M.Tech.

2011

M.Tech. Admission Committee Indian Institute of Technology Hyderabad Acceptance of Offer of Admission by the Candidate

FORM 01

Name of Candidate (Block Letters) M.Tech. Application No. Address :

PIN Code
To The Chairman M.Tech Admission Committee IIT Hyderabad Sir, With reference to your letter No.IITH/M.Tech. Admn./ I enclose the following: (i) Original GATE SCORE CARD based on which present offer has been made. GATE Registration No. (ii) A Challan (Rs.15,000/- for all categories) towards admission fee, the Challan details of which are given below:
Amount Rs. Journal No. Date Name of the Bank Bank Code

dated ___ 2011, I hereby accept your offer of

admission to M.Tech programme in the stream ______________________________________.

(iii)

I am currently employed at (Organization) ________________________________________ (location) _________________________________. I understand that I need to produce the relieving order from the competent authority of the employer at the time of admission, failing which the offer of admission will be cancelled. I am not employed.

I shall be reporting to the Institute on Thursday, 28th July at 9:00 AM.

Date: Place: Signature

M.Tech. 2011

M.Tech. Admission Committee Indian Institute of Technology Hyderabad DECLARATION by the Candidate

FORM 02

Name of Candidate (Block Letters)

M.Tech. Application No.

Please tick [] any one of the options given below:

I do not wish to be considered for updating the M.Tech. stream allotted to me.

I wish to be considered for updating the M.Tech. stream, if vacancy arises. I understand that, once upgraded, I cannot go back to the original stream.

The department in which I am joining does not have different MTech streams. Hence the option of updating does not arise.

Date :

Signature

M.Tech. 2011

M.Tech. Admission Committee Indian Institute of Technology Hyderabad DECLINING OFFER OF ADMISSION

FORM 03

Name of Candidate (Block Letters) M.Tech. Application No. Address :

PIN Code
Tick whichever is applicable below: I am declining the present offer (No. IITH/M.Tech. Admn./ME/2011/
dated ).

I am declining the present offer (No. IITH/M.Tech. Admn./ME/2011/ dated ). However, I would like to be considered for the higher preferences (M.Tech. Programme) as given in my application.

Place : Date To The Chairman M.Tech Admission Committee IIT Hyderabad : Signature

M.Tech. 2011

M.Tech. Admission Committee Indian Institute of Technology Hyderabad

GENERAL INSTRUCTIONS AND ADMISSION SCHEDULE

FORM 04

I.

Reporting for Admission:

You are required to report for admission at the Academic Office of this Institute and participate in the orientation programme at 9:00 AM on 28th July 2011(Thursday) II. 1. You must bring the following documents at the time of reporting for admission: Date of birth extract: A copy of your SSLC / SSC / Matriculation certificate along with the original. 2. Degree Certificate: Originals of degree/provisional degree and Grade Cards/Mark Sheets of all the semesters of your degree programme with one set of xerox copies of the above. 3. Declaration by Parent: Declaration signed by your Parent/Guardian in the enclosed Form 05. 4. Medical Fitness Certificate: Medical fitness certificate in the enclosed Form 06. 5. 6. Draft for Hostel Deposit: Course Completion Certificate: All the candidates admitted in M.Tech. programme at IIT Hyderabad should have completed all the examinations including Viva-voce by July 15, 2011. If the results of the final examination are not yet announced, a Course Completion Certificate from the Head of your Institution must be produced in Form 07 (enclosed). Such candidates must submit the Provisional Certificate on or before 30-09-2011. 7. Relief Certificate: Employed candidates must submit relief certificate from the employer at the time of admission, failing which the offer of admission will be cancelled. 8. Community Certificate: SC/ST/OBC (Non-Creamy Layer) candidates should produce the original and a copy of the community certificate issued by the Competent Authority.

M.Tech. 2011

M.Tech. Admission Committee Indian Institute of Technology Hyderabad DECLARATION BY PARENT / GUARDIAN
[to be submitted at the time of Admission]

FORM 05

Name of Candidate (Block Letters) M.Tech. Application No.

To The Chairman M.Tech. Admission Committee IIT Hyderabad Sir, In the event of the applicant, my son/daughter/ward, being admitted to the M.Tech. programme at Indian Institute of Technology Hyderabad, I undertake to pay regularly the amounts due from him/her to the Institute towards tuition fee, mess charges, hostel seat rent, etc., within the prescribed dates. Place: Date : Signature of Parent/Guardian Name in Block Letters Profession Address
*

: .... : .... : ..... : .. .. ..... .....

Pin Code

Phone No. with STD Code E-mail, if available

Office

Residence

Mobile

Note: In the case of guardian, please give the relationship in brackets below the signature.

