Your IP : 216.73.216.40
<table><tr><td colspan=2 align=center><h2>Indian Institute of Information Technology Allahabad</h2></td></tr>
<tr><td width=20% align=center><img src="images/logo.gif" width="75" height="78" /></td>
<td width=80% align=center>
(A Deemed to be University under Section 3 0f UGC Act 1956)<br>
A Centre of Excellence in Information Technology, Estd. By Min. of HRD, Govt. of India, New Delhi<br>
Devghat Jhalwa, Allahabad – 211012, U.P. (INDIA)<br>
<!-- Ph: 0532-2922025,2922067 Fax: 0532-2922081 <br> -->
Web: <a href="http://www.iiita.ac.in/">www.iiita.ac.in</a>
</td></tr>
<tr><td colspan=2><hr><center><h3>Online Applicantion Form For Ph. D. Programme 2013-2014 </h3></center></td></tr>
</table>
<form method="post">
<?php
include "include/javafunctions.inc";
include "include/functions.inc";
include "include/arrays.inc";
dbConnect();
$tbl = 'tbl_registration_phd';
$id = $_REQUEST["id"];
$regid = $_REQUEST["regid"];
$dob1 = $_REQUEST["dob1"];
if ($regid && $dob1) {
include "reprintfindindex.php";
}
echo "
<table>
<tr><td valign=top>
<table>
<tr><td width=20%>Application for </td><td width=80%><b>".ucwords($division)."</b></td></tr>
<tr><td width=20%>Full Name </td><td width=80%> ".ucwords($fullname)." </td></tr>
<tr><td>Date of Birth </td><td> ".$dob." - Age ".$age." </td></tr>
<tr><td>Place of Birth </td><td> ".ucwords($pob)." </td></tr>
<tr><td>Gender </td><td> ".ucwords($gender)." </td></tr>
<tr><td>Marital Status </td><td> ".ucwords($mstatus)." - Children ".$children."</td></tr>
<tr><td>Nationality </td><td> ".ucwords($nationality)." </td></tr>
<tr><td>Category </td><td>";
switch ($category){
case "GE";
echo "General";
break;
case "SC";
echo "Scheduled Cast";
break;
case "ST";
echo "Scheduled Tribe";
break;
case "PH";
echo "Physically Handicapped";
break;
case "SN";
echo "Sponsored";
break;
case "NR";
echo "Non-Resident Indian";
break;
case "OB";
echo "Other Backward Classes";
break;
}
echo "</td></tr>
<tr><td>Father's Name </td><td> ".ucwords($fathername)." </td></tr>
<tr><td>Mother's Name </td><td> ".ucwords($mothername)." </td></tr>
<tr><td>Address (Permanent)</td><td> ".ucwords($address1)." </td></tr>
<tr><td>City </td><td> ".ucwords($city1)." </td></tr>
<tr><td>State </td><td> ".ucwords($state1)." </td></tr>
<tr><td>Pin Code </td><td> ".$pincode1." </td></tr>
<tr><td>Address (Correspondance)</td><td> ".ucwords($address2)." </td></tr>
<tr><td>City </td><td> ".ucwords($city2)." </td></tr>
<tr><td>State </td><td> ".ucwords($state2)." </td></tr>
<tr><td>Pin Code </td><td> ".$pincode2." </td></tr>
<tr><td>Contact No. </td><td> ".$phone1." , ".$phone2."</td></tr>
<tr><td>FAX No. </td><td> ".$fax." </td></tr>
<tr><td>Email Address </td><td> ".$email1." , ".$email2."</td></tr>
</table>
</td> <td valign=top align=center nowrap><br>
<b>Application No. : ".$regid."</b><br><br>";
if (!$photo) {
echo "<img src='photos/demo.jpg' height=150 width=130 border='1' /> <br><br>";
} else {
echo "<img src='photos/$id.jpg' height=150 width=130 border='1' /> <br><br>";
}
echo "
<input type='text' size=20 /><br>
Signature of Candidate
</td></tr>
<tr><td colspan=2><hr>
<b>Application Fee Details </b><br>
</td></tr><tr><td colspan=2>
<table width=100%>
<tr><td>".$txn_type."</td>
<td>Number ".$txn_number."</td>
<td>Amount Rs. ".$txn_amount."</td>
<td>Dated ".$txn_date."</td>
</tr>
<tr><td colspan=4>Bank & Branch issued ".ucwords($txn_bankbranch)."
