Application No. (to be filled by IIST). : __________

Government of India Department of Space

INDIAN INSTITUTE OF SPACE SCIENCE AND TECHNOLOGY (Declared as Deemed to be University under Section 3 of the UGC Act, 1956)

Valiamala PO, Thiruvananthapuram 695547

Application Form M.Tech./M.S. Programme-2014-2015 (for DOS/ISRO Employees)

(Separateapplicationshouldbesubmittedforeachprogramme) Programme Code

Name of Programme (Please verify you are satisfying the eligibility requirement for the programme before filling the application form).

1. Name: _________________________________________________

2. Office address/address for correspondence: ____________________

________________________________________________________

________________________________________________________

____________________________________ Pin _________________

Telephone No. _____________Mobile (if any) _______________ E-Mail: ______________

3. Residential address: : ______________________________________________________

________________________________________________________________________

________________________________________________________________________

____________________________________ Pin ___________________

4. Date of Birth (DD-MM-YYYY) (Please attach proof): _________________

5. Nationality :_________________________________

6. Fathers Name: _________________________Mothers Name:______________

7. Gender: _________________________ Marital Status: ___________________

8. Spouse Name __________________________

9.Category (Mark3):

UR OBC SC ST PWD

Pleaseaffixyourlatestpassportsizephotograph

10. Details of academic record (Attested copies of mark sheets/certificates to be enclosed):

Degree / Certificate

Name of Board/University

Year of passing Subjects

Percentage of marks/ CGPA* Class/Division

(*Marks/CGPA considered for awarding first class)

111. Name of DOS/ISRO Centre /Unit Date of Joining

Present Designation

Present Pay Band with Grade Pay

Present Division/ Section

12. Any other relevant information:

Declaration I affirm that the information given in this application are true and correct to the best of my knowledge and belief. I also fully understand that if at any stage it is discovered that any attempt has been made by me to willfully conceal or misrepresent the facts, my candidature may be summarily rejected and my admission to Post Graduate programme terminated.

(Signature of the candidate)

Place: __________________________ Date: __________________________

Forwarding of Application of Candidate by Designated Authority of DOS/ISRO (For the use of Administration in DOS/ISRO centres/units)

I am directed to forward herewith the application of Shri/Smt/Kum...

SC NoDesignationDivision..Centre... for

admission to two year on-camps M. Tech/MS. Programmed in IIST, Valiamala, Thiruvananthapuram-695 547.

Shri/Kum/Smt has joined this centre on

Signature .. Seal of forwarding Authority Date: (Office Seal) List of Enclosures: