gipedi-application-part-a.pdf

PART‐A GIPEDI APPLICATION FORM CATEGORY: ______From Table 3

BATCH: ____ (1/2/3/4) Year : Mode:

Starting on: 15 JAN / MAY / JULY / DEC Ending on: 14 JAN / MAY / JULY / DEC(CHOOSE DATES)

Name:

MailingAddress:

Tel #: ( _ _ _ _ ) Mobile:

email(s):OFFICIAL EMAIL ADDRESS FIRST; ALTERNATIVE FREE EMAIL ADDRESSES ALSO MAY BE GIVEN AS SECOND EMAIL

CURRENT INSTITUTE: DisciplineACADEMIC PROFILE ( ONLY STATE MARKS OBTAINED; DO NOT ENCLOSE COPIES OR ORIGINALS OF ANY CERTIFICATE)

Class 10:LANGUAGE1 SCIENCE MATHS SST LANGUAGE2 AGGREGATE RANK, IF ANY

Class 12:PHYSICS CHEMISTRY BIO MATHS OTHER:……… LANGUAGE1 AGGREGATE RANK, IF ANY

BACHELORSSEM‐1 SEM‐2 SEM‐3 SEM‐4 SEM‐5 SEM‐6 SEM‐7 AGGREGATE RANK, IF ANY

MASTERSSEM‐1 SEM‐2 SEM‐3 SEM‐4 RANK, IF ANY

PROPOSED TOPIC OF INTERNSHIP (ONE

ONLY):

Signature:

Office Tel: IITD email: Date:

LOCALAddress:

Signature

Tel #: ( _ _ _ _ ) Mobile: NAME:

email(s): Seal:OFFICIAL EMAIL ADDRESS FIRST; ALTERNATIVE EMAIL ADDRESSES ALSO MAY BE GIVEN AS SECOND EMAIL

DECLARATION BY THE APPLICANT1

2

3

NAME: PAYMENT DETAILS EXEMPT o ED‐APP‐FEEs

DATE: DD # : Rs:

PLACE: Signature BANK:

I hereby certify that by signing and submitting this application, I certify the above facts to be true.

I also agree that if I apply for any Batch other than a upcoming Batch (i.e. any batch for which the application is not being advertised), the application fees shall be forfeited and my application shall not be processed further unless I have applied under the Early Decision Scheme.Indemnity: I also take full responsibility for any accident / loss and agree to insure myself against any such accident / loss of life / disability to myself arising directly or indirectly due to/ during the internship. I agree that FITT or IIT Delhi will NOT be held responsible or liable for compensation in any manner for any such accident / loss of life / disability to my self.

INSTITUTIONAL CONSENT (FROM TPO) : I forward this application, having read and agreeing to comply with all terms and conditions of the GIPEDI.

(Before consenting to become Faculty Mentors, Faculty are advised to see “GUIDELINES FOR SELECTING STUDENTS” available at http://sites.google.com/site/gipediinterns/guidelines‐for‐facilitators)

I have read the GUIDELINES FOR SELECTING STUDENTS (Faculty Mentor must fill this box) I have filled and signed the Faculty Consent Form in Part‐B and enclosed it (Faculty Mentor must fill this box)

LOCAL ADDRESS (REQUIRED ONLY FOR APPLICANTS WHO ARE NOT APPLYING UNDER ANY MoU SUCH AS IASc,KVPY,etc)

I state that I have a local address to stay in Delhi / NCR and, if selected, will make my own arrangements for stay and travel to IIT Delhi as per Internship timings without any pre-conditions

FACULTY MENTOR IN IITD:

I have attached my Statement of Purpose separately (Statement of Purpose : Please attach separately – see page 20 (maximum 1 page typed in single‐space 12 pt font). I have attached descriptions of my projects done so far (Attach separately (maximum 1 typed page) – see page 21 giving details of team size, your specific contributions, the deliverables, significance of what you did and highlighting objectives met.)

