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INDIAN INSTITUTE OF TECHNOLOGY GANDHINAGARApplication Form for Admission to Doctoral Programme

Ph.D. Program in:

Disciplines: Chemical Engineering, Chemistry, Civil Engineering, Cognitive Science,Computer Science and Engineering, Electrical Engineering, English, Mechanical Engineering,Materials Science & Engineering, Mathematics, Physics, Philosophy, Psychology, Sociology

Research Areas of Interest: (Please refer to Faculty Research Profiles at www.iitgn.ac.in/phd.htm)

Name (as in qualifying degree certificate)

First Name

Middle Name

Last Name

Contact details

Address for communication: Permanent Address:

City:PinCode

City:PinCode

State: State:

Telephone Number Mobile Number Email Address:

Alternate Email Address:

Category under which you want to apply (Please check appropriate box)

Regular (RR):Fulltime residentialresearchercandidate

Start Early (RR):Fulltime residentialresearchercandidate*

External (ET): Candidatesserving in researchinstitution/Industry**

Faculty DevelopmentProgram (FDP): Candidatesserving in educationalInstitutions only**

*All Start early (RR) applications must include signed letter/certificate from head of department indicating rank of the candidate at the end of 6semesters**All ET/FDP applications must include employers support/sponsorship letter

Rank in your discipline after 6 semesters in BTech/BE programme (For Start Early (RR) category)

Must be supported by a signed letter/certificate from the head of the department stating the rank of the candidate

GATE/UGC-NET/CSIR-UGC performance

Name of Examination Year Score Percentile All India Rank(AIR)

Date of Birth Nationality Gender Category: GN/OBC/SC/ST/PD

Paste passportsize photograph

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Details of academic record (From 12th onwards for Start early (RR) and Bachelors onwards for Regular (RR), ET and FDP)

Degree Subject College University/Institute

Year ofPassing

Class/Division

% of Marks/Grade/CGPA

Details of Any Research/Professional Experience or Publication

Details of any past employment

Organization DesignationDuration

From To

Declaration:1. I have carefully read the web-advertisement and the faculty research profiles uploaded on the web2. The SOP submitted with the application form was written only by me.3. I hereby declare that the information given above is correct to the best of my knowledge and belief. I am also aware

that providing incorrect information in the application form can result in the cancellation of my admission at any stage.

Place:

Date: Signature of the Applicant

Please send the completed application form to the following address with PhD Application written on the envelop

Assistant Registrar (Academics)Indian Institute of Technology GandhinagarVGEC Campus, ChandkhedaAhmedabad 382424Phone: 09328474222, Fax: 07923972324E-mail: academics@iitgn.ac.in

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Check List for Enclosures:

Copy of Mark sheets / Grade cards (From 12th onwards for start early and Bachelors onwards for RR,ETand FDP)

Statement of purpose Copy of GATE score/UGC-NET/CSIR-UGC (if applicable) Copy of Certificate of SC/ST/OBC (if applicable) Signed letter/certificate from head of department indicating rank of the candidate at the end of 6

semesters (in case of Start early Program candidates)

Employers support/sponsorship letter (in case of External/Faculty Development Program candidates)