NATIONAL INSTITUTE OF TECHNOLOGY SIKKIM

APPLICATION FORMforadmission in M.Tech(sponsored)

Self-attested Photograph

To
The Dean (Academic Affairs)
National Institute of Technology Sikkim
Ravangla, South Sikkim – 737 139
Sikkim, India
Advertisement No. / NITSKM / Admission / 2017-18 / Monsoon / MTech(Sponsored) & PhD
Name of the offering Department
Name of the M.Tech. Programme
Years of Experience in Industry/Academia
Name and Address of the Organisation offeringSponsorship
Tenure of the Sponsorship
GATE qualified (Please tick √) / Yes / No
If yes, please provide details and enclose certificate / Exam: / Year:
Rank: / Score/Percentile:
If you wish to apply for more than one Department, please send separate applications for each Department.
Demand Draft No. / Date
Amount / Rs. / Drawn at
Name in full (in capital letters) (Underline Surname)
Father’s / Husband’s Name
a. Marital Status / b. Male / Female/ Others :
a. Permanent address / b. Address for correspondence
Mobile No. / E-mail ID
Date of birth
(please attach true copy of certificate )
Category (Please tick √)
(Please attach true copy of certificate in case of SC/ST/OBC/PD) / SC / ST / OBC / PD / General

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  1. Details of educational qualifications: Please give particulars of all examinations passed and degrees obtained commencing with the 10th standard / Matriculation. Please attach true copies of self-attested mark-sheets and certificates.

Sl.
No. / School / College / Institute / Date of
entry / Date of
leaving / Name of the Board
/ University / Institution / Examination
/ Degree / Diploma passed / Distinction
/ Class / Division / Subjects (Please mention field of specialization, honours, etc, where applicable) / Percentage
of marks or C.P.I. / Year of
passing
  1. Details of employments: Please give particulars of your present and past employments in chronological order, starting with the present one:

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No. / Organisation / Institute / Position held / Nature of duties / work / Date of joining / Date of leaving / Last Pay & Scale
of pay / Additional remarks about experience, if any.*

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9. / Nationality
10 / Are you a citizen of India by birth or by domicile?
11 / Present basic pay & scale of pay
Whether leave will be granted/ already granted
(a No Objection Certificate and Sponsorship Certificate to pursue M.Tech. issued by the employer to be enclosed) / Yes / No
Research & Development, Training, Publication etc, if any:
(a) Please enclose a list of your Research & Development works and attended Industrial Trainings /Short-term courses / Workshops / Conferencesetc, if any.
(b) Please state no. of publications (Published/Accepted) in the format below and enclose the first page of publications, if any:
In Journals / In Conferences /
Technical Reports / Book Chapters
National / International / National / International
(d) Citation of your published papers, if any:
(For each of the above items, please give full details in separate sheets)
(a) Awards and honours, if any:
(b) Member of professional bodies, if any:
Additional Remarks, if any:
(Applicants may mention here any special qualifications, experience etc. which have not been included under the heads given above)
Details of self-attested enclosures sent with the application / 1.
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I hereby declare that I have carefully read and understood the instructions and particulars supplied to me and that all the entries in this form are true to the best of my knowledge and belief.

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Date: ...... Signature of the Candidate

  • Send complete application form with subject:“Application for M.Tech.(Sponsored)in______(fill the name of Department/Discipline - Programme category)”, latest by 22ndMay, 2017 to the above mentioned address.
  • Thescan-copyof the application form with all enclosed documents must have to sendas asingle .PDF filethrough e-mailto:
  • Incomplete applications or applications not reaching in time will not be considered.
  • The Institute will not be responsible for any postal or other of delay.It takes approximate 10 days for delivery at Ravangla through Speed Post.

Format for “Sponsorship Certificate” from Employer on Official Letter Head

Ref No:Date:

To

The Dean (Academic Affairs)

NIT Sikkim

Subject:Sponsorship of Mr./Ms./Mrs.______for M.Tech (Sponsored) programme in NIT Sikkim

Dear Sir,

Mr./Ms.______who has been working at ______(Organizationname) as ______(Designation) is hereby sponsored for carrying out his/herM.Tech in ______(name of the course) at NIT Sikkimfor the session 2017-19 as a sponsored candidate.

He/She will be relieved from his/her duties in the organization with effect from______to join the M.Tech(Sponsored) programme at NIT Sikkim.

Date: Signature:

Place: Name:

Designation:

Seal of Sponsoring Authority:

Format for “No-Objection Certificate” from Employer on Official Letter Head

Ref No:Date:

To

The Dean (Academic Affairs)

NITSikkim

Subject: No objection certificate for M.Tech (Sponsored) programme in NIT Sikkim

Dear Sir,

It is hereby certified that Mr./Ms./Mrs.______has been working in our organization as ______.

We donot have anyobjection to his/her being admitted to theM.Tech (Sponsored) programme at NITSikkim for the session starting on July, 2017 as a sponsored candidate.

The employee will be relieved from his/her duties for 02years to complete the programme, examinations, Dissertation and other formalities forM.Tech. programme at NIT Sikkim.

.

Date:Signature:

Place:Name:

Designation:

Seal of competent authority:

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