Application Format for M Tech Admission

Grams: KARENG

NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKA, SURATHKAL

P.O. SRINIVASNAGAR, MANGALORE-575 025

Registration No.

(for office use only)

Admission to Post-Graduate Programme M.Tech (SPONSORED)/M.Tech (RESEARCH)2015-16Application for M.Tech. ________________________________(SPONSORED)/M.Tech (RESEARCH) (Write Name of the Programme)

Name of the Dept. _____________________________________________________________________________

Instructions:1. Fill in the application form and the index sheet completely.

(Separate Application for each P.GProgramme with required DD)

2. Fill your address in the address slips & Registration Memo.

3. Enclose self attested Xerox copies of marks card and other documents.

4. Candidates who have appeared for the Final degree Examination of May/

June 2015 may also apply provided they can produce proof of their eligibility

for admission by September 15, 2015 (for M Tech Research).

5. Late/incomplete/Applications without DD are liable to be rejected.

6. Last date for submission of filled in application is 22.05.20151. Name of the Candidate in full (in Block Letters as mentioned in the Degree marks card)

2. Address of the applicant (with pin code):

a. Permanent:

2. b. Correspondence

3. c. Telephone with STD Code or

Mobile No. :

4. d. Email:

3. Name and address of Father/Mother (or Guardian, if the parents are not alive, state relationship of Guardian)

4. Occupation of Father/Mother/Guardian

Annual Income

5.a. Religion of the Candidate:................

Caste/Subcaste .

b. Do you belong to Scheduled Caste/Tribe/OBC (( Tick mark) Yes / No SC / ST / OBC

If yes, enclose a copy of the Caste Certificate issued from

Competent Authority

c. Place of domicile

d. Nationality

e. Do you belong to Persons with Disabilities (PWD) group? Yes / No

(if yes, enclose copy of a medical certificate from a DMO)

(Tick mark the appropriate)

6. Date of Birth (Copy of the Supporting document to be enclosed)

In Figures:

In Words:

7. Academic Record:

a. i. Qualifying Examination Passed : B.E./B.Tech./B.Sc.(Engg.)/M.Sc./AMIE/ B.Arch./

AMIE, if any other mention it.

ii. Specialisation :

iii. Institute:

iv. Period of study : from __________________ to ________________

v. University :

b. Marks obtained in the Qualifying Examination (Bachelors Degree in Engg. or Arch./M.Sc./AMIE, etc.):

Year of PassingMarks/SGPA obtainedMax. MarksPercentageClass/ Division

CGPA

I YearI Sem

II Sem

II YearIII Sem

IV Sem

III YearV Sem

VI Sem

IV YearVII Sem

VIII Sem

c. Aggregate percentage of marks (all semester/years)/CGPA: 8. GATE Score details

Year of passing

(Enclose a Xerox Copy of the Score Card)

GATE Score

GATE mark9. Class X and class XII academic record:Year of passingMarks obtainedMax. marks Percentage / CGPAClass / Division

Class X

Class XII

9. Details of Practical Training under gone, if any, other than that

required for graduate Course. Attach extra sheet if necessary.

10. Professional/research or other Experience (Enclose Copies of Certificates from Employer)

EmployerPost HeldPeriodSalary

11. Are you a Sponsored candidate?

(If yes, forward your application through your employer) Ref. No.15.12. References 1.

(Give the names and addresses of

two responsible persons well acquainted

with your work and character) 2.

13. DECLARATION OF CANDIDATE I hereby declare that to the best of my knowledge, the particulars furnished in this application are correct.

I am willing to forfeit the seat secured for any course, if any information provided by me is false.

If selected for admission, I promise to abide by the conditions of admission and Rules of the Institute, and the Academic Regulations that govern the programme of study. I also promise to refund the entire Scholarship amount drawn by me in case I discontinue the course at any stage before completion.

Place :

Date : Signature of candidate

Self attested photocopy of the following documents is to be enclosed.

1. Marks Card of Qualifying Exam (all years) / all Semesters.

2. GATE score card.

3. S.S.L.C./ X Std. Marks Card (for date of birth).4. XII marks card.5. Caste Certificate issued by Competent authority for SC/ST.6. OBC Certificate as per Central Govt. format issued by competent authority, if applicable7. Persons with Disabilities (PWD) Certificate, if applicable.

