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Indian Institute of Technology Indore

IET Campus: IET-DAVV Campus, Khandwa Road, Indore 452 017 (M.P.)
Ph.: 0731-2438719, Fax: 0731-2364182 (for Basic Sciences & HSS)
PACL Campus: 113/2-B (Opp. to Veterinary College), Village Hernia Khedi, MHOW Road,
Indore 453 446 (M.P.) Ph.: 07324-240701 (for Engineering)
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Application Form for Admission
M.Tech ( ) or M.Tech + Ph.d. Dual Degree ( )
Communication & Signal Processing ( ) Production & Industrial Engineering ( )
M.Sc. ( ) or M.Sc.+ Ph.D. Dual Degree ( )
Chemistry ( ) Physics ( )
Ph.D. ( )
Computer Science Engineering ( ) Electrical Engineering ( ) Mechanical Engineering ( )
Chemistry ( ) Mathematics ( ) Physics ( )
Psychology ( ) Sociology ( ) Bioscience and Bioengineering ( )
Philosophy ( ) English ( )

1. Full Name in Capital Letters: (as mentioned in the qualifying degree certificate)
Type or Write Legibly in English Keep one block blank between the two words



2. Date of Birth: (as per matriculation or equivalent certificate):
(Original Certificate should be produced at the time of interview) (DD/MM/YYYY)

3a. Category GN/OBC-NC/SC/ST 3b. Physically Disabled (Yes/No)
(Original Certificate should be produced at the time of interview)

3c. Marital Status (Single (S)/ Married (M)) 3d. Hostel Accommodation required (Yes/No)

4. Sex (M/F) 5. Nationality






A. Admission for the Year: _____________________ Semester: Autumn ( ) or Spring ( )


B. Registration No.:_______________________________________________________________
(To be filled in by the Office)

C. Programme.: (Please tick)

Paste (do not pin)
passport size
photograph in this
space

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6. Contact details*:
(a) Address for Correspondence: (b) Permanent Address:







City: Pin Code City:

Pin Code

State:

State:


Telephone Number (with STD code) Mobile No E-mail Address(s)

* It is the responsibility of the candidate to intimate change of address.

7. Category of PhD admissionunder which you want to apply: 1) 2)
(in order of preference)
At present the Institute admits PhD students as Full Time categories of:
Full-Time Scholars Categories-
A. Teaching Assistantship (TA) #
B. Govt./ Semi-Govt. Fellowship Awardees (FA)
(CSIR, UGC, DAE, DBT, NBHM, Commonwealth, Nehru Memorial Doctoral Fellowship, etc.)

# As per MHRD Directives, candidate selected under TA category cannot accept or hold any appointment paid or otherwise or receive
any emoluments, salary, stipend from any source during the tenure of TA ship. Hence, candidates selected as TA and having
employment with or without pay with any organization/institution/establishment/project etc. must leave the job and submit relieving
certificate before joining the Ph.D. programme under TA category.

For I nstitute Fellowship i.e. Teaching Assistantship (Except students with ME/M.Tech./M.Phil degree) all candidates should have
qualified GATE or CSI R-J RF or CSI R -NET or UGC-J RF or UGC-NET.

8. Details of Educational Qualifications from Matriculation onwards
(Original Certificates should be produced at the time of interview)
Degree/
Examination
Passed

Branch/Subject University/ Institute Month &
Year of
Entering
Month &
Year of
Passing
% of
Marks or
CPI/CGPA
Class/
Division









9. Details of qualifying examination like GATE, CSIR-NET, UGC-NET, or any other equivalent examination
(Original Certificates should be produced at the time of interview)
Name of Examination Year of Passing Validity Period Number of Candidates
Appeared
Marks
Obtained
AIR Rank Score/Percentile


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10. Details of Professional/ Work Experience:
(Original Certificate should be produced at the time of interview)
Organization Designation Date Nature of Responsibilities
From To






11. Present Employment status: (Employed /Not Employed)

If employed, then details of the employer:


12. Details of the Research Experience:


12 (A). Details of the Bachelors and Masters project/ thesis/ dissertation
Name of the University/
Institute
Year of submission Name of the
supervisor
Title










12 (B). List of Publications*, if any (Attach a separate sheet if required)
* mention in the order of giving name(s) of author(s), title of paper, details of the journal/conference, year, volume, page numbers.


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13. Broad Area of Specialization in which intend to work in the PhD programme:




14. Any other relevant information
(Attach a separate sheet)

15. Contact Details of the Referees: (The referees may be contacted telephonically or through email to comment on you academic or
professional capabilities)

Particulars Referee 1 Referee 2
Name
Designation
Organization
Office Address
Office Telephone (with STD code)
Email

16. Number of Enclosures attached with this application form:


17. Declaration: I do hereby solemnly declare that the information given above is correct to the best of my knowledge and belief. I
am fully aware that I must submit attested copies of my qualifying degree certificate / final transcripts, failing which, my admission
will stand canceled. I am also aware that providing incorrect information in the application form can result in the cancellation of my
admission at any stage.


Place:

Signature of the Applicant with date
Name of the Applicant:
Please post ONLY the completed application form to the following address. The envelope should be
marked Application for Ph.D. admission in the Discipline of _________" and should be sent to the
Deputy Registrar (Academic Affairs) INDIAN INSTITUTE OF TECHNOLOGY INDORE PACL
Campus, 113/2-B (Opp. to Veterinary College), Village Hernia Khedi, Indore-Mhow Road, Indore 453
446 (M.P.) India

To,
Deputy Registrar (Academic Affairs)
INDIAN INSTITUTE OF TECHNOLOGY INDORE
PACL Campus, 113/2-B (Opp. to Veterinary College), Village Hernia Khedi,
Indore-Mhow Road, Indore 453 446 (M.P.) India

Website: www.iiti.ac.in
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Indian Institute of Technology Indore

IET Campus: IET-DAVV Campus, Khandwa Road, Indore 452 017 (M.P.)
Ph.: 0731-2438719, Fax: 0731-2364182 (for Basic Science & HSS)
PACL Campus: 113/2-B (Opp. Ti Veterinary College), Village Hernia Khedi, MHOW Road,
Indore 453 446 (M.P.) Ph.: 07324-240701 (for Engineering)
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Statement of Purpose (Attach separate sheet for details, if required)
Statement of Purpose (SoP) is an opportunity for the applicant seeking admission to the PhD programme at IIT
Indore, to share your thoughts with the Admissions Committee about why you want to pursue PhD studies. While writing
the SoP, please describe briefly about the past project / research work done by you. However, restrict yourself to 300-350
words. The personal SoP will aid the admission committee in evaluating your application.














































Place: Signature of the Applicant with date
Name of the Applicant: