ORM INDIAN INSTITUTE O F TECHNOL OGY KANPURAPPLICATION F $ FOR ADMISSION TO POST-GRADUATE PROGRAMME (For filling this a pplication form see instr uctions ov erleaf) 1. Full Name : Paste your photograph here2. Date of Birth : . Place of Birt h : . Sex: Male/Female5. Mar ital Status: 6. Nationality : 7. Fat her’s Name : 8. Addr ess of Corr espondence : State: Pin Code : 9. If available, please provide: Ph one No. : Mobile No. : E-mail address : 10. Details of Demand Dr aft Codesfo r Items11-16a r egiven overleaf 11. Department/Programme 12. Admissio n for Deg r ee13. Category14. Student Status15. Financial Statu s16. P hysically Handicapped a) Amount Rs . ……………………………………..… No. …………………..……….. Dat e ………………………….……… b) I ssued b y (Bank Name & Br anch ) …………….…………………….…………….……….…………………………………….. 17. Academic Reco r d/Work E xperience A. GATE, CSIR, UGC, other fellowship exam details ( *) Exam NameExam disciplineGATE Score/CSIR/UGC RankExam Year B. Qualifying Deg r ee (*) already obtained or in pr ogress Instit ute/ Colleg e(Name & Address) University(Name & Addr ess )DisciplineDegreeExam DateFinal results expected byPass Marks % or Grade Average% Marks or Grade AverageSem. I Sem. II Sem. III Sem. IVOve rall % orGrade Average(if degree completed)Sem. VSem. VI Sem. VII Sem. VIII C. Ot her Degrees (*) obtained aft er 10+2 ( Do no t include th e degree lis ted in 17 B) Institute/ College(Name & Addr ess )University(Name & Addr ess) DisciplineDegreeMarks or CPI Date of completion