Indian Institute of Information Technology SriCity

Paste your
Application Form for MS (Research) and PhD Programmes photograph
Please read the instructions carefully before filling up the form here

1. Full Name :

2. Date of Birth: 3. Place of Birth:

4. Gender: Male/ Female 5. Nationality:

6. Father’s Name:

7. Address of Correspondence: 9. Department/Programme: CSE/ ECE

10. Admission for Degree: MS/ PhD

11. Student Status Appeared/ Completed

State: Pin Code :

8. Contact Details:

Phone No. : Mobile No. :

E-mail address :

12. Academic Record/Work Experience

A. GATE/CSIR/UGC/JEST/NBHM or any other fellowship exam details

Exam Name Exam discipline GATE Score/CSIR/UGC Rank Exam Year

B. Qualifying Degree (already obtained or in progress)

Institute/ College University Discipline Degree Exam Date Final Marks %

(Name & Address) (Name & Address) results or CGPA /
expected CPI
by

C. Other Degrees obtained after 10+2 (Do not include the degree listed in 12 B)

Institute/ College University Discipline Degree Pass % Date of

(Name & Address) (Name & Address) CGPA / completion
CPI
 D. Working Experience

Dates (from-to) Employer Position Nature of Work

E. Number of Technical Papers: Published in Journals Presented in Conferences

Provide details separately

13. State something about why you are interested in MS (Research) or PhD?

14. Any other relevant information?

15. Areas of specialization in the Department/Programme

Pref. 1 Pref. 2

Pref. 3 Pref. 4

16. Declaration by the applicant:

Certified, that all information provided by me on this form is correct to the best of my knowledge and belief. I understand that any
willful misrepresentation of facts will result in my dismissal from the institute. If admitted, I shall abide by all the rules and regulations
of the institute.

Date : Signature :
 IN S T R U C T I O N S FOR FIL LING THIS FORM

Either TYPE or WRITE the entries on the form neatly.

CHECKLIST (CIRCLE THE ENCLOSED DOCUMENTS). Send OnlySelf-attested Copies.

(Original certificates must be produced at the time of interview/admission).

1. Date of Birth (DOB) Certificate or High School (Class Ten) Certificate with DOB

2. SC/ST/OBC(NCL) Certificate, if applicable.

3. Certificate of Physical Disability, if applicable.

4. Sponsorship certificate for sponsored candidates.

5. GATE/CSIR/UGC score card (Item 12 A) (Computer generated printout is also accepted)

6. Copies of mark/grade sheets of qualifying degree or higher (Items 12B & 12C)

7. No Objection Certificate from employer, if applicable.

The completed Application Form must reach on or before

March 31, 2018

The completed application form alongwith self-attested copies of all the necessary documents may be sent to the following address:

PG Admission Cell,

IIIT SriCity,

SriCity, Satyavedu Mandal,

Chittoor District,

Andhra Pradesh- 517646

Alternatively, the scanned copy of the signed application form alongwith the scanned copies of the necessary documents may be sent
through the emailid:

pgadmissions@iiits.in