8. Sponsorship letter for deputed candidates.9. Two Self-Addressed Envelopes with Stamp each worth Rs 17/- (For postage in Mangalore) / Rs 39/- (for Postage outside Mangalore). 14. DECLARATION OF PARENT OR GUARDIAN(Not applicable to M.Tech. candidates deputed on full salary by Institutions/ Industries)

In case my son/daughter/ward discontinues the course at any stage before completion without obtaining permission from the Director and without repaying the scholarship amount drawn by him/her, I hereby undertake to repay the scholarship amount payable by my son/daughter/ward to the Institute.

Place:

Date: Signature of Parent or Guardian with Postal Address

In case declaration is signed by Guardian, Name

indicate relationship with the candidate Relationship

15. FOR USE BY FORWARDING AUTHORITY (EMPLOYER)Sponsorship (Deputation) Certificate/

The applicant (name) .has been a permanent staff of this Institute/Organization from .. and has .. years of experience (teaching/R&D/industry).

1.Sponsorship/ (Deputation) certificate:

He/She is sponsored (deputed) with full salary, for full time study in National Institute of Technology Karnataka, Surathkal.

2.The candidate and his/her sponsorship (deputation)/ NOC will not be withdrawn before the completion of the course/programme.

Office Seal

Station:Signature of the Employer

Date : Name:

Designation:

(Note: Sponsorship certificate should be submitted in the same format as indicated in this application form duly signed by the Employer/ Sponsoring Institute Head and seal.)

N.I.T.K. SURATHKAL, SRINIVASNAGAR, MANGALORE 575 025

INDEX SHEET M.Tech (Sponsored Seats/Research)(READ INSTRUCTIONS OVERLEAF BEFORE FILLING)

1. Full Name (as mentioned in the Degree Certificate)

2. Programme Code

3. Qualification

4. Year of passing qualifying degree exam

5. Name of University :6. Name of the Institution:

7. Have you obtained your final semester/ year marks sheet:

8. Percentage of Marks/SGPA* obtained in final Semester of qualifying degree

(write R.A. if results are awaited)

9. Aggregate of percentage of marks (all semesters/years)/CGPA** of qualifying degree

10. Percentage Marks/CGPA obtained in Class X

11. Percentage Marks/CGPA obtained in Class XII

12. Year of Passing GATE: All India Rank

13. GATE Percentile GATE Score Score:

14. Reservation Category Code

15. Sponsorship Code

16. Experience (in years)

All the above information are correct to the best of my knowledge.

Signature of the applicant

* SGPA - Semester Grade Point Average ** CGPA - Cumulative Grade Point Average

INSTRUCTIONS FOR FILLING INDEX SHEETa.Give your full name as in Degree Certificate/Provisional pass certificate. Give blank columns to separate first

and second name etc.

b. Programme codes: (item 2 of the Index Sheet)

a) Department of Civil Engineering (CV)

Program Code

i.Structural Engineering

(ST)

ii. Geotechnical Engineering

(GT)

iii.Environmental Engineering

(EN)

iv.Transportation Engineering

(TS)v. Construction Technology and Management

(CM)b) Department of Applied Mechanics and Hydraulics (AM)

vi. Marine Structures

(MS)

vii. Water Resources Engineering and Management

(WR)viii. Remote Sensing & Geographic Information Systems (RS) c) Department of MiningEngineering (MN)

ix. Rock Excavation Technology and Management

(RT)d) Department of Computer Engineering (CO)

x. Computer Science and Engineering

(CS)xi. Computer Science and Engineering Information Security

(IS)e) Department of Electronics and Communication Engineering (EC)

xii. VLSI Design

(VL)xiii. Communication Engineering

(CE)f) Department of Electrical and Electronics Engineering (EE)xiv. Power and Energy Systems (PS)g) Department of Information Technology

xv. Information Technology (IT)

h) Department of Mechanical Engineering (ME)

xvi. Thermal Engineering

(TH)xvii. Manufacturing Engineering

(MF)xviii. Mechatronics Engineering (MC)xix. Design and Precision Engineering (DP)i) Department of Chemical Engineering (CH)

