Indian Institute of Technology Hyderabad

Ordnance Factory Estate, Yeddumailaram 502205

Phone: (040) 2301 6032; eMail: dac@iith.ac.in, iith@iitm.ac.in

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Application for PhD Program
Please tick only the relevant box / item.

1. PhD Program of which Department is the applicant applying for:

Computer Science & Engineering Civil Engineering Chemical Engineering

Material Science & Engineering Mechanical Engineering Electrical Engineering

Mathematics Physics Chemistry

Humanities & Social Sciences

2. Areas (order of priority) in which applicant desires to undertake research:

(a) _______________________________________________________

(b) _______________________________________________________

(c) _______________________________________________________

3. Category: General / SC / ST / OBC

4. Physically Handicapped: No / Yes

Paste Recent
5. Registration Status: Passport Size Photo
Regular PhD Registration
(Full-time student at IITH, not employed in any organisation)
EXTERNAL PhD Registration
(Full-time student at IITH, employed in an organisation)

6. Financial Status: Need Institute Assistantship / Employer will pay salary

7. Name of Applicant ______________________________________________________________

8. Date of Birth (DD/MM/YY) _____________ 9. Place of Birth __________________________

10. Gender: Male / Female 11. Nationality: Indian / Others (specify) ________________

12. Marital Status: Single / Married 13. Father’s Name: _________________________________

14. Communication Address: ____________________________________________

____________________________________________

____________________________________________

City ________________________ PIN ____________

Mobile ___________________ eMail ______________

Indian Institute of Technology Hyderabad

 Application for PhD Program
Page 2/2
15. Educational Background (Bachelor’s level and above)

Degree Branch Institute University Year Marks

/College (%,
CGPA)

Was any degree obtained thro correspondence course / in distance education mode? Yes / No
16. Academic Performance
(a) Bachelors Degree (Attach Copy of Marks Sheet and Degree)
Semester I II III IV V VI VII VII IX X Average
I
% of marks
obtained
(b) Masters Degree (Attach Copy of Marks Sheet and Degree)
Semester I II III IV Average
% of marks
obtained
(c) Additional Qualifying Examination (Attach Copy of Score Card)
Exam Name Exam Discipline Score Exam Year

17. Work Experience (Teaching / Industrial)

Name of Organization Designation Period Nature of Work
From To

18. Research Experience

Name of Organization Designation Period Nature of Work

From To

Number of Research papers published in: ______ Journals _____ Conferences

(Please provide copies of the above papers)

DECLARATION
I have carefully read the instructions and particulars supplied to me. I declare that the entries made in
this application form are true to the best of my knowledge and belief.

Place______________________

Date ___________________ Signature of Applicant

 Indian Institute of Technology Hyderabad
Ordnance Factory Estate, Yeddumailaram 502205
Phone: (040) 2301 6002; eMail: dac@iith.ac.in, iith@iitm.ac.in

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Instructions to Fill Application for PhD Program

1. If any one wants to apply more than one department, he/she should apply separately for each
department.
2. Please ensure that the following items are enclosed:
(a) Copy of Date of Birth Certificate or High School Certificate with Date of Birth on it
(b) Copies of all marks sheets/grade cards in the preceding degree programs
(c) Copies of all preceding degree certificates
(d) Copy of GATE/CSIR/UGC Score Card
(e) Employer’s Certificate for applicants seeking External PhD Registration
(f) Acceptance of Co-Supervisor for applicants seeking External PhD Registration
3. To demonstrate your academic profile and suitability to PhD program, please include:
(a) Details of Journal publications, Conference papers, books authored, etc.
(b) Awards, Patents, prizes, etc., received
4. In case you are offered admission, you should provide the following in ORIGINAL:
(a) Date of Birth Certificate, or High School Certificate with Date of Birth on it
(b) All marks sheets/grade cards in the preceding degree programs
(c) All preceding degree certificates
(d) GATE/CSIR/UGC Score Card
(e) Community Certificate for candidates of SC, ST and OBC categories
(f) Doctor’s Certificate for candidates with Physical Disabilities
5. If the applicant is employed,
(a) he/she must send the application through the employer; an advance copy may be sent
to IIT Hyderabad directly to facilitate early scrutiny; and
(b) a relief certificate from the employer should be produced at the time of admission, in
case he/she is offered admission.
6. The applicant should indicate clearly the Department AND Area of Research at the top of the
application form.
7. Application from can be downloaded form the IIT Hyderabad website www.iith.ac.in
8. Send ONLY hard copies of the applications; soft copies will NOT be accepted. Please mark the
envelope “APPLICATION for PhD Program (Department of _______)” with the abbreviation of
the name of the Department included from the following list:
CSE : Computer Science & Engineering CE : Civil Engineering
ChE : Chemical Engineering MSE : Material Science & Engineering
ME : Mechanical Engineering EE : Electrical Engineering
MA : Mathematics PH : Physics
CY : Chemistry HSS : Humanities & Social Sciences
9. Duly filled forms with all enclosures listed above should be sent to reach the undersigned
Professor C. Pandurangan
Professor In-charge (Current Academic Programs)
Indian Institute of Technology Hyderabad
Ordnance Factory Campus
Yeddumailaram 502205
Andhra Pradesh, India
eMail: dean_academics@iith.ac.in

