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NATIONAL INSTITUTE OF TECHNOLOGY ROURKELA

Application Form for Admission Session 2012-13 30-Nov-2012

To, Asst. Registrar (Academic) NIT Rourkela Rourkela, 769008, Odisha, India

Application No. : Programme Applied : Transaction Id :

PG5/S12/CS/1144 Ph.D 489

Academic Information Department Applied : for Studentship Category : Proposed Research : Area Personal Information Applicant Name Cast Code Blood Group Email : ADITYA JAIN : OM : B+ve : jainaditya300@gmail.com Date of Birth Gender Marital Status Mobile No Permanent Address At : 487 ,Jain Bazar : 22-SEP-1988 : Male : Unmarried : 8860099992 Pref 1 Specialisation Computer Science & Engineering

Full Time Student with Fellowship/Assistantship Computer Science

Communication Address At : 487 ,Jain Bazar

City/Village/Town : Jammu Post District State PIN Code Country Telephone No. : rani park,jammu : Jammu : Jammu & Kashmir : 180001 : India : 01912546464

City/Village/Town : Jammu Post District State PIN Code Country Telephone No. : rani park,jammu : Jammu : Jammu & Kashmir : 180001 : India : 01912546464

Parental Information
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Parental Information Father's Name : Rajesh Jain Mother's Name Relationship : Madhavi Jain : father-son

Financing Person : Rajesh Jain Parent's Mobile No. : 8716047883

Academic Career
Sl.No. 1 2 3 Name of Examination 10th 12th B.E. Branch of Study General Science School / College cooperative public school SRML jammu Board / University JKBOSE JKBOSE Jammu University Year of Passing 2005 2007 2011 % of Marks or CGPA 87.80 76.80 67.71 Division/ Class Awarded dst dst dst

Computer Science & GCET Jammu Engineering

If your result is not yet declared , please mention your Marks as "Awaited" and leave Class Awarded field as it is.

If the results of the qualifying examination are not declared, while coming for the interview, please come with a Course Completion Certificate from Principal or Registrar of the College last attended stating that all examinations including practical necessary for award of the degree have been completed. The results must be submitted before January 3, 2013, failing which the admission will be cancelled.

GATE/NET/Any Other Test Meant for Admission Examination : Score : GATE 538 Subject : Year : CS - Computer Science and Information Technology 2011 Results : Qualified 15-Mar2013

Valid Till :

Experience (if any)

Previous Research work and Publication (if any)

Related to NIT Rourkela I do not have a close relative among officers and faculty of NIT Rourkela. Record of Past Study as a sponsored candidate or other contractual obligation (if any) NA

Declaration
I do hereby declare that the information furnished in this application is true to the best of my knowledge and belief. If admitted, I shall abide by the rules and regulations of the Institute. If any information furnished in this application is found to be untrue, I am liable to forfit the seat alloted to me any time in future and legal action to be taken against me.

Date : ___________________________

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Place : ___________________________

Full Signature of the Applicant

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