Application Form Kanpur

ORM INDIAN INSTITUTE O F TECHNOL OGY KANPUR APPLICATION F $ FOR ADMISSION TO POST-GRADUATE PROGRAMME (For filling this a pplication form see instr uctions ov erleaf) 1. Full Name : Paste your photograph here 2. Date of Birth : . Place of Birt h : . Sex: Male/Female 5. Mar ital Status: 6. Nationality : 7. Fat her’s Name : 8. Addr ess of Corr espondence : State: Pin Code : 9. If available, please provide: Ph one No. : Mobile No. : E-mail address : 10. Details of Demand Dr aft Codes fo r Items 11-16 a r e given overleaf 11. Department/Programme 12. Admissio n for Deg r ee 13. Category 14. Student Status 15. Financial Statu s 16. P hysically Handicapped a) Amount Rs . ……………………………………..… No. …………………..……….. Dat e ………………………….……… b) I ssued b y (Bank Name & Br anch ) …………….…………………….…………….……….…………………………………….. 17. Academic Reco r d/Work E xperience A. GATE, CSIR, UGC, other fellowship exam details ( *) Exam Name Exam discipline GATE Score/CSIR/UGC Rank Exam Year B. Qualifying Deg r ee (*) already obtained or in pr ogress Instit ute/ Colleg e (Name & Address) University (Name & Addr ess ) Discipline Degree Exam Date Final results expected by Pass Marks % or Grade Average % Marks or Grade Average Sem. I Sem. II Sem. III Sem. IV Ove rall % or Grade Average (if degree completed) Sem. V Sem. VI Sem. VII Sem. VIII C. Ot her Degrees (*) obtained aft er 10+2 ( Do no t include th e degree lis ted in 17 B) Institute/ College (Name & Addr ess ) University (Name & Addr ess) Discipline Degree Marks or CPI Date of completion

Application Form Kanpur

Documents