1. Name of the Applicant MR. XXXX 2. Upload Your Photo No file selected. 3. Upload Your Signature No file selected. 4. Type 5. School in which admission is sought 6. Proposed Research Area Minimum 1 Research Area is Mandatory Institute Assistantship Sponsored/GOI Fellowship Project Scholar (Projects running at IIT Bhubaneswar) Visveswaraya Ph.D. Scheme for Electronics and IT Basic Sciences Biochemistry Biophysical Chemistry Computational Biology Biosciences 7. Name of the Mother 8. Occupation of the Mother 9. Name of the Father 10. Occupation of the Father 11. Date of Birth of Candidate 05-05-1986 12. Nationality 13. Marital Status Married Unmarried 14. Gender Male Female 15. Category GEN SC ST OBC 16. Belong to PWD Yes No 17. Religion xxx 18. Address Details Address for Correspondance Permanent Address Same as Address for Correspondance Town/Village Town/Village Street Street District District State State Pin/Zip 444444 Pin/Zip 444444 Email Email Cell Number 000000000000 Numbers only Cell Number 000000000000 Numbers only Telephone Number Telephone Number (with STD code) (with STD code)
19. Educational Qualification (Please specify percentage/cgpa) Examination Passed University/Institute Year Subjects/ Discipline/ Specialization Division/Class Percentage CGPA HSC (10 Level) 2001 NA xxx 98 / HS (10+2 Level or Equivalent) 2003 xxx 99.5 / B.Tech. 2006 xxx 8 / 10 M.Tech. 2008 xxx 6 / 7 19A. Master Degree Details Whether joined into M.Tech through GATE Yes No 20. Performance in GATE Discipline Year of Examination Score Percentile AIR (All India Rank) Validity xxx 2017 562 52 YES 21. Performance in NET Discipline: xxx Year of Examination: 2016 Qualified Junior Research Fellow 22. Experience, if any, of Service and/or Research including Present Position held NOTE: Please fill the current month and year in "Date-To" field, if you are continuing with a position/service. Name and Address of Employer Designation From To Nature of Work Salary Draw (in INR) Experience (in Years) xxx xx 01 2013 01 2017 xxx 21555 4 23. Publication in refered Journals (if any) 1 xx
SELECT * FROM phdaut17a_experiences WHERE app_id='1' and emp_from!='0/0' and emp_to!='0/0' ORDER BY exp_id ASC 24. LIST OF ENCLOSURES Following documents are compulsorily needed to upload: Mark/grade sheets, certificates and documents starting from Matriculation till highest degree attained. Please upload any other relevant documents & certificates related to educational and professional experience. Please upload documents related to GATE/UGC/CSIR-NET JRF No Objection Certificate (In case of Sponsored) Release certificate from the present employer (If currently employed) Updated Curriculum Vitae. N.B. : Applications without uploading relevent supporting documents (certificates & marksheets) shall be outrightly rejected. Please mention the document title against the document (certificate/ marksheet). S.N. Document Title Upload File 1 HSC No file selected. 2 HS No file selected. Instructions If you have more than 10 documents to upload, then upload 5 documents first and again come to step 3 and upload next 4/5 documents and repeat the step. (Uploading more documents at a time may slow down your application submission; so try to upload in stages.) Please upload any other relevant documents & certificates related to educational and professional experience. The documents/certificates must be in PDF. The maximum size of each file to be uploaded is 200 Kb. If required, split a larger document into multiple parts and clearly name the documents such as CV_part1of3.pdf, CV_part2of3.pdf, CV_part3of3.pdf 3 B.Tech. No file selected. 4 M.Tech. No file selected. 5 GATE No file selected. 6 NET No file selected. 7 xx(01/2013 to 01/2017) No file selected.
Application Form for Ph.D. Admission (STEP 4/4) Review Application UPDATED ON : 28-02-2017 Photo 1. Full name of the Applicant MR. XXXX 2. Type Institute Assistantship 3. School in which admission is sought Basic Sciences 4. Discipline Biosciences 5. Proposed Research Area 1. Biochemistry 2. Biophysical Chemistry 3. Computational Biology 6. Name of the Mother 7. Ocupation of the Mother 8. Name of the Father 9. Occupation of the Father 10. Date of Birth of Candidate 05-05-1986 11. Nationality XXXX 12. Marital Status MARRIED 13. Gender MALE 14. Category GEN 15. Religion XXX 16. PWD: NO 17. Address Details Address for Correspondance PIN: 444444 Email: Cell Number: 000000000000 Permanent Address PIN: 444444 Email: Cell Number: 000000000000 18. Educational Qualification Examination Passed University/Institute Year Subjects/ Discipline/ Specialization Division/Class Percentage CGPA HSC 2001 NA xxx 98 HS 2003 xxx 99.5 B.Tech. 2006 xxx 8/10 M.Tech. 2008 xxx 6/7 18A. Master Degree Details Whether joined into M.Tech through GATE: yes 19. Performance in GATE Discipline Year of Examination Score Percentile AIR (All India Rank) Validity xxx 2017 562 52 YES 20. Performance in NET Discipline: xxx Year of Examination: 2016 Qualified : Junior Research Fellow 21. Experience, if any, of Service and/or Research including Present Postion held Name and Address of Employer Designation From To Total Period Nature of Work Salary Draw Remarks (mm/yyyy) (mm/yyyy) (mm/yy) (in INR) xxx xx 01/2013 01/2017 00/04 xxx 21555 NA 22. Publication in refered Journals (if any) 1. xx 23. LIST OF ENCLOSURES
1 HSC view 2 HS view 3 B.Tech. view 4 M.Tech. view 5 GATE view 6 NET view 7 xx(01/2013 to 01/2017) view Signature (Signature of Applicant) Note : Please review the application fully before submitting. You will not be able to edit after submission. If you click "SAVE & QUIT" your application will be saved but not submitted. You have to relogin to edit and/or submit your application. If you click "SAVE & SUBMIT" your application will be submitted. You will NOT be able to edit or make any further changes in the application form. After clicking on "SAVE & SUBMIT" you will get the Application Number, using which you can proceed for the Fee Payment. EDIT CURRENT APPLICATION SAVE & QUIT SAVE & SUBMIT