Indian Institute of Information Technology Guwahati
Application Form for Admission to M.Tech Programme
For office use : Sl. No.
1.(a) Name: Mr/Ms............................................................………………………… Insert Photo
(b) Parent/Spouse/Guardian ...........................................................................
(c) Addresses:
i) For correspondence ii) Permanent
............................................................................ ...........................................................................
............................................................................ ...........................................................................
............................................................................ ...........................................................................
............................................................................ ...........................................................................
Email: Mobile Phone:
2. (a) Date of Birth (dd/mm/yyyy):………........................ (c) Married / Single :……….................................
(b) Nationality:………….…… (d) Category: GEN/OBC(Non-creamy layer)/SC/ST:.......................
(e) whether Person with Disability (PwD): Yes / No
(Please specify category, and enclose self attested copies of necessary certificates)
3. Discipline to which the candidate seeks admission (Strike out not applicable options):
(a) CSE: On-Campus / Online
(b) ECE (Specialization: Communication and Signal Processing): On-Campus / Online
(c) ECE (Specialization: VLSI and Embedded System): On-Campus
4. Details of Institutions attended (from 10 th standard onwards)# (for School, give name of school &
Board; for UG degrees give name of College;Others give name of Institution
(self attested copies of certificates and mark sheets/grade cards must be attached);
School+Board/ Degree Date Date % Marks/ Class Subjects
College/ obtained (from) (to) CGPA/ CPI obtained taken
Institution (with
discipline)
# (a) Candidates still to appear in their qualifying degree examinations may also apply, provided they appear in
all their qualifying degree examinations and complete all requirements for their degrees before 31-07-2023.
If selected, such candidates shall be admitted provisionally, and they will have to furnish the results of their
qualifying degree examinations latest by 30-10-2023, failure to which their admissions shall stand
automatically cancelled.
(b) If final year qualifying degree examination results are awaited, please indicate percentage of marks or CPI
of examinations up to the last year (in case of system with annual examination)/last semester (in case of
semester system).
5. (a) Professional qualifying examination passed, if applicable (upload self attested copy of
certificate in the google form, if applicable)
(1) GATE (2) UGC/CSIR NET/INSPIRE/Others
Subject Year GATE GATE All Exam Subject Date of Rem
Score Marks Indi Qualifying
a
Ran
k
(b) Any other fellowship/ scholarship obtained:
6. Projects
(a) B.Tech / MCA /MSc/ Equivalent Main Project
Project Title: Duration:
Brief Description:
(b)Title and duration of other Projects that have been completed
i)
ii)
iii)
iv)
7. (a) Professional Experience (Teaching/ Research/ Industrial) if any ( proof to be attached).
Name of organization Position held Period Pay
(i)
(ii)
(iii)
(b) List of publications or papers presented at Conferences (full details):
8. List of Enclosures (upload scanned self-attested copies of your degree certificates, your class
X and XII pass certificates, marksheets of your qualifying examinations, GATE/ NET/Other score
card,copy of category certificates in the google form).
Declaration
I hereby declare that the entries made in this application form are correct to the best of my
knowledge and belief. If selected for admission, I promise to abide by the rules and regulations of the Institute.
I note that the decision of the Institute is final in regard to selection for admission and assignment
to a particular department and field of study. The Institute shall have the right to take any action it deems fit,
including expulsion, against me at any time after my admission, if it is found that any information furnished by
me is incorrect.
Place:
Date: Signature of the applicant
(Please type your full name)
ANNEXURE-I
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING
FOR ADMISSION TO CENTRAL EDUCATIONAL INSTITUTIONS (CEIS) UNDER THE
GOVERNMENT OF INDIA
This is to certify that Shri/Smt./Kum..……………………………………………Son/daughter
ofShri/Smt..………………………...................................Village………..................…………District/
Division…………………………..........……in……………….............…….State, belongs
to……………………………………………………………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 I No.186 dated 13/09/03.
(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 I No.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, and
as revised from time to time.
Dated:
District Magistrate/Dy Commissioner etc.,
NOTE: (a) The term “Ordinarily resides” used here will have the same meaning as in Section 20 of the Representation
of the Peoples Act, 1950.
(b) The Authorities competent to issue caste certificates are indicated below:
(i) The District Magistrate/Additional Magistrate/Collector/ Deputy Commissioner/Additional Deputy
Commissioner/ Deputy Collector/First Class Stipendiary Magistrate/ Sub- Magistrate/Extra Assistant
Commissioner (not below the Rank of First 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.
ANNEXURE-II
Declaration / Undertaking – for OBC Candidates only
I, Shri/Smt./Kum. ____________________________________, son / daughter of Shri/Smt.
_____________________________________, resident of village/town/city __________________, district
___________________State __________________, hereby declare that I belong to the
______________________Community which is recognized as a backward class by the Government of
India for the purpose of reservation in admission in Central Educational Institutions 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
08.09.1993, and as revised from time to time.
Signature of the Candidate
Place:…………………………
Date: …………………………
Declaration/undertaking not signed by candidate will be rejected