10. In case you have a query, please contact Professor C. Pandurangan at:
eMail: dac@iith.ac.in; Phone: (040) 2301 6034
 Indian Institute of Technology Hyderabad
Ordnance Factory Estate, Yeddumailaram 502205
Phone: (040) 2301 6032; eMail: dac@iith.ac.in, iith@iitm.ac.in

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Certificate of Employer

For Applicant applying under EXTERNAL REGISTRATION

The application of Mr./Ms.___________________________________________ working as

in ___________________________________ since __________________ is herewith

recommended and forwarded for admission to PhD Program at IIT Hyderabad under External

Registration scheme in the Department of _________________________________________.

1. This organization has adequate facilities for carrying out the research indicated by the applicant
and if he/she is selected, and these will be made available to him/her during regular working
hours till the completion of the program.

2. The applicant will be deputed/given leave for duration of his/her residence period at IIT
Hyderabad.

3. Facilities will be made available to the Co-Supervisor to supervise the work of the applicant and
to attend the meetings at IIT Hyderabad as and when necessary.

4. Till the completion of his/her research program, the applicant will not be ordinarily transferred
to another unit or place which may impede his/her research. If such a transfer is necessary, IIT
Hyderabad will be informed before a month of such transfer. We understand that continuing of
registration will depend on IIT’s decision in this regard, taking into account all relevant factors.

5. We note that the facilities of IIT Hyderabad will be made available to him/her for carrying out
the work and that there will be no separate charge (other than tuition fees payable by the
candidate) for the use of laboratory, library and other facilities.

6. No part of the work carried out in fulfillment of the research program will be utilized
commercially or for applying for a Patent without the approval of Indian Institute of Technology
Hyderabad and on terms other than mutually agreed to be IIT Hyderabad and this organization.

Signature of the Approving Officer

Name :

Designation :

Postal address :
Seal
Date:
 Indian Institute of Technology Hyderabad
Ordnance Factory Estate, Yeddumailaram 502205
Phone: (040) 2301 6032; eMail: dac@iith.ac.in, iith@iitm.ac.in
Acceptance of Co-Supervisor
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Applicant applying under EXTERNAL REGISTRATION

Please note:
In addition to being in a position to ensure technical and logistic support to the scholar in
his/her research work in the organization, the Co-Supervisor must have a minimum academic
qualification of a Master’s degree in Engineering/Management or PhD in Science and adequate
professional experience in the relevant field. The Co-Supervisor should not himself be a scholar
working for any higher degree of any university. He will be an invitee to the Doctoral Committee
meeting at IIT Hyderabad.

(1) Name of proposed Co-Supervisor

(2) Academic qualifications of Co-Supervisor

(3) Membership of Professional Societies of Co-Supervisor

(4) Designation of Co-Supervisor

Acceptance of Co-Supervisor

This is to state that in the event of Mr/Ms _________________________________ of this

organization being selected to the PhD Program under the External Registration Scheme in the
Department of ___________________________ at Indian Institute of Technology Hyderabad, I
agree to be his/her Co-Supervisor and shall extend all possible facilities to enable him to carry out
his research program towards the submission of thesis.

Signature of Co-Supervisor

Name :

Designation :

Postal address :
Seal
Date: