodara payable at Gandhinagar)
Bank:.Amount:(INR)
Demand Draft No.:.......................Date:.

STATEMENT OF PURPOSE

Please write here Statement of Purpose not exceeding 500 words, highlighting your main
subjects of study/research interests and research plans (if any).

Declaration by the applicant

I, hereby, declare that all the particulars stated in this application are true to the best of my
knowledge and belief. In the event of suppression or distortion of any fact like educational
qualifications, date of birth, etc. made in my application form, I understand that I will be denied
admission and if already admitted, my admission is liable for cancellation at any point of time. I
also understand that the decision of the Institute regarding my admission is final and I shall abide
by the decision. If admitted, I promise to abide by the rules, regulations, and discipline of the
Institute.
I, hereby, also declare that I have not been involved in ragging in any form in any of the previous
institutes that I have studied in.
Place:

Date:.

Signature of the applicant

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