M. Tech Programmes (For Teachers of AICTE-Recognized Degree-Level Programmes of Engineering Institutions and Industrial Professional )

Transcription

1 CONTINUING EDUCATION CENTRE INDIAN INSTITUTE OF TECHNOLOGY KHARAGPUR M. Tech Programmes (For Teachers of AICTE-Recognized Degree-Level Programmes of Engineering Institutions and Industrial Professional ) (Test held on ) Provisionally Selected Candidates in Electronics and Communication Engineering Electrical Engineering & Information & Communication Technology Electronics and Communication Engineering Sl.No. Application No. Name Centre Pankaj Kr. Jain Raipur Atul Kr Sahu Raipur Shital Baghel Raipur Souva Gayen Kolkata Aniruddha Koley Kolkata Arun Kumar Kolkata Dolly Kumari Kolkata Sudipta Dutta Kolkata Subhasish Roy Kolkata Chanchala Kumari KGP Biswaranjan Pattanayak BBSR Manas Ranjan Mantri BBSR Harish Chandra Monhanta BBSR Swastik Sahoo BBSR Rajib Kr. Nanda BBSR Debashree Rupalin BBSR Electrical Engineering Sl.No. Application No. Name Centre Madhuri Shukla PortBlair Abhishek Sinha Kolkata Partha Sarathi Mitra Kolkata Puspen Biswas Kolkata Rudranil Prosad Roy Chowdhury Kolkata Soumen Ghosal Kolkata Ila Koley KGP Swagata Ghosh KGP Manoj Samal BBSR Smrutirekha Mahanta BBSR Priyadarshinee Das BBSR Prashanta Kr. Tripathy BBSR

2 Information & Communication Technology Sl.No. Application No. Name Centre Nishant Yadav Raipur Kamble Jagadish Kashinath Raipur Moumita Basu Kolkata Shouvik Bose Kolkata Subhra Maji Kolkata Animesh Kundu (Waiting list -for not submission of Sponsorship cert.) Kolkata Atanu Moitra Kolkata Abhoy Kole Kolkata Souvick Mukherjee Kolkata Ananjan Maiti Kharagpur Sourav Kumar Giri Kharagpur Saikat Bagchi BBSR Registration : Date : July 28 th 2012 (Saturday) Time : A.M P.M. Venue : IIT Kharagpur-CEP Office, Bhubaneswar Campus / Kolkata Campus./Raipur Extension Centre(Address: Govt. Engg. College, Sejbahar, Old Dhamtari Road, Raipur, Chhatrishgarh, ) Contact Number : / , (BBSR) : , (Kolkata) : & 2119 Session starts on : 29 th July, 2012 ; ** Set of proformas attached herewith to download & Print (each 2 copies) Candidates are requested to bring all ORIGINAL MARK SHEETS, CERTIFICATES, SC/ST/PD certificates (if applicable), along with their attested copies (1 set) at the time of Registration. The originals will be returned after verification; At the time of registration they are required to pay the first installment of Rs.50,000/- (Rupees Fifty thousand Only) through a single Demand Draft drawn in favour of CEP-MTech, payable at IIT Kharagpur. (S. Sengupta) Dean(CE)

3 (Applicable for Teachers only) CERTIFICATE OF AICTE RECOGNITION This is to certify that (Name of the College/Instt. and Address) as well as the Academic Department to which Mr./Mrs./Ms. belongs are recognized by AICTE. Date: Signature of the Head of the Instt/Competent Authority [Office Seal]

4 Certificate and Forwarding Note by the Principal/Head of the Institution/ Divn. Manager of the industry a) The applicant has a total of years and months of teaching/industry experience as on June 30, 2012, as a full-time, faculty/industry professionals b) The applicant will be relieved on part-time basis for the programme as per schedule declared by IIT Kharagpur from time to time and will be paid full salary and allowances during the tenure of his/her sponsorship, if selected for admission. c) All facilities, upgradation and assistance will be created in our Institute/Industry to facilitate execution of the M.Tech project of the candidate in the Institute. Signature of Principal or Head of Institution/Divn. /ProjectManager Office Seal: Date: (With full contact details) Note: Conditional Recommendation will not be accepted. This Forwarding Note should be signed only by the Principal or the Head of the Institution Divn. /ProjectManager. Any alteration made in the text of this Forwarding Note leads to automatic rejection of the application. Please attach separate experience certificate.

5 Indian Institute of Technology Kharagpur Kharagpur REGISTRATION FORM FOR ( Autumn Semester) M.TECH (to be submitted on the date of Registration i.e.28 th July 2012) Roll No.: (Available at the time of Registration) 1. Name (Surname) (First and Middle Name) [Name must be same (in form and spelling) as recorded in the mark sheet/certificate of the qualifying examination] 2. a) Category :Self sponsored b) Gender : M/F c) Reference No. of Admission letter: date: 3. a) MTech/MCP Regn. No. b) Whether SC/ST/PH 4. Course admitted to (*): a) Course Code(*): b) Course Name(*) c) Department/Center/School(*) : 5. Extension Centre Allotted: 6. Particulars of qualifying examination: a) Name of degree: Branch/Department b) Whether completed all parts of the qualifying degree examination: c) Year of completion/passing: d) Institute passed/completed from: e) Whether pass certificate/mark sheet enclosed? : 7. Payment details: Tuition Fee of Rs. 50,000/- (Rupees Fifty thousand Only) Bank Draft No.: Date: Amount (Rs.): Issuing Bank : Signature of Student with date: Payable at

6 CERTIFICATE OF MEDICAL FITNESS (To be given by a Registered Medical Practitioner conducting the medical examinations) Candidate s Name: M.Tech Admission offer letter No. date. M.Tech.offered under QIP in the Department of Mr./Ms. (Name of the candidate) examined by me has the following health parameters: 1. Height cm. 2. Weight kg. 2. Blood Pressure : 4. Blood Group: 5. Colour Blindness: Yes/No. I certify (please strike out which is not applicable) that the candidate is free from any medical condition that is detrimental for the pursuit of the postgraduate programme as indicated above and I declare that the candidate is fit. That on account of the reason stated I do not wish to declare the candidate fit to pursue of the postgraduate programme as indicated above. Reason: Date: (Signature of the Medical Practitioner) Registration No: Seal: Counter signed by the Principal of Parent Institution / Divisional Manager Remarks:

7 U N D E R T A K I N G (1) I,, working as in the Department of of, (Name of the College/Industry and place) selected for admission to the M.Tech programme on in the Department of IIT, Kharagpur hereby undertake that after joining the programme if the study cannot be continued till the completion for any reason from either sides, I am not entitled to seek refund the amount drawn by IIT Kharagpur as tuition fee. Signature: Name : Address : Signature of the Head/Principal of Institution/Divisional Manager (Office Seal)

8 UNDERTAKING (2) 1. I a candidate admitted to the M Tech programme of the Department with specialization in the session 2011 (Autumn Semester) hereby undertake that: ii) After joining the course I shall not leave my studies from the Institute before the prescribed programme is completed. iii) I shall abide by the admissible rules and regulations of IIT Kharagpur. iv) I shall not ask for change of course after admission to a particular course / specialization. 2. I further undertake that I shall not be involved in anyway in the act of ragging or indulge in any misbehavior. In the event of breach of this undertaking the Institute will have the authority to take any disciplinary action it deems fit. 3. I shall continue with my parent sponsoring organization during the duration of the programme till completion and participate in the upgradation programme of the parent organization/institution apart from performing normal academic duties without hampering the attendance of the M.Tech programme. Date (Signature of Student) Name (in full) Admission Regn. No Year of Admission Full Addres : : : :

9 INDIAN INSTITUTE OF TECHNOLOGY KHARAGPUR M.Tech (Autumn) STUDENT BIO-DATA PERSONAL INFORMATION Roll No.: (Available at the time of Registration) Full Name : (in BLOCK LETTERS) As per High School (X standard) Certificate Gender (M/F) : Date of Birth : (Date Month Year) Father s/guardian s Name : Father s/guardian s monthly Income : Mailing Address : Permanent Address : Telephone No. (with STD code) : Current place of residence : Height (cms) : Nationality : Weight (Kgs) : Blood Group : Native State : Mother Tongue : Cat. (Gen/SC/ST/PH) : Bank A/C No. : Hall of Residence : Passport No. : Identification Marks:

10 EDUCATIONAL INFORMATION Qualifying Exam. (BE/B.Tech etc) : Year of Graduation : Name of Department/Branch : Name of Board/University : Percentage Marks/CGPA obtained : Roll No. : Year of Admission : Department : Specialisation : Category : Degree Status : (With Assistantship/Without Assistantship/Sponsored/QIP) Year of Graduation : *Strike out which are not applicable