INDIAN INSTITUTE OF TECHNOLOGY KANPUR

APPLICATION FORM FOR BRANCH CHANGE

(To be submitted on or before April 11, 2016)

The Chairperson, SUGC

IITK
In response to the notice dated April 1, 2016, issued by ADUG, I wish to apply for change of
branch. The details asked for are furnished below:

1.

Name:

2.

Roll No.:

3.

Present Branch:

5.

Branch applied for *1 1 10

6

10

(*Fill up your choice in decreasing order of preferences. You can fill up any number
of choices by adding extra boxes.)
-------------------------------------------------------------------------------------------------------------------------Branch codes for B.Tech. are: AE, BSBE, CHE, CE, CSE, EE, ME, MSE, ES-EEC*, ES-MECH**
Branch codes for B.S. are:
CHM, ECO, MTH, PHY
* ES-EEC = Engineering Science (Energy, Enivronment & Climate); ** ES-MECH = Engineering Science (Mechanics)

Date:

Signature of Student
Mobile No.

RECEIPT
Received Application form for Branch Change from:

Name of the Student:

Roll No.:
Date: ././2016
Signature
UG Section, DOAA Office

FOR OFFICE USE ONLY

1.

Grades received by the student in following courses:

Sl. No.

Course No.

1.

CHM101A

2.

CHM102A

3.

ESC101A

4.

HSS-1

5.

MTH101A

6.

MTH102A

7.

PE101A

8.

PE102A

9.

PHY101A

10.

PHY102A

11.

PHY103A

12.

LIF101A

13.

TA101A

Grade
(in first attempt)

2.

CPI: (at the end of Semester)

3.

Has the student ever availed the privilege of Branch change earlier:

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