Indian Institute of Technology Guwahati

Application Form for Admission to MA in Development Studies Programme

For office use Sl. No. ACAD/MA/11/ For Department’s use Reg. No. M/

Demand Draft No......................dated.........................drawn in

Bank.........................................................

1.(a) Name: Mr/Ms/Mrs.............................................................………………………… Affix passport

size Photograph
(b) Father/Husband/Guardian ...........................................................................

(c) Addresses:

i) For correspondence ii) Permanent

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

Email: Phone: Fax:

2. (a) Date of Birth (dd/mm/yyyy):……….......................... (c) Marital Status:

……….................................
(b) Nationality:………….………......... (d) Category: GEN/OBC(Non-creamy layer)/SC/ST/PD:
………………..
(Please specify category, and enclose attested copies of necessary
certificates)

3. Category : ( Tick  )

Regular Sponsored (Full-Time)

4. (a) Qualifying Degree examination results : Declared/Awaited

[Please tick ( ) mark whichever is applicable]

(b) Details of Universities/Institutions attended (from 10th standard onwards)#

(attested copies of certificates and mark sheets/grade cards must be enclosed with
application form)

University/College Degree obtained Year % Marks/ Class Subjects taken

/ (with discipline) CGPA/ CPI obtained
Board
 # (a) Candidates still to appear in their qualifying degree examinations may also apply, provided they appear in all their qualifying
degree examinations and complete all requirements for their degrees before 19-07-2011. If selected, such candidates shall be
admitted provisionally, and they will have to furnish the results of their qualifying degree examinations latest by 02-09-2011,
failure to which their admissions shall stand automatically cancelled.
(b) If final year qualifying degree examination results are awaited, please indicate average percentage of marks or CPI of
examinations up to the last year (in case of system with annual examination)/last semester (in case of semester system).

5. a) Professional Experience (Teaching/ Research/ Industrial) if any ( proof to be

attached).

Name of organisation Position held Type of work

Period

(i)

(ii)

(iii)

6. List of Enclosures :

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.

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 any information
furnished by me is incorrect.

Place:

Date: Signature of the applicant

Please note:

Application fee of Rs. 150/- (for Gen/OBC candidates) and Rs. 75/- (SC/ST/PD candidates) must be
sent with this application by a demand draft drawn in favour of IIT Guwahati and payable at
Guwahati.
 Form I - Sponsorship Letter
(This should be typed on the letterhead of the sponsoring organisation)

Ref. No.:
Date:
To,
The Director,
Indian Institute of Technology Guwahati

Sub: Sponsoring an Employee for MA in Development Studies Programme.

Dear Sir,

We hereby sponsor the candidature of Mr./Ms.________________________________ who is an

employee in our organisation, for joining MA in Development Studies programme in
_____________________________________ at your Institute as a full-time student.

It is certified that he/she has completed 2(Two) years of service in our organisation/institute as
a regular employee.

We shall relieve him/her of his/her duties in the organisation during the two years of the MA in
Development Studies programme.

Signature and Seal of the

Sponsoring Authority.
 ANNEXURE-I

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES

APPLYING FOR ADMISSION TO CENTRAL EDUCATIONAL INSTITUTIONS (CEIS)
UNDER THE GOVERNMENT OF INDIA

This is to certify that Shri/Smt./Kum..……………………………………………Son/daughter

of Shri/Smt..…………….....………...................................Village………..................…………
District/Division…………………………..........……in……………….............…….State, belongs
to……………………………………………………………community which is recognized as a
backward class under

(i) Resolution No. 12011/68/93-BCC(C) dated 10/09/93 published in the Gazette of India
Extraordinary Part I Section I No.186 dated 13/09/03.
(ii) Resolution No. 12011/9/94-BCC dated 19/10/94 published in the Gazette of India Extraordinary
Part I Section I No.163 dated 20/10/94.
(iii) Resolution No. 12011/7/95-BCC dated 24/05/95 published in the Gazette of India Extraordinary
Part I Section I No. 88 dated 25/05/95.
(iv) Resolution No. 12011/96/94-BCC dated 9/03/96.
(v) Resolution No. 12011/44/96-BCC dated 6/12/96 published in the Gazette of India Extraordinary
Part I Section I No.210 dated 11/12/96.
(vi) Resolution No. 12011/13/97-BCC dated 03/12/97.
(vii) Resolution No. 12011/99/94-BCC dated 11/12/97.
(viii) Resolution No. 12011/68/98-BCC dated 27/10/99.
(ix) Resolution No. 12011/88/98-BCC dated 6/12/99 published in the Gazette of India Extraordinary
Part I Section I No.270 dated 06/12/99.
(x) Resolution No. 12011/36/99-BCC dated 04/04/2000 published in the Gazette of India
Extraordinary Part I Section I No.71 dated 04/04/2000.
(xi) Resolution No. 12011/44/99-BCC dated 21/09/2000 published in the Gazette of India
Extraordinary Part I Section I No.210 dated 21/09/2000.
(xii) Resolution No. 12015/9/2000-BCC dated 06/09/2001.
(xiii) Resolution No. 12011/1/2001-BCC dated 19/06/2003.
(xiv) Resolution No. 12011/4/2002-BCC dated 13/01/2004.
(xv) Resolution No. 12011/9/2004-BCC dated 16/01/2006 published in the Gazette of India
Extraordinary Part I Section I No.210 dated 16/01/2006.

Shri/Smt./Kum. _____________________________________________ and/or his family

ordinarily reside(s) in the ________________________________ District/Division of
_______________________ State. This is also to certify that he/she does not belong to
the persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the
Government of India, Department of Personnel & Training O.M. No. 36012/22/93-Estt.
(SCT), dated 08/09/93, and as revised from time to time.

Dated:
District Magistrate/Dy Commissioner etc.,
NOTE: (a) The term “Ordinarily resides” used here will have the same meaning as in Section 20 of the
Representation of the Peoples Act, 1950.
(b) The Authorities competent to issue caste certificates are indicated below:
 (i) The District Magistrate/Additional Magistrate/Collector/ Deputy Commissioner/Additional Deputy
Commissioner/ Deputy Collector/First Class Stipendiary Magistrate/ Sub- Magistrate/Extra Assistant
Commissioner (not below the Rank of First Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
(iii) Revenue Officer not below the rank of Tehsildar; and
(iv) Sub-Divisional Officer of the area where the candidate and/or his family resides.

ANNEXURE-II
Declaration / Undertaking – for OBC Candidates only

I, Shri/Smt./Kum. ____________________________________, son / daughter of Shri/Smt.

_____________________________________, resident of village/town/city

__________________, district ___________________State __________________,

hereby declare that I belong to the ______________________Community which is

recognized as a backward class by the Government of India for the purpose of reservation

in admission in Central Educational Institutions as per orders contained in Department of

Personnel and Training Office Memorandum No. 36012/22/93-Estt.(SCT), dated 8/9/1993.

It is also declared that I do not belong to persons/sections (Creamy Layer) Mentioned in

Column 3 of the Schedule to the above referred Office Memorandum, dated 08.09.1993,

and as revised from time to time.

Signature of the Candidate

Place:…………………………

Date: …………………………

Declaration/undertaking not signed by candidate will be rejected