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 <headsire@iitd.ac.in>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,