Indian Institute of Technology Bombay

LAST DATE FOR RECEIVING COMPLETED FORM: 25 APRIL 2014

Registration No. (to be filled by office)

New Delhi M.TECH (Renewable Energy Engineering and Management) ADMISSIONS 2014/15 Paste (do not pin) your photograph (with white ground) in this space and attest it yourself

Choice of test centre

1. Do not send any attested copies of certificates with this form. Original and attested copies of degree certificates/marksheets will be needed later. 2. Incomplete application forms are likely to be rejected. 3. Candidates who are in the final year of their qualifying programme will be considered for admission only if they have completed all requirements for award of the qualifying degree by 28 July 2014 and if their provisional degrees are available before 15 October 2014. 4. This form must be accompanied by a demand draft of Rs 1450/-. 5. Use capital letters wherever possible.

TYPE OR WRITE LEGIBLY IN ENGLISH 1. Name in full (as in 10+2 certificate):

2. (a) Address of the candidate for (b) Name and Address of Parent/Present communication Guardian (i.e. Permanenent Address)

City ______City ______State ______Pin State ______Pin

3. Telephone Number (with STD Code): ______

4. Mobile: 5. E-mail: ______

5／25／2018 6. Date of Birth: (as in School Leaving Certificate) D D M M Y Y Y Y 7. GN/SC/ST/PH2 8. Nationality (I-Indian, F-Foreign) 9. Sex (M/F) 10. Blood Group ______RH Factor ______11. Status of qualifying examination result: (write A: Appeared and result awaited, P: Passed) 12. Details of Academic Record of the Bachelor’s programme: a) Programme completed/ongoing (eg. B.Tech, B.E) etc. ______b) Branch/Specialization ______c) College d) Year of Passing______e) University f) City/State ______g) Name of HOD ______h) Contact phone ______i) Contact address of HOD ______j) Contact Email of HOD ______k) Name of any other faculty ______l) Contact phone ______m) Contact address of Faculty ______n) Contact Email of Faculty ______o)

Exam Semester Subjects/courses taken Month % Passed/ (Please provide details) / Year Marks/Grade / Appeared Class obtained I year Sem 1

II year Sem 3

III year Sem 5

IV year Sem 7

Sem 8 p) Final aggregate marks/Grade point obtained#

13. Do you have a valid GATE Score (Y/N)

2 General/Scheduled Caste/Scheduled Tribe/Physically Handicapped # If the programme is not completed, indicate the aggregate marks/grade point obtained so far.

5／25／2018 14. Have you qualified NET (Y/N)

15. Details of Academic Record of any Master’s programme; if relevant: a) Programme completed/pursuing (eg. M.Sc) etc. ______b) Branch/Specialization ______c) College d) University

Exam Passed/ Subjects/courses taken Month/ % Marks/Grade Appeared (Please provide details) Year /Class obtained I year

II year

e) Final aggregate marks/Grade point obtained#

16. If you hold a higher degree/degrees, please mention the degrees here and give details in the format of item 12 on a separate sheet of paper.

Higher Degree 1

Higher Degree 2

17. Are you a sponsored candidate? (Y/N)

18. If yes, indicate the name and address of the sponsoring agency:

19. Declaration by the Applicant:

If selected for admission, I undertake to abide by the rules and regulations of TERI University. I certify that the information given above is correct and I am aware that providing incorrect information in the application form may result in the cancellation of admission secured. I am further aware that, if the admission is secured before the results for the qualifying examination are published and if I fail to satisfy the minimum academic requirement for admission when such results become available, the admission will be cancelled. I also certify that I have not been convicted in any criminal case and that there is NO pending criminal case against me.

Place: ______Date: ______Signature of Applicant

5／25／2018 Details of Demand Draft drawn in favour of “Registrar, TERI University”, payable at New Delhi, enclosed with this application

Demand Draft No. ______Dated ______Amount Rs______

Bank Name______

Please indicate how you got to know about the TERI University and its programmes (you may mark more than one): 1.Website 2. Newspaper/Magazine advertisement Month of January Month of February Month of March Month of April

3.Word of mouth from friends 4. Word-of-mouth from alumni

5. Functions at TERI University 6. Educational fairs

7. Facebook/Twitter/other social media

5／25／2018