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For Office Use

Degree: Department: Date of Receipt: Reg. No.:

NATIONAL INSTITUTE OF TECHNOLOGY SILCHAR


ASSAM 788 010
Application Form for Admission into Ph.D./M.Sc./M.Tech(Sponsored) program, July-Dec. 2013 session

1. Name: .. . (Tick ) Fathers name: . 2. .. Mothers name: 3. .. 4. Address: (a) For correspondence

Femal Male e

Affix Recent Passport size Photograph

(b) Permanent

(c) Email: 5. (a) Date of Birth:.

(d) Phone/Cell No : (d) Marital Status: (e) Nationality: ....


(if yes, a certificate must be

(b)Age on 01.01.2013: . .
attached)

(c) Whether SC/ST/OBC/PWD: .


(d) Specify if you belong to any

Other

Backward

Class:

6. (a) Department to which .

the

candidate is admission

seeks : is

admission: . sought::

(b) Programme in which admission . (c) Specialization to which .

sought

Are you also applying to any other (d) Department/Specialization? If yes, list the other Department(s)/Specialization: Category (e) : (Tick ) Regular Part-time
(i)

Yes/No.

Sponsored Institute Staff (ii)

Project Staff

(f) Choice in order of preference, for area of specialization (please check the website) :
(iii)

7. Details of Universities/Institutions attended (from 10th Standard


Degree obtained

onwards) (attested copies of certificates and mark sheets/grade cards must be attached).
Year % Marks/CGPA/ Class Obtained Subjects

University/College/

Board

(with discipline)

CPI

(if applicable)

taken

8.

(a) Professional Qualifying Examination passed (attested copy of certificate must be attached): (I) GATE (II) UGC/CSIR NET

Subject

Score

Valid up to

Subject

Date of qualifying Valid up to

(b) Any other source for fellowship/scholarship: 9. (a) Professional Experience (Teaching/Research/Industrial) if any (proof to be attached).
Name of organization Position held Type of work Period Fro m To

(i) (ii) (iii )

(b) Attach a list of publications/projects etc. separately, if any: 10. (a) If employed, name of .. (b) Whether employers permission obtained?: Yes (c) If yes, whether NOC in form-I/II/III is enclosed: 11. List of Enclosures:
(a) (b) (c) (d)

the No

present

employer:

Declaration
I hereby declare that the entries made in this application form are correct to the best of my knowledge and belief. If selected for admission, I promise to abide by the rules and regulations of the Institute as amended from time to time. I note that the decision of the Institute is final in regard to selection for admission and assignment to a particular department and field of study. The Institute shall have the right to take any action it deems fit, including expulsion, against me at any time after my admission, if it is found that information furnished by me are false or incorrect. I shall abide by the decision of the Institute, which shall be final. Place : Date : Signature of the applicant

For office use only


a . To be filled in by Departmental Admission Committee after verification and selection test

(i) % of B.Sc/B.Tech marks/Grade (ii) % of M.Tech/M.Phil/M.Sc marks/ Grade (iii) GATE/NET score

Recommendation for admission: Signature of member b.

(iv) Performance of Selection Test (v) Position in order of merit (vi) Category(General/SC/ST)

Signature of member Signature of member Departmental PG Admission Committee

Chairman,

To be filled by central admission committee:

(i) Verified and found suitable and recommended to Chairman, Senate for admission (ii) Recommendation for Ph.D Assistantship (iii) Not recommended for admission
(Signature of members):

........

.......................

c.
Date:

Admitted on approval from Chairman, Senate.

Dean (R&C)

Form I SPONSORSHIP LETTER


(This should be typed on the letter head of the sponsoring organization) No. Date: To The Director, National Institute of Technology, Silchar. Sub: Sponsoring an Employee for M.Sc/M.Tech/Ph.D. Programme (Strike out which is not applicable)

Dear Sir, We hereby sponsor the candidate of Mr./Ms


who is an employee in our organization, for joining M.Sc./M.Tech/Ph.D. Programme in . at your Institute as a full-time student.

We shall relieve him/her of his/her duties in the organization during the (i) first two years of M.Sc/M.Tech Programme (ii) first three years of the Ph.D. Programme (Strike out which is not applicable)

Signature and Seal of the Sponsoring Authority

Form II No Objection Certificate for Part-Time Students


(This should be typed on the letter head of the sponsoring organization) No. To The Director, National Institute of Technology, Silchar. No objection Certificate Date :

Sub:

Dear Sir, We have no objection if Mr./Ms. , an employee Program in in our organization, is admitted to the M.Tech/Ph.D.

.. at your Institute as a part-time student.

We shall give him/her leave of absence to attend classes and research work at NIT Silchar during first two years for M.Tech/Ph.D. programme (Strike out which is not applicable).

Signature and Seal of the Sponsoring Authority

4
Form III Sponsorship Certificate of External Registration for Ph.D Program
(This should be typed on the letter head of the sponsoring organization) No. 1. Name of the sponsoring Date:

organization: Address: 2. 3. 4. 5. Designation of the applicant: Present status of the applicant: Division/Section where research work is proposed to be done: Name of the Local Supervisor: (Bio-data of the Local Supervisor to be enclosed giving details of designation, qualification, research experience etc.) 6. 7. Details of relevant facilities which will be made available to the candidate: Statement of Local Supervisor: If Mr.Ms. is admitted to the Ph.D. programme at National Institute of Technology, Silchar, I agree to supervise his/her research programme jointly with the Supervisor from NIT, Silchar.

Signature of Local Supervisor (Sponsoring Organisation)

If Mr./Ms. is admitted to the Ph.D. Program, we agree to relieve him/her to enable him/her to be in residence at NIT, Silchar during the first semester of his/her Ph.D. Program. Mr./Ms will be permitted to carry out research leading to the Ph.D. degree at our organization under the guidance of Dr. The necessary facilities will be provided for the purpose.

Signature and Seal of the Sponsoring Authority

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