xx. Chemical Plant Design

(PD)xxi. Industrial Pollution Control

(PC)xxii. Industrial Bio-Technology

(IB)j) Department of Metallurgical and Materials Engineering (MT)

xxiii. Process Metallurgy

(PM)xxiv. Materials Engineering

(ML)xxv. Nanotechnology

(NT)

k) Department of Mathematical And Computational Sciences (MA)

xxvi. Computational Mathematics

(CMA)c) For Item 3 choose one of the codes corresponding to branch of Engg./Science in which you have passed your

qualifying degree (s) and indicate the same in the appropriate box.

Automobile Engg. AM Manufacturing Engg. MF

Chemical Engg. CH Mechanical Engg. ME

Civil Engg CV Metallurgical Engg. MT

Computer Science/Engineering CS Mining Engg. MN

Electrical Engg. EL M.Sc. Applied Science AS

Electrical and Electronics Engg. EE MathematicsMAElectronics and Comm. Engg.

EC

Physics

PH

Electronics & Instrumentation EIChemistry CY

Electronics & Control Engg.EOElectronics & TelecommunicationET

InstrumentationIN GRAD IETE

GI

Instrumentation TechnologyIS Instrumentation Engineering IE

Industrial Engg. IL Industrial and Production Engg. IP

Production cum Plant Engg. PP Production Engg. PR

Industrial Engg. and Management IM Transportation Engineering TR Construction Management CM Environmental Engg. EN ArchitectureAR

Structural Engg. ST Any other OO

Information Technology ITd) Against item (5) give name of University/Autonomous institution awarding qualifying degree. Candidates who

have passed AMIE may indicate Institution of Engineerse) Against Item (8) give Percentage of marks scored in final semester Those awaiting final semester/year Mark list must leave the column blank.

f) Against Item (9) give the overall aggregate Percentage of marks obtained in all the semesters/ years of qualifying degree.

g) Sponsorship Code (item 15)

Not Sponsored NSP

Sponsored from:

a. Central/State owned Colleges SGC b. Aided Colleges SAC

c. Private Colleges SPC d. Research Institute SRD

e. Private Organisations SPO f. Public Sectors- Govt. Undertaking SPS

g. Govt. Organisations SGO

NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKA

SURATHKAL, POST SRINIVASNAGAR, MANGALORE- 575025,

KARNATAKA STATE.

REGISTRATION MEMO.Date:......... 2015Ref: Application for admission to M.Tech. Programme (Sponsored /Research) 2015-16/Odd Semester

The Registration No. assigned to your application for admission is noted below, which must be quoted in all correspondences connected with your application. No notice will be taken of any communication or document sent by you unless it bears your Registration Number.

Registration Number:

M.Tech. ........../ 2015-2016

Asst. Registrar (Academic)

To:

The Asst. Registrar (Academic),Mr./Ms. ________________________

N.I.T.K., Surathkal ______________________________

Post Srinivasnagar _______________________________

MANGALORE - 575 025. _______________________________

(Write address of the candidate)

To

To:

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

Pin Code ________ (__________ State) Pin Code ___________ (________State)

To To:

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

Pin Code _________ (__________State) Pin Code __________(__________State)

APPLICATION FOR

BY REGISTERED POST

ADMISSION 2015

Post Graduate Programme - M.Tech.(Sponsored /Research) _____________________ (Specify the Programme)From: To:

____________________________The Asst. Registrar (Academic),

____________________________N.I.T.K., Surathkal

____________________________Post Srinivasnagar

____________________________MANGALORE - 575 025.

____________________________

Affix self attested recent Passport size photograph

TeachingResearchField/Industry

GMSCSTOBCPWD

YESNO

B.E.B.Tech.AMIEB.Sc.(Engg.)B.Arch.M.Sc.Other

Particulars of D.D. drawn

Name of the issuing Bank ______________________________

Drawn at ____________________________________________

D.D. No. ____________________ dated ___________________

Rs. _______________ Category: OC / SC / ST / OBC / PWD

(Tick mark the appropriate)

EMBED Word.Picture.8

Affix

Stamp

Rs.6/-

_1169455650.doc