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INDIAN INSTITUTE OF TECHNOLOGY KANPURApplication Form For Admissions To Post Graduate 2015-2016

Date:20-APR-2015

Reference No: IITK/2015-16-I/PG/10717

Application Date: 13-APR-2015

Application Status: Submitted

1. General Information Full Name abhishek singh DOB 14-JUL-1989

Place of Birth gorakhpur Sex Male Marital Status Single

Father's Name gorakh prasad Nationality Indian

Address for Corres. af 45

jawahr bhawaniit roorkee

State Uttaranchal PinCode 247667

E-Mail abhisitm2012@gmail.com Phone NA Mobile 7505471957

2. Demand Draft Details DD No. 818795 Amount Rs. 200.0 DD Date 06-APR-2015

Issued by Bank Name STATE BANK OF INDIA Branch Code(Drawee) 01069

3. Applied Department/Programme Details and Category Department Civil Engg. Admission for Degree PhD Student Status Full Time

Appling directly PhD after BE/BTech from Centrally Funded Technical Institute No

Financial Status Sponsored Category SC Phy. Handicapped No

Areas of specialization in the Department/Programme

Pref. 1. Structural Engineering Pref. 2.

Pref. 3. Pref. 4.

4. Academic Information/Work Experience A. GATE,ICMR-JRF,ICAR,DBT-JRF,CEED,CSIR-JRF/LS,UGC-JRF/LS,Other Fellowship Details Exam Name Exam Discipline Score Rank Exam Year

GATE Civil Engg. 359.0 3623 2012

B. Qualifying Degree already obtained or in ProgressUniversity Name Uni Address 1 Uni Address 2 Rank in University Total Student in Uni

IIT roorkee IIT roorkee NA NA

Institute Code Institute Name & Place Centrally Funded Technical Inst. (Only applicablefor direct PhD after BE/BTech)

Rank in Institute

UK018 Indian Institute of Technology, Roorkee No NA

Degree Discipline Final Result expected by Min. Pass Marks Max. Marks

M.Tech. Earthquake engineering 2015 4.0 10.0

% Marks or GradeAverage

Sem. I Sem. II Sem. III Sem. IV Overall/Current gradeaverage6.0 5.8 9.0 0.0

Sem. V Sem. VI Sem. VII Sem. VIII 6.05

0.0 0.0 0.0 0.0

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C. Other Degrees Obtained after 10+2(Do not include the degree listed in 4B)Degree Discipline University Name & Address Institute Name & Address Marks or

CPICompletion Year

B.E. civil engineering BIT mesra BIT mesra ranchi Bit Mesra ranchi Jharkhand 6.97 2012

D. Working Experiences

Duration Employer Position Nature of work

E. Number of Technical Papers(Provide details separately) Papers Published in Journals 0 Presented in Conference 0

5. Names and addresses of two referees from whom letters of reference have been obtaioned(For Ph.D Only)1. Dr. Amita Sinvhal 2. Dr. Y Singh

Address: IIT roorkee Address: IIT roorkee

Earthquake dept earthquake dept

Email: amitafeq@iitr.ac.in Email: yogenfeq@iitr.ac.in

Declaration by the ApplicantCertified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any wilful misrepresentation of factswill result in my dismissal from the institute. If admitted, I shall abide by all the rules and regulations of the institute.

Date: Signature:

Checklist (Send self attested photocopies(Not Original) and mention reference no. on each of the document)1. Date of Birth (DOB) Certificate or High School (Class 10) Certificate withDOB

2. SC/ST/OBC Certificate if applicable

3. Certificate of Physical Disability (Type of disability to be attached) 4. Sponsorship Certificate for Sponsored Candidate 5. GATE/CSIR/UGC/ICMR/CEED/Other Fellow Exam Score card (If you havenot received GATE score card then please send printout of the online GATEscore card.)

6. Photocopies of qualifying degree marks/grade sheets

7. The application fee of Rs.400/ for candidates in General/OBC and Rs.200/ forSC/ST/PD must be paid through demand draft payable to The Registrar IITKanpur at Kanpur.(Note: Send original)

8. Printed copy of your Online filled application form (If photograph is notloaded, then write reference no at back of self attested passport size photographand staple it.).

9. No Objection/relieving Certificate from Employer (For employed candidatesat the time of admission)

10. Two letters of reference (For Ph.D. applicants only)

11. For applicants to the PhD programme of the ME Department, please see http://www.iitk.ac.in/me/admission/phd2014.htm for additional mandatoryrequirements

Mailing Address for Applications:The Convenor, DPGC

Department/Programme of _________________________

(Kindly mentioned the Department name where you are seeking your admission)Indian Institute of Technology, Kanpur

Kanpur-208016 U.P.

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SPEED POSTAPPLICATION REF NO: IITK/2015-16-I/PG/10717PROGRAM: PhD

To,

The Convenor, DPGCDepartment/Programme of Civil Engg.(CE)Indian Institute of Technology, Kanpur

Kanpur-208016 U.P.