Indian Institute of Technology Guwahati

Application Form for Admission to PhD Programme

For office use : Sl. No. ACAD/PhD/11/01/ For Department/Centre’s use : Reg. No.P/

Demand Draft No...............…….....dated......….........drawn in Bank.........................................................

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

size
(b) Father/Husband/Guardian ........................................................................... Photograph
(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.(a) Department/Centre to which the candidate seeks admission………………………………

:................................................................
(b) Are you also applying to any other Department/Centre? Yes/No.
If yes, list the other Department/Centre(s):
(c) Category : ( Tick  )

Regular Sponsored Self-Financed Part-Time

(Full-Time) (Full-Time)

IITG’s Project Sponsored

Staff (External Regn.)

(d) Choice for area of research, in order of preference (as given in the advertisement) :

(i) ………………………………………………………….

(ii)………………………………………………………….

(iii)…………………………………………………………..
4. Details of Universities/Institutions attended (from 10th standard onwards)#
(attested copies of certificates and mark sheets/grade cards must be attached)
University/College Degree Year % Class Subjects taken
/ obtained Marks/ obtaine
Board (with CGPA/ d
discipline) CPI

# (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 qualifying examination passed (Attested copy of certificate must be enclosed.

Also, fill-in the required information by going through the prescribed eligibility criteria):

(1) GATE/CEED (2) UGC/CSIR NET/INSPIRE/Others

Subject GATE/ GATE All India Valid up Subject Date of Valid up to
CEED Marks* Rank to Qualifying
Score

* GATE marks above cut-off shall only be considered.

b) Any other source for fellowship/ scholarship:

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

attached).

Name of organisation Position held Type of work

Period

(i)

(ii)

(iii)

(b) List of publications/projects if any:

(Attach a separate sheet with details, if required)
7. 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/- (for ST/SC/PD candidates) must
be sent with this application by a demand draft drawn in favour of “Indian Institute of Technology
Guwahati” and payable at Guwahati.
 Form I
Sponsorship letter
(This should be typed on the letter head of the sponsoring organization)

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

Sub: Sponsoring an Employee for PhD Programme

Dear Sir,

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

employee in our organization, for joining PhD programme in ____________________________ at
your institute as a full-time student.

It is certified that he/she has completed 1(One) year of service in our organization/institute as a regular
employee.

We shall relieve him/her from his/her duties in the organization during the first three years of the PhD
programme.

Signature and Seal of the

Sponsoring Authority
 Form II
No-Objection Certificate for IIT Guwahati’s Project Staff
(This should be typed on the letterhead of the R&D Section of IIT Guwahati)

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

Sub: No-Objection Certificate for IIT Guwahati’s Project Staff

Dear Sir,

The R&D Section, of IIT Guwahati, has no objection if Mr./Ms./Mrs. ___________________________ a

project employee in the project _________________________________________________ under
___________________________________________department, is admitted to the PhD programme
in _____________________________.

Principal Investigator of the concerned project has agreed to allow him/her to attend classes/research
work during the PhD programme.

Signature and Seal of the

Dean (R&D)
 Form III
No-Objection Certificate for Part-Time Students
(This should be typed on the letter head of the sponsoring organization)

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

Sub: No-Objection Certificate

Dear Sir,

We have no objection if Mr./Ms./Mrs. ________________________________________ an employee

in our organization, is admitted to the PhD programme in _____________________________ at your
institute as a PART-TIME student.

It is certified that he/she has completed 1(one) year of service in our organization/institute as a regular
employee.

We shall grant him/her leave of absence to attend classes/research works at IIT Guwahati
during the PhD programme.

Signature and Seal of the

Sponsoring Authority
 Form IV
Sponsorship Certificate of External Registration
(This should be typed on the letterhead of the sponsoring organization)

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

Sub: Sponsoring an Employee for PhD Programme for External registration

1. Name of the sponsoring organization:

2. Address:

3. Designation of the applicant:

4. Present status of the applicant:

5. List of Division/Section where research work is proposed to be done:

6. List of available local supervisor(s):

(Bio-data of local supervisor(s) to be enclosed giving details of designation, qualification,
research experience with area of research etc. along with their consent for research guidance)

7. Details of relevant facilities which will be made available to the candidate:

It is certified that he/she has completed 1(One) year of service in our organization/institute as a regular
employee.

If Mr./Ms./Mrs. ________________________________________ is admitted to the PhD programme,

we agree to relieve him/her to enable him/her to be available at IIT Guwahati to attend classes for
completion of his/her course works relating to the PhD programme.

Mr/Ms./Mrs. _________________________________________will be permitted to carry out research

leading to the PhD degree at our organization under the guidance of selected local supervisor. The
necessary facilities will be provided for the purpose.

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