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M.Tech. (Closing Date 19 Apr 2012) INDIAN INSTITUTE OF TECHNOLOGY DELHI Application Form for Admission to M.Tech. Programme Please read the instructions given in the Information Brochure Before you fill up the form Visit : http://www.iitd.ac.in/ Application Number: Admission Type: Category: Test GATE Year 2012 00010080 Full-Time General Registration ID 3153003 Academic Program: Mode of Support: Physically Challenged: M.Tech.(Master of Technology) Paste your Unattested Photograph Yes Score 566
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  Paste yourUnattestedPhotograph  M.Tech. (Closing Date 19 Apr 2012) INDIAN INSTITUTE OF TECHNOLOGY DELHI Application Form for Admission to M.Tech. Programme Please read the instructions given in the Information Brochure Before you fill up the formVisit : http://www.iitd.ac.in/    Application Number:00010080Academic Program:M.Tech.(Master of Technology)Admission Type:Full-TimeMode of Support:Category:GeneralPhysically Challenged:Yes  TestYearRegistration IDDisciplineScorePercent GATE20123153003Comp Science and Engg/Tech56698.5 PROGRAM Department/Centre:Computer Science & EngineeringProgram Code:MCS PERSONAL Name:Name: PRADEEP JAINGender: MaleDate of Birth: 03-FEB-1989Father Name: PRAKASH JAINMother Name: GUNMALA JAIN QUALIFYING DEGREE Qualifying Exam: B.E.Course duration(Years): 4Discipline: COMPYear of Passing: 2012Name of University/Institute: DAVV,I.E.T. Indore  Year/SemMarks ObtainedMax MarksYear/SemMarks ObtainedMax Marks Year1/Sem18971200Year1/Sem28551200Year2/Sem19031200Year2/Sem29101200Year3/Sem18961200Year3/Sem29361200Year4/Sem17811050Aggregrate % marks (of all years/semesters): 74.80 PREVIOUS ACADEMIC RECORD Exam/DisciplineInstitute/Year ofGrading%Marks/RankDegreeUniversityPassingSchemeCGPA10+2MATHSST. PAUL /CBSE2008Percent65NA CONTACT DETAILS Correspondence284 CH SCHEME 74 C,Address:VIJAY NAGAR,INDORE, Madhya Pradesh, IndiaPIN:452010Email:poojacs35@gmail.comMobile No.:91~9826719058Permanent284 CH SCHEME 74 C,Address:VIJAY NAGAR,INDORE, Madhya Pradesh, IndiaPIN:452010Email:poojacs35@gmail.comMobile No.:91~9826719058  Payment Information Bank Draft Number: Date: 28-MAR-2012Drawn on: State Bank of indiaAmount Rs:75.00Have you ever studied and discontinued your studies at IIT Delhi ?NoDate____________(Signature of the Candidate)FOR DEPARTMENT/CENTRE`S USE FOR P.G. SECTION USE ONLY (Recommendations/observations of the office)The candidate may be provisionally admitted/not admitted subject to the following :1) Submission of attested copies of the qualifying degree certificate and marks sheet showingthe required % of marks/CGPA by /.2) Submission of proof from the University/Head of the Institution of having appeared/passed inthe qualifying Degree Examination by .3) Submission of GATE Score Card (in srcinal) by .4) Submission of relieving certificate from Employer by .   _________________________________________________________________________________________________________________  DR/AR (PGS&R)Signature of OS (PGS&R)
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