National Institute of Technology, Agartala: Rayt/Iya - Éaoooovaooigaki Samsqaana Agartlaa

For Office Use
Degree: Department: Date of Receipt Reg No.
National Institute of Technology, Agartala

Barjala, Tripura - 799055
Application form for Admission to M.Tech Programme, for the academic session 2012-13
raYT/Iya |aooOVaooigakI saMsqaana Agartlaa
1. Name (In Block letter): ..

. Male Female P
Stamp Size Photo
2. Fathers / Husband name: .. 3. Mothers name:.. 4. Address: (a) For correspondence (b) Permanent
(c) Email: 5. (a) Date of Birth :. (b) Age on 01.07.2012: .
(d) Phone :
(e) Fax :
(e)Marital Status: (f) Nationality: ..
(c) Whether SC/ST/OBC (if yes, a certificate must be attached) (d) Specify if belong to any Other Backward Class: 6. (a) Department to which the candidate seeks admission: (b) Specialization (preference wise) 1. . 2. . 3. 4. . 5. (c) Are you also applying to any other Department ? If yes, list the other Department(s): Yes / No (d) Category: ( Tick ) Regular Sponsored Institute Staff
7. Details of Universities/Institutions attended (from 10th Standard onwards) (attested copies of certificates and mark sheets/grade cards must be attached).
University / College / Board Degree obtained (with discipline) Year % Marks / CGPA / CPI Class Obtained (if applicable) Subjects taken
8. (a) Professional Qualifying Examination passed (attested copy of certificate must be attached):
(I) GATE
Subject
Qualifying score
Score obtained
Valid up to
(b) Any other source for fellowship/scholarship:

9. (a) Professional Experience (Teaching/Research/Industrial) if any (proof to be attached).
Sl No
(i) (ii) (iii)
Name of organization
Position held
Type of work From
Period To
(b) Attach a list of publications/projects etc. separately, if any:
10. (a) If employed, name of the present employer: (b) Whether employers permission obtained?: Yes No (c) If yes, whether NOC in form-I/II is enclosed?: (d) Actual period of service up to the date of application: 11. List of Enclosures: a e b c d f G h
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 undertake to abide by the rules and regulations of the Institute as exist and amended from time to time. 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 information furnished by me are false or incorrect. I shall abide by the decision of the Institute, which shall be final. Place : Date :
Signature of the applicant
For office use only a. To be filled in by Departmental Admission Committee after verification and selection test i i % of B.Tech marks/Grade Performance of Selection Test ii GATE/NET Score (if any) ii Position in order of merit iii Category(General/SC/ST/OBC)
Recommended/ Not recommended for admission:
Signature of member Signature of member Signature of member Departmental PG Admission Committee
Chairman,
b. To be filled by Central Admission Committee: (i) Verified and found suitable and recommended to Chairman, Senate for admission (ii) Recommended for M.Tech Assistantship (Yes/No).. (iii) Not recommended for admission .. (Signature of members): ..........
..........................................................
c. Admitted on approval from Chairman, Senate.

Date:
Dean (Academic)
Form I SPONSORSHIP LETTER (This should be typed on the letter head of the sponsoring organization)
To TheDirector, NationalInstituteofTechnologyAgartala Agartala. ReferenceNo. Date:
Sub: Sponsoring an Employee for M.Tech (full time)

DearSir, I/We hereby sponsor the candidate of Mr./ Ms. who is an employee in our organization, for joining M.Tech Programme in ...atyourInstituteasafulltimestudent.
I/We shall relieve him/her of his/her duties in the organization during the first two years of the M.Tech Programme.
SignatureandSealofthe SponsoringAuthority

National Institute of Technology, Agartala: Rayt/Iya - Éaoooovaooigaki Samsqaana Agartlaa

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National Institute of Technology, Agartala: Rayt/Iya - Éaoooovaooigaki Samsqaana Agartlaa

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For Office Use

Degree: Department: Date of Receipt Reg No.

National Institute of Technology, Agartala

raYT/Iya |aooOVaooigakI saMsqaana Agartlaa

1. Name (In Block letter): ..

Stamp Size Photo

(c) Email: 5. (a) Date of Birth :. (b) Age on 01.07.2012: .

(e)Marital Status: (f) Nationality: ..

(b) Any other source for fellowship/scholarship:

Type of work From

(b) Attach a list of publications/projects etc. separately, if any:

Signature of the applicant

Recommended/ Not recommended for admission:

Signature of member Signature of member Signature of member Departmental PG Admission Committee

c. Admitted on approval from Chairman, Senate.

Sub: Sponsoring an Employee for M.Tech (full time)

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