Form 06

CONFIDENTIAL Medical History and personal particulars of Students joining at IIT Hyderabad
1. 2. 3. 4. Full Name (in capitals) . Roll No. . . Name of Parent/Guardian Personal Abuse of substances (if any) 5. Past Medical/Surgical Treatment 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 6. : : : No Allergies/Bronchial Asthma/Tuberculosis Abdomen including Urinary Tract Locomotor system (Spinal/Vertebral column/Joints) Cardiovascular system Neurological disorders/Psychological disorders Sexually-transmitted/Venereal Diseases/Skin Hepatitis Diabetes Rheumatism Thyroid disease : No 3.1 3.2 3.3 3.4 3.5 3.6 3.7 7. Tuberculosis Leprosy Diabetes Hypertension Ischemic heart diseases Psychiatric illness Cancer : 1) 2) Yes Yes Veg. / Non-Veg. Smoking / Alcohol / Drugs / Any other

Family history of any major illness

Identification marks

8.

Blood Group

I declare that all the statements above are true and correct to the best of my knowledge. I fully understand that I am responsible for the accuracy of all statements given. Candidates Signature : .. Counter signed by Parent/Guardian : . Date : Place :

:2:

HEALTH CERTFICATE
1. Examination by a General Physician (M.D. in General Medicine)

I, Dr. .. after examining (with necessary investigations) Mr./Ms. . Son / Daughter of Mr./Ms. .... born on

CERTIFY:
Weight . Kg. Height . cm. Blood Pressure .. /. mm Hg. (b) After deep inspiration .. Heart Heart Sounds

Girth of Chest : (a) At rest . : Cardiovascular System Respiratory System Neurological System Psychological disturbance Past Medical or Surgical Record Identified allergies Current treatments : : : : : : :

Yes / No

If yes, specify

Current vaccination Status (All candidates who do not have adequate active/passive immunity against diseases mentioned below should take these injections/adult booster dose as recommended, just before joining the Institute and the date to be mentioned below): VACCINATION AGAINST DISEASES BCG Diphtheria Tetanus - Poliomyelitis Measles, Mumps, Rubella Hepatitis B Hepatitis A Meningitis Typhoid Chicken Pox 1st Injection Date Yes / No Last Booster Date Yes / No

Candidates Signature : .
:3:

2. Examination by Ophthalmologist*
Acuity of Vision R.E. L.E. *Latest Optometrists Recommendations, if any to be attached in original. Remarks / Special Recommendation, if any : Far Vision Naked Eye With Glasses Near Vision Naked Eye With Glasses Colour Vision

I, Dr. ..... have examined (with necessary investigations) Mr./Ms. . Son / Daughter of Mr./Ms. ..... born on and the above information given to the best of my knowledge are correct and true. Date : Place : Signature & Seal

3. Examination by ENT Specialist*

Inspection / hearing Right Ear Left Ear *Audiometry

*Latest Audiometry report to be attached in original. Remarks / Special Recommendations, if any.

I, Dr. ... have examined (with necessary Daughter investigations) of Mr./Ms. Mr./Ms. ... Son / on

...

born

and the above information given to the best of my knowledge are correct and true. Date : Place : Signature & Seal

Candidates Signature :

:4:

INVESTIGATIONS
1. *Electrocardiogram 2. *Chest X-ray 3. *Sonography (whole abdomen) 4. *Urine 5. *Blood Tests a) Blood Sugar (F/PP) b) Urea/Creatinine c) Peripheral Smear Study/HB% d) Lipid Profile e) Blood Group/typing (if not known) f) HBS Ag g) HIV I & II Date .. Date .. Date .. Date .. Date .. Date .. Date .. Date .. Date .. Date .. Date .. Date .. Result Result Result Result Result Result Result Result Result Result Result Result

*All original investigation reports (only) to be attached. Remarks / Special Recommendation, if any:

Conclusion : Fit / Unfit to pursue higher education with a very tight academic schedule. Reason :

Date : Place : Signature & Seal

Candidates Signature : .

M.Tech. 2011

M.Tech. Admission Committee Indian Institute of Technology Hyderabad

FORM 07

COURSE COMPLETION CERTIFICATE

Certified that Mr./Ms. , Roll No. . final year student of this College, has completed all the requirements including practical, project, Viva-voce, etc. for the award of the degree, and

a) b)

He/She has appeared for the final examination held during .. 2011, the results of which are awaited. He/She has passed the final examination
(Strike out either (a) or (b) whichever is not applicable)

Place Date

: :

Signature & Name of Principal with Office Seal

Name of the College :

University

NB: Selected candidate must have appeared for all the examinations including project viva for the award of the qualifying degree by 15th July, 2011, otherwise the candidate is not eligible for admission even if the offer of admission to M.Tech. is issued by IIT Hyderabad.

