admission form jam 2011

8/6/2019 Admission Form JAM 2011

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7. Qualifying Examination Result (In the box to the right, write P forPASSED and A forAWAITED)

8. Details of the academic record (attach photo copies of certificate(s) and mark sheet(s)):

ExaminationPassed

Name of Board /University

Year ofPassing

Subjects / Papers TakenAggregate*Marks (%)

10th Standard

12th

Standard(+2 orequivalent)

BachelorsDegree**

Provide details in Table I

(Ref. Page 3)

* Aggregate of all subjects, including languages and subsidiaries, for all years/ semesters of the programme

** If result is awaited, fill details up to pre-final year / semester.

Signature of the Candidate


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TABLE I

Marks obtained in all papers, including languages and subsidiaries, in

Bachelors Degree for all years / semesters of the programme*.

S. No. Title of PaperMarks / Grade

Obtained +Maximum Marks

for the Paper

IYear/1sta

nd2ndsem

ester

IIY

ear/3rd

and4ths

emester

IIIYear/5th

and6ths

emester

Total I = Total II =

Aggregate % of Marks = (Total I / Total II) x 100 = %*If result is awaited, fill details up to pre-final year/ semester+ For candidates with letter grade, the photocopy of mark sheet with grading scheme followed by theUniversity / Institute must be enclosed Signature of the Candidate


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9. Choice Sheet: Academic programmes for JAM 2011

Registration Number in JAM 2011 :

Name of the Candidate :

Choose the programmes of interest that you are eligible for, based on the paper qualified in JAM 2011. If you have qualified inmore than one paper, you are eligible for programmes covered by both papers. Mention the order of preference (1, 2, 3, etc.) in

the last column. In the 'Order of Preference' column, mark 'X' against the programmes that you are NOT interested in. Please

note that the order of preference plays an important role in the admission process.

Note: If you have qualified in two papers in JAM 2011, and would like to choose programmes eligible under both the papers,the order of preference should be combined. For example, a candidate qualifying both BT and CY can have an order ofpreference such as 1 under BT, 2 under CY, 3 under BT, and so on.

Programmes Eligible for JAM 2011 Paper: BT

Code JAM Paper Programme Title InstituteOrder of

Preference

104 BT M.Sc. Biotechnology (4 Semesters) IIT Bombay

110 BT M.Sc.-Ph.D. Dual Degree in Biotechnology IIT Bombay

112BT M.Sc.-Ph.D. Dual Degree in Environmental Science & Engineering IIT Bombay

703 BT M.Sc. Biotechnology (4 Semesters) IIT Roorkee

Programme Eligible for JAM 2011 Paper: CA


Preference

709 CA Master of Computer Applications (6 Semesters) IIT Roorkee

Programmes Eligible for JAM 2011 Paper: CY

Code JAM Paper Programme Title Institute

Order of

Preference

105 CY M.Sc. Chemistry (4 Semesters) IIT Bombay

111 CY M.Sc.-Ph.D. Dual Degree Programme in Energy IIT Bombay

112 CY M.Sc.-Ph.D. Dual Degree in Environmental Science & Engineering IIT Bombay

201 CY M.Sc. Chemistry (4 Semesters) IIT Delhi

301 CY M.Sc. Chemistry (4 Semesters) IIT Guwahati

401 CY M.Sc. Chemistry (4 Semesters) IIT Kanpur

501 CY Joint M.Sc.-Ph.D. Programme in Chemistry IIT Kharagpur

601 CY M.Sc. Chemistry (4 Semesters) IIT Madras

704 CY M.Sc. Chemistry (4 Semesters) IIT Roorkee

801 CY M.Sc. Chemistry (4 Semesters) IIT Hyderabad



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Registration Number in JAM 2011:

Programmes Eligible for JAM 2011 Paper: GG


Preference

101 GG M.Sc. Applied Geology (4 Semesters) IIT Bombay

108 GG M.Sc.-Ph.D. Dual Degree in Applied Geology IIT Bombay

502 GG Joint M.Sc.-Ph.D. Programme in Geology IIT Kharagpur

701 GG M.Sc. Applied Geology (4 Semesters) IIT Roorkee

707 GG M.Tech. Geological Technology (6 Semesters) IIT Roorkee

Programmes Eligible for JAM 2011 Paper: GP


Preference

102 GP M.Sc. Applied Geophysics (4 Semesters) IIT Bombay

109 GP M.Sc.-Ph.D. Dual Degree in Applied Geophysics IIT Bombay

708 GP M.Tech. Geophysical Technology (6 Semesters) IIT Roorkee

Programmes Eligible for JAM 2011 Paper: MA


Preference

106 MA M.Sc. Mathematics (4 Semesters) IIT Bombay

111 MA M.Sc.-Ph.D. Dual Degree in Energy IIT Bombay

112 MA M.Sc.-Ph.D. Dual Degree in Environmental Science & Engineering IIT Bombay

113 MA M.Sc.-Ph.D. Dual Degree in Operations Research IIT Bombay

202 MA M.Sc. Mathematics (4 Semesters) IIT Delhi

302 MA M.Sc. Mathematics & Computing (4 Semesters) IIT Guwahati

402 MA M.Sc. Mathematics (4 Semesters) IIT Kanpur

504 MA Joint M.Sc.-Ph.D. Programme in Mathematics IIT Kharagpur

602 MA M.Sc. Mathematics (4 Semesters) IIT Madras

702 MA M.Sc. Applied Mathematics (4 Semesters) IIT Roorkee

705 MA M.Sc. Industrial Mathematics and Informatics (4 Semesters) IIT Roorkee



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Registration Number in JAM 2011:

Programmes Eligible for JAM 2011 Paper: MS


Preference

103 MS M.Sc. Applied Statistics and Informatics (4 Semesters) IIT Bombay

113 MS M.Sc.-Ph.D. Dual Degree in Operations Research IIT Bombay

404 MS M.Sc. Statistics (4 Semesters) IIT Kanpur

Programmes Eligible for JAM 2011 Paper: PH


Preference

107 PH M.Sc. Physics (4 Semesters) IIT Bombay

111 PH M.Sc.-Ph.D. Dual Degree in Energy IIT Bombay

112 PH M.Sc.-Ph.D. Dual Degree in Environmental Science & Engineering IIT Bombay

114 PH M.Sc.-Ph.D. Dual Degree in Physics IIT Bombay

203 PH M.Sc. Physics (4 Semesters) IIT Delhi

303 PH M.Sc. Physics (4 Semesters) IIT Guwahati

403 PH M.Sc. Physics (4 Semesters) IIT Kanpur

405 PH M.Sc.-Ph.D. Dual Degree in Physics IIT Kanpur

505 PH Joint M.Sc.-Ph.D. Programme in Physics IIT Kharagpur

603 PH M.Sc. Physics (4 Semesters) IIT Madras

706 PH M.Sc. Physics (4 Semesters) IIT Roorkee

802 PH M.Sc. Physics (4 Semesters) IIT Hyderabad

Declaration

I hereby declare that the order of preference given by me for my eligible programmes is final.



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10. Details of Demand Draft of Rs. 300/- (Rupees Three Hundred Only) drawn in favour of Chairman, JAM, IIT Roorkeepayable at Roorkee.

Amount Date of issue Number Name of the issuing Bank Branch

Rs. 300/- State Bank of India / Punjab National Bank

11. Documents to be enclosed: (Attach a photocopy of each document and tick the relevant box(s))

10th standard Certificate.

12th standard (10+2) Certificate showing the subjects passed.

Mark sheets (including title of papers taken) for all semesters/ all the years or up to pre-final

year/semester of the qualifying degree if the result is awaited.

Category Certificate of SC/ST (if applicable), issued by a competent authority (list given inAppendix II of the JAM 2011 Information Brochure).

Category Certificate of OBC (non-creamy layer) (if applicable), issued by a competent authority in the

format attached (No other format is acceptable).

Certificate to support the Person with Physical Disability (PD) status, if applicable, issued by a

Government Medical Board.

Please attach only photocopies. DO NOT SEND ORIGINALS.