</td></tr>
</table>
<hr>
</td></tr>
<!-- -------------------------- -->
<tr><td colspan=2>
<b>Details of Qualifying Examination (#) passed or appearing</b>
</td></tr>
<tr><td colspan=2>
<table border=1 width=100%>
<tr><td>Name of the Qualifying <br>Examination<br> Passed/Appearing</td>
<td>Discipline</td>
<td>Degree/Programme</td>
<td>University/Institute/Board</td>
<td>Year of Passing/Appearing</td>
<td colspan='2'>
Marks Obtained <br>
%
CPI</td>
<td>Final Result Expected by<br> (If Appearing)</td></tr>
<tr><td><b>Post Graduate</b></td>
<td>".$pg_discipline."</td>
<td>".$pg_degree."</td>
<td>".$pg_university."</td>
<td>".$pg_year."</td>
<td>".$pg_percentage."</td>
<td>".$pg_cpi."</td>
<td rowspan='5' valign='top'>".$pg_appearing."</td>
</tr>
<tr><td><b>Under Graduate</b></td>
<td>".$ug_discipline." </td>
<td>".$ug_degree." </td>
<td>".$ug_university."</td>
<td>".$ug_year."</td>
<td>".$ug_percentage."</td>
<td>".$ug_cpi."</td>
</tr>
<tr><td><b>Class XII</b></td>
<td>".$im_discipline." </td>
<td>".$im_degree." </td>
<td>".$im_university."</td>
<td>".$im_year."</td>
<td>".$im_percentage."</td>
<td>".$im_cpi."</td>
</tr>
<tr><td><b>Class X</b></td>
<td>".$hs_discipline." </td>
<td>".$hs_degree." </td>
<td>".$hs_university."</td>
<td>".$hs_year."</td>
<td>".$hs_percentage."</td>
<td>".$hs_cpi."</td>
</tr>
<tr><td><b>Others</b></td>
<td>".$ot_discipline."</td>
<td>".$ot_degree."</td>
<td>".$ot_university."</td>
<td>".$ot_year."</td>
<td>".$ot_percentage."</td>
<td>".$ot_cpi."</td>
</tr>
</table>
</td></tr>
<tr><td colspan=2>
<b>GATE/JRF/Fellowship Exam details.</b>
</td></tr>
<tr><td colspan=2>
<table border=1 width=100%>
<tr><td>Exam Name </td>
<td>Exam Discipline </td>
<td>Exam Year </td>
<td>Rank/Score </td>
</tr>
<tr><td>".ucwords($gate_name)."</td>
<td>".ucwords($gate_discipline)."</td>
<td>".$gate_year."</td>
<td>".$gate_rank."</td>
</tr>
<tr><td>".ucwords($jrf_name)."</td>
<td>".ucwords($jrf_discipline)."</td>
<td>".$jrf_year."</td>
<td>".$jrf_rank."</td>
</tr>
<tr><td>".ucwords($fellowship_name)."</td>
<td>".ucwords($fellowship_discipline)."</td>
<td>".$fellowship_year."</td>
<td>".$fellowship_rank."</td>
</tr>
</table>
</td></tr>
<!-- --------------------------- -->
<tr><td colspan=2>
<hr>
<b>Publications (Latest five only)</b>
</td></tr><tr><td colspan=2>
<table border='1' width='100%'>
<tr><td> Title of the Paper</td>
<td>Name of the Journal/Conference</td>
<td>Year</td>
<td>Impact Factor (if any)</td>
</tr>
<tr><td>1 ".$p_title1."</td>
<td>".$p_jc1."</td>
<td>".$p_year1."</td>
<td>".$p_impfact1."</td>
</tr>
<tr><td>2 ".$p_title2."</td>
<td>".$p_jc2."</td>
<td>".$p_year2."</td>
<td>".$p_impfact2."</td>
</tr>
<tr><td>3 ".$p_title3."</td>
<td>".$p_jc3."</td>
<td>".$p_year3."</td>
<td>".$p_impfact3."</td>
</tr>
<tr><td>4 ".$p_title4."</td>
<td>".$p_jc4."</td>
<td>".$p_year4."</td>
<td>".$p_impfact4."</td>
</tr>
<tr><td>5 ".$p_title5."</td>
<td>".$p_jc5."</td>
<td>".$p_year5."</td>
<td>".$p_impfact5."</td>
</tr>
</table>
</td></tr>
<!-- --------------------------- -->
<tr><td colspan=2>
<b>Working Experience<sup>*</sup> (if applicable latest three only)</b>
</td></tr><tr><td colspan=2>
<table border=1 width=100%>
