INDIAN INSTITUTE OF TECHNOLOGY BOMBAY Powai, Mumbai – 400 076 Ph.D. Admission (July/January) Year 20_ _ _ _ Paste passport size photograph in this space ( This form is meant for foreign students FRNTA only) IITB IITBMONASH Application for IIT Bombay IITB Monash Academy (please tick appropriate) Details of payment of application fee: Bank's name ____________________Banker's Cheque No. _______________ Date:________$/Rs: _____ Programme in : i) __________________________________________ 1. Name in full (In capital letters as in qualifying degree certificate) (Type or Write Legibly in English – Keep one block blank between two words) 2. Category under which you want to apply : FRNTA (Foreign National – Teaching Assistantship) 3. (a) Address for postal communication* : b) Name & Address of Parent/Guardian (i.e. Permanent Address) for postal communication _______________________________________________ ______________________________________________ ________________________________________________ _____________________________________________ City ____________________________________________ City _________________________________________ State ______________Pin _________________________ State ___________________ Pin_________________ * It is the responsibility of the candidate to intimate change of address, if any, to the Deputy/Assistant Registrar(Academic), IIT Bombay. 4. Telephone Number: (with STD code) Mobile No*: Email Address(s) *: * Candidate must provide Email address or Mobile number or both. Notifications will be sent by email and /or SMS. 5. Date of Birth: (as in School Leaving Certificate): ____________(DD/MM/YYYY) 6a. Birth category : 6b. Person with Disability (Y/N) : 7. Sex (M/F): 8. Nationality : _____________ 9. Passport details : Passport No : _______________________________________ Date of Issue _________________________ Valid up to : _______________________________________ Place of Issue _________________________ 10a). Performance in Competitive Examination (such as GRE, GMAT / TOFEL etc. ) : Name of Examination Score Year Valid up to b). Proficiency in English (TOEFL/IELTS) Name of Examination Year Score 12 . Areas of your research interest ( in order of preference : i) ___________________________________________ ii) ______________________________________________ '' Contd. on page..2.. 2 13. Details of Academic Record (Secondary Onward):(Mention, if the degree is through Distance Education programme) Degree (list all degrees, Graduate/ Postgraduate) Name of Degree Branch/ Name of University/ Mode of Discipline/ Institute Programme (B.E./B.Tech./ Specialization ( Write full name) (Regular/Part Month & Year of Passing/ time/Correspond Result ence) Awaited M.Sc./M.E./ M.Tech./MBA etc.) % of Class/ marks/ Division CPI / CGPA (on the scale of 10) Qualifying degree (will be used for shortlisting application) Other degree1 Other degree2 Other degree3 Other degree4 14. Research/ Professional Experience, Papers published etc.: ( please bring a copy of your publications and thesis if you are called for written test and/or interview. Attach a separate sheet for details, if required ). Name of University/ Institute/ Industry Period Position held/ Nature of duties Name of Supervisor Title of Dissertation/ Topic of Research/ Papers Published* * mandatory to give title of paper, name of author(s), journal name, volume, page(s), year. 15 : Statement of Purpose : please check the format as provided in the Information Brochure under Appendix2. 16. Employment details (after acquiring the qualifying degree): Total Duration(in months): _________ Name and Address of the Organization Designation Period From To (MMYYYY) (MMYYYY) 15. Present status : (Employed /Not Employed ) ________________ 16. Declaration: I certify that the information given above is correct. I am fully aware that I must submit attested copies of my qualifying degree certificate / final transcripts on or before joining, IIT Bombay, failing which, my admission will stand canceled. I am also aware that providing incorrect information in the application form can result in the cancellation of my admission at any stage. Place: Date: Signature of the Applicant http://www1.iitb.ac.in/academic/phd.jsp [please email a copy of the application form to : dean.ir.office@iitb.ac.in ] _________________
© Copyright 2025