Declaration:

I hereby declare that the particulars stated by me in this Application Form for Admission are true to the best of my

knowledge and belief. Moreover, I have verified the information given above and it is found to be correct. I have read theInformation Brochure of JAM 2011 and agree to abide by the terms and conditions therein. It is entirely my responsibility to

prove my eligibility for admission to the programme for which I may be admitted and also, in respects of qualification and

entitlement for admission against reserved category, if claimed, to the satisfaction of the Admitting Institute. Further, in the

event of suppression or distortion of any facts such as category, educational qualifications, nationality etc. made in my originalApplication Form of JAM 2011 as well as in this Application Form for Admission, I understand that my admission, if granted,and/or degree/ diploma acquired subsequently are liable to be cancelled/ withdrawn. I also understand that the decision of the

Organizing Institute and the Admitting Institute regarding my admission will be final and I shall abide by the ordinances and

regulations of the Admitting Institute in vogue from time to time. I further understand that the Order of Preferences for

programme(s) and corresponding Institute(s) given by me in this form are final and no alteration will be permissible

under any circumstances.

Place:

Date:



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INDIAN INSTITUTES OF TECHNOLOGY

(Bombay, Delhi, Guwahati, Hyderabad, Kanpur, Kharagpur, Madras, Roorkee)

UNDERTAKING

To be given by a candidate whose qualifying examination result is awaited and hence is provisionally admitted.

1. Name :

2. Registration Number in JAM 2011 :

3. Test Paper(s) :

4. All India Rank(s) :

I understand that my admission to any of the IITs is provisional since I have not submitted the attested

copies of the qualifying examination certificate and/or mark sheet as per the eligibility criteria stated in

Sections 4 and 5 of the Information Brochure for JAM 2011.

I also understand that in the event of my failing to fulfill the eligibility criteria on or beforeSeptember 30, 2011, my provisional admission to any of the IITs will stand cancelled.

_____________________

Signature of the candidate

Place : _____________________

____________________________

Countersigned by Parent/ Guardian

Date : ______________________


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JAM 2011

Organizing Institute: IIT Roorkee(Bombay, Delhi, Guwahati, Hyderabad, Kanpur, Kharagpur, Madras, Roorkee)

COURSE COMPLETION CERTIFICATE

Certified that Mr / Ms. . ...... , Roll No. ...............

final year B.Sc. / B.Sc.Ed. / B.E student of this College,

a) He / she has appeared for the final examination held during .. 2011, the results of

which are awaited.

b) He / She has passed the final examination

*Strike out either (a) or (b) whichever is not applicable)

Place : Signature & Name of Principal

with Office Seal

Date :

Name of the College :

University :

___________________________________________________________________________________________________

NB: Those who are appearing for qualifying examination after 15th

July 2011 are not eligible for admission even if

offer of provisional admission is issued.


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Proforma for Other Backward Class (OBC) Certificate

(CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR ADMISSIONS TO

CENTRAL EDUCATIONAL INSTITUTIONS (CEIs), UNDER THE GOVERNMENT OF INDIA)

This is to certify that Shri/Smt./Kum. _____________________________ Son/Daughter of Shri/Smt.

__________________________________ of Village/Town ________________________________ District/Division __________________________ in the _________________________ State belongs to the ________________________

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 INo. 186 dated 13/09/93.

(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 INo. 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, modified vide OM No. 36033/3/2004 Estt.(Res.)

dated 09/03/2004, or the latest notification of the Government of India.

This certificate is being issued based on the annual income / status of the parents / guardian of the applicant

as on financial year ending March 31, 2010.

Dated:

District Magistrate/

Seal Deputy Commissioner, etc.

NOTE:(a) The term Ordinarily used here will have the same meaning as in Section 20 of the Representation of the People

Act, 1950.

(b) The authorities competent to issue Caste Certificates are indicated below:

(i) District Magistrate / Additional Magistrate / Collector / Deputy Commissioner / Additional DeputyCommissioner / Deputy Collector / Ist Class Stipendiary Magistrate / Sub-Divisional Magistrate / Taluka

Magistrate / Executive Magistrate / Extra Assistant Commissioner (not below the rank of 1 st 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/her family resides.