CA
TEG
OR
Y
FULL TIMEAssistantship required through SIRe
Experience - Years:
Through SIReM.Tech Degree
OR GATE Description Year GATE Score GATE Marks (%)
……………….. ………. ………………. …………………
CSIR/UGC/DST/
DBT or equivalent with validfellowship
Any other NET
Tick whichever is applicable
GENERAL OBC
(Non‐Creamy Layer)
SC ST PH
INDIAN INSTITUTE OF TECHNOLOGY DELHI School of Interdisciplinary Research (SIRe)
Application Form for Admission to Ph.D Program Please read the instructions given in the information Brochure BEFORE you fill up the form
Submission of Application is only by email to <[email protected]>Hard copy NOT accepted
Visit: http://sire.iitd.ac.in for details
Ph.D. Code (See Annexure‐I of Information Brochure)
Proposed Area of Research
PER
SON
AL
Name (in CAPTAL)
Gender/D.O.B. Male Female Date‐of‐birth (dd/mm/yyy)
Father’s Name
Mother’s Name
Address for Correspondence
PIN : Tel No. with STD Code
Email: Mobile No:
Permanent Address PIN: Tel No. with STD Code
Email: Mobile No:
QU
ALI
FYIN
G D
EGEE
Qualifying Exam…………………………………… Duration of the course (Years)…………………………….. …………………Discipline……………………………………………… Year of Passing……………………………………… Name of University/ Institute…………………………………………………………………………………………………………………
CGPA/ Marks
Obtained
Marks Obtained Max. Marks Marks Obtained Max. Marks
Year 1 Semester I Semester II
Year 2 Semester I Semester II
Year 3 Semester I Semester II
Year 4 Semester I Semester II
CGPA Secured out of OR Aggregate % of marks (of all years/semesters)
Details of Marks Secured in the Examinations other than qualifying examinations
PR
EVIO
US
ACAD
EMIC
RE
CORD
Exam./ Degree Discipline Institute/ University Year of Passing % Marks/ CGPA Rank in Class/ University
10+2/ Equivalent
B.Sc./ BA
M.Sc./B.Tech/B.E
MA
Any other
PART TIME
IRD/FITT Project No.:
CH
OIC
E o
f
SIR
e P
RO
JEC
T Place your recent phtotgraph (Size should not be above 200KB)
Application No.(will be assigned by the school)
Only for candidates employed in projects in IITD
Appointment valid upto:
With existingassistantship
Choice 1:
Provide here the project number of your choice from the list provided in the SIRe website (http://sire.iitd.ac.in)
Choice 2: Choice 3:
EXP
ERIE
NC
E, IF
AN
Y Experience (From date to date) Designation Organization with address
PA
YMEN
T
Candidates belonging to General/OBC categories are required to pay for each application form a fee of Rs.300/- and
the candidates belonging to SC/ST/PH categories are required to pay Rs.150/-. The candidates have to make thepayment via NEFT transfer to our bank account (details below)
Account Name: IITD Revenue AccountAccount Number: 10773572622 Bank: State Bank of India Branch: IIT Delhi Branch Address: IIT Delhi Campus, Hauz Khas, New Delhi - 110016 IFSC Code: SBIN0001077 MICR Code: 110002156
Transaction reference number (to help us track your payment) Amount Bank Name Date Reference Number
Have you ever studied and discontinued your studies at IIT Delhi? YES NO
and the particulars of the program earlier attendedIf YES, give Entry number
and the reason for discontinuation.
Date
FOR SIRe’S USE
FOR P.G. SECTION USE ONLY
(Recommendations/observations of the office)
The candidate may be provisionally admitted/not admitted subject to the following:
1) Submission of attested copies of the qualifying degree certificate and marks sheet showing the required% of marks/CGPA.
2) Submission of proof from the University / Head of the institution of having appeared/passed in thequalifying Degree Examination.
3) Submission of relieving certificate from Employer by………………………….4) Submission of GATE Score Card/CSIR/NET award letter (in original).
DR (PGS&R) Signature of OS (PGS&R)
Project no.: Completion date:
Signature of the Candidate
(Place your signature photo here)
Assistantship Source:
If funded from IRD/FITT project,