<tr><td colspan=2 align='center'>Dates (From -To)</td><td>Employer</td><td>Position</td><td>Nature of Work</td></tr>
<tr><td>".$we_datefrom1."</td>
<td>".$we_dateto1."</td>
<td>".ucwords($we_employer1)."</td>
<td>".ucwords($we_position1)."</td>
<td>".ucwords($we_nature1)."</td>
</tr>
<tr><td>".$we_datefrom2."</td>
<td>".$we_dateto2."</td>
<td>".ucwords($we_employer2)."</td>
<td>".ucwords($we_position2)."</td>
<td>".ucwords($we_nature2)."</td>
</tr>
<tr><td>".$we_datefrom3."</td>
<td>".$we_dateto3."</td>
<td>".ucwords($we_employer3)."</td>
<td>".ucwords($we_position3)."</td>
<td>".ucwords($we_nature3)."</td>
</tr>
</table>
</td></tr><tr><td colspan=2>
<hr><b>Identified Tentative Problem for Research for the Ph.D. Degree under consideration </b>
<br><br>".$researchtopic."<br>
</td></tr><tr><td colspan=2>
<hr><b>Any other facts/documents in support of suitability for being considered for admission to Ph.D. programme </b>
<br><br>".$factsdocs."<br>
</td></tr>
</table>
";
?>
<br><hr>
<b>Declaration by the applicant:</b>
<p align="justify">Certified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any willful misrepresentation of facts will result in my admission being cancelled/dismissal from the Institute. If admitted, I shall abide by all the rules and regulations of the Institute.</p>
Date: ... ... ... ... ... ...
Signature of Applicant: ... ... ... ... ... ...
<br><br>
Place: ... ... ... ... ... ...
<br><br></td></tr>
<b>Declaration by Parent/Guardian (Not to be filled by sponsored candidates)</b>
<p align="justify">In the event of Mr./Ms. ... ... ... ... ... ... ... ... ... ... ... ... ... son/daughter/ward being admitted, I hereby give an undertaking to pay regularly all admissible dues to the Institute and Hostel till the completion of his/her studies. I undertake the responsibility for his/her good conduct. I am also aware that RAGGING is prohibited at the Institute and is treated as a cognizable offence at IIIT-Allahabad, under the Indian Penal Code and the directions of Hon'ble Supreme court of India and will ensure that he/she will not be involved in any ragging related activity.</p>
Date: ... ... ... ... ... ...
Signature of Parent/Guardian: ... ... ... ... ... ...
<br><br>
Place: ... ... ... ... ... ...
<br>
<br><hr>
# Attach self attested copies of certificate, marksheet etc.<br>
* A candidate presenetly working (including those on projects) must provide a "No Objection / Relieving certificate" from the employer.<br>
<hr>
<b>Checklist</b><br>
1. DD of the requisite application fee.<br>
2. Two reference letter in prescribed format.<br>
3. Certificate of DoB, Category, Educational Qualification etc.<br>
4. Equivalence Certificate from the Institution (in case Grades are awarded in the qualifying examination).<br>
5. Xerox documents should be attested by self.<br>
<hr>
<b>Please take a printout of your submitted registration details and keep the application no. for further communication. </b>
<hr>
<center>
<input type="button" value="Print" onclick="printpage()" />
<!--<input type="button" value="Edit" onclick="parent.location='formindex.php?edit=1&id=<?php echo $id; ?>'" /> -->
</center>
</form>