FORMAT OF CERTIFICATES
Certificate for SC / ST Candidates : To be issued by District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional Deputy Commissioner /Deputy Collector/1st Class Stipendiary Magistrate/City Magistrate/Sub-Divisional Magistrate/Taluk Magistrate/Executive-Magistrate/Extra Assistant Commissioner/ Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate/Revenue Officer not below the rank of Thasildar/Sub-Divisinal Officer of the area where the candidate and/or his family normally resides/Administrator/ Secretary to Administrator/Development Officer (Lakshadweep Islands). This is to certify that Mr./Ms. .. son/daughter of . of Village/Town . in District/Division .. of the State/Union Territory .. belongs to the .Caste/Tribe which is recognised as Scheduled Caste/Scheduled Tribe.

Official Seal :

Signature Name in Block Letters ..

Place & Date :

Designation

Alternative Certificate
Applicable only to SC/ST persons who have migrated from one state to another for purpose of employment, education, etc. This certificate is issued on the basis of the Scheduled Caste/Scheduled Tribe Certificate issued to Shri/Shrimathi ...

father/mother of Shri/Shrimathi ..... of Village/Town . in District/Division .. of the State/Union Territory who belongs to the .... Caste/Tribe which is recognised as a Scheduled Caste/Scheduled Tribe in the State/Union Territory . issued by the ... (name of issuing authority) vide their No.. and date ...

Place :

Signature Name in Block Letters ..

Date :

Designation

(with seal of Office)

Please delete the words which are not applicable. True copy/xerox copy attested by Headmaster of School/Gazetted Officer be submitted.

FORM OF CERTIFICATE
TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR ADMISSION TO PROGRAMMES OFFERED BY CENTRAL EDUCATIONAL INSTITUTIONS This is to certify that Shri / Smt. / Kum.................................................................................... Son / Daughter of Shri Town / Smt.......................................................................................... ....................................... of Village District / /

........................................................................

Division.......................................................................... in the State of .............................................................. belongs to the................................................................. Community, which is recognized as a backward class under:

(i) (ii) (iii)

(iv)

(v)
(vi) (vii) (viii)

(ix) (x) (xi)

(xii) (xiii) (xiv)

(xv)

Resolution No. 12011/68/93-BCC(C) dated 10/09/93 published in the Gazette of India Extraordinary Part I Section I No. 186 dated 13/09/93. 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. 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. Resolution No. 12011/96/94-BCC dated 9/03/96. 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. Resolution No. 12011/13/97-BCC dated 03/12/97. Resolution No. 12011/99/94-BCC dated 11/12/97. Resolution No. 12011/68/98-BCC dated 27/10/99. 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. 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. Resolution No. 12011/44/99-BCC dated 21/09/2000 published in the Gazette of India Extraordinary Part I Section I No. 210 dated 21/09/2000. Resolution No. 12015/9/2000-BCC dated 06/09/2001. Resolution No. 12011/1/2001-BCC dated 19/06/2003. Resolution No. 12011/4/2002-BCC dated 13/01/2004. 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 the State of .........................................................................................
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 which is modified vide OM No. 36033/3/2004 Estt.(Res.) dated 09/03/2004.

Dated: District Magistrate/ Seal NOTE: Deputy Commissioner, etc.

(a)
(b)

The term Ordinarily used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950. The authorities competent to issue Caste Certificates are indicated below:

(i)

District Magistrate / Additional Magistrate / Collector / Deputy Commissioner / Additional Deputy Commissioner / Deputy Collector / Ist Class Stipendiary Magistrate / Sub-Divisional magistrate / Taluka

Magistrate / Executive Magistrate / Extra Assistant Commissioner (not below the rank of Ist 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 family resides.

*****

Declaration / Undertaking - for OBC (Non-Creamy Layer) Candidates only

I, ........................................................................................................................, son /daughter of Shri / Smt. ...................................................................................................... resident of Village / Town / City ...................................................................................... ...........................................................in the District State

..................

of ..................................................................... hereby declare that I belong to the community............................................................................., which is recognised as a backward class by the Government of India for the purpose of reservation in services as per orders contained in Department of Personnel and Training Office Memorandum No.36012/22/93- Estt. (SCT), dated 8/9/1993. It is also declared that I do not belong to persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the above referred Office Memorandum, dated 8/9/1993, which is modified vide Department of Personnel and Training Office Memorandum No.36033/3/2004 Estt. (Res.) dated 9/3/2004.

Place: Date:

Signature of the Candidate

Declaration/undertaking not signed by the candidate will be rejected