_ _ / _ _ / _ _ _ _D D M M Y Y Y Y

DATE OF BIRTH

CONCURRENCE OF FACULTY MENTOR IN IIT DELHI (OPTIONAL [see FAQ 2.10] / ONLY NEEDED IF YOU ALREADY HAVE A MENTOR'S CONSENT ‐ do not fill a name if you have not obtained a prior agreement in writing from the proposed Faculty Mentor):

PHOTO WITH WHITE BACKGROUND WEARING WHITE OR LIGHT COLORED CLOTHING (please write your

name on the back)

FIRST NAME MIDDLE NAME SURNAME

EARLY DECISION REGULAR DECISION

o Female?GENDER

Please send the completed application to: GIPEDI Program, FITT (Attn: Prof.Subrat Kar/Mr.K.K.Roy), IIT Delhi, Hauz Khas, New Delhi 110016 India


STATEMENT OF PURPOSE: If you need to include rich‐media or matter which cannot be enclosed as text such as video, images, audio please feel free to give a web link below where the media can be found. Please use a URL shortening service such as bitly.com or tinyurl.com.

I have more information which can be found at: http://



Statement of Project Abstracts / Work Experience (For each project, please give the title, team size, your role, scope of what you did, significance of what you did, approximate man‐days, any referee(s) and their contact email and phone) If you need to include rich‐media or matter which cannot be enclosed as text such as video, images, audio please feel free to give a web link below where the media can be found. Please use a URL shortening service such as bitly.com or tinyurl.com.




APPLICANT RECOMMENDATION FORM (please photocopy this blank form if you need more LoRs)

Tell us about yourself in the form of an essay about what you expect to achieve as an Intern (highlight anything special which you think will allow you to contribute to the community here at IIT Delhi ). If you need to include rich‐media or matter which cannot be enclosed as text such as video, images, audio please feel free to give a web link at the end where the media can be found. Please use a URL shortening service such as bitly.com or tinyurl.com.




(Area code)

(Area code)

For Respondent Use Only

Inadequate opportunity to observe

Below average Average Good Superior Out-standing

(FITT/IITD OFFICE to insert) the Handling # here :

Imagination / Original thought

Potential for success in chosen areaGrowth observed during period

OVERALL RATING

OVERALL RANKING Best student this year Best student in ……. Years Top …….% of students this year Unable to rank

Ability to work with others

Ability to work in multicultural environment

Leadership potential

Please evaluate the applicant by placing a check after each characteristic to be evaluated in the column that most nearly represents your opinion. Compare the applicant with a representative group of students qualified for graduate study to whom you have known and who have had approximately the same amount of experience and training as the applicant. If you lack knowledge to make a definite rating, give your estimate of applicant's ability and also check the column "Inadequate Opportunity to Observe."

Desired Area of Work:

Integrity

Creative or innovative talent

On what specific basis do you assign the particular rating given ?

Analytical Ability

Research Ability

Do you know the applicant personally (as a relative / friend etc) ?

No / Yes(specify how)

Phone number:

(please ensure that you print or photocopy both pages of this form on the two sides of the same sheet of paper, not on separate sheets)Please answer the following questions (no box should be left unfilled in this table as that will disqualify the recommendation ) :

Respondent Referee's Postal Address:

Respondent Referee's Name

Title (Prof. / Dr. / Mr. / Ms.)

Designation

Institution/Employer

Email address (ONLY OFFICIAL EMAIL ADDRESSES PLEASE)Phone # (with STD code)

Applicant Name:

Year / Discipline:

Ability to master academic work

Fundamental knowledge in field

Skill/originality of research work

Lab / hands-on skills

Research productivity (papers published/ talks given etc)Ability in oral expression

Ability to write

Motivation towards a career

Initiative

Emotional stability and maturity

Self-reliance and independence



As

Please answer the following:NO NO NO YES YES YES

Not Applicable Not recommended

Un-enthusiastically

Fairly strongly Strongly

Enthusiastically, without reservation

APPLICANT RECOMMENDATION FORM(please ensure that you print or photocopy both pages of this form on the two sides of the same sheet of paper, not on separate sheets)

What are the applicant's chief weaknesses, or areas for growth ?

What do you consider the applicant's most outstanding talents or characteristics?

Please type your name, understanding that it is legally equivalent to your signature (if this recommendation is sent by electronic means) and constitutes your certