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    Application Form For Non Degree Student

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    g731046

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form For Non Degree Student

    Uploaded by

    g731046
    11 views2 pages

    Original Title

    Application_Form_for_Non_Degree_Student

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    Copyright:

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    11 views2 pages

    Application Form For Non Degree Student

    Uploaded by

    g731046

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    INDIAN INSTITUTE OF TECHOLOGY KANPUR

    DEAN OF ACADEMIC AFFAIRS

    Application Form for Non-Degree Student

    Name & Address of the Home University: __________________ AFFIX


    RECENT
    ________________________________________________________ PASSPORT
    SIZE
    ________________________________________________________ PHOTOGRAPH

    Duration: From: _____________________________ To: _______________________________

    Department (Area of Interest) : _______________________________________________________

    Intended activities during stay as non-degree student and/or tentative list of courses:
    ________________________________________________________________________________
    ________________________________________________________________________________
    Research Work OR Course Work _______________________________________

    A. Personal Data of the student :


    1) Name: _____________________________________________________________________
    (in block letters) (First Name) (Middle Name) (Last Name)

    2) Father’s Name: ______________________________________________________________


    3) Mother’s Name: _____________________________________________________________
    4) Date of birth:____________________ 5) City & Country of Birth: _________________
    6) Nationality: _____________________ 7) Marital Status: ________________________
    8) Passport No.: _____________________ 9) Date of Issue: _________________________
    10) Place of Issue: _____________________ 11) Valid up to: __________________________
    B. Address of the student :
    i) Address for Correspondence : _________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    Tel: Alternate No.

    Email:
    ii) Hostel Accommodation needed at IIT Kanpur: YES NO
    iii) Faculty Supervisor at IIT Kanpur (if intended for Research Work):
    Prof. ______________________________________________________________________
    iv) Address of the University/Department: _________________________________________
    ____________________________________________________________________________
    ____________________________________________________________________________
    Tel: ______________________ Fax: ______________ E-mail:________________________
    C. Studies at Home University :
    i) Department: ________________________________________________________________
    ii) Degree (Masters/ Bachelors): __________________________________________________
    iii) Academic Year/Semester: _____________________________________________________
    D. Other Information :
    i) Language Known: ____________________________________________________________
    ii) Special Interests, hobbies, extracurricular activities:
    ____________________________________________________________________________
    ____________________________________________________________________________
    iii) Contacts in India: __________________________________________________________________
    (If available)
    _______________________________________________________________________________________

    Place: ___________________________
    Date: ___________________________ _________________________________
    (Signature of the Applicant)

    Application Recommended & forwarded


    By Home University

    ______________________________________________________
    SIGNATURE OF FORWARDING AUTHORITY WITH SEAL

    NB:- 1) Copy of the latest Transcripts of the Program to be enclosed. 2) All courses may not be offered
    in every semester. 3) Semester-I commence from July, Semester-II commence from December &
    Summer Term commences from May.

    Enclosure Check List:


    Recommendations from Home University
    Proof of Registration from Home University
    Academic Record of last semester
    Study Plan
    Statement of Purpose
    Letters of Reference
    Copy of Passport (for foreign national only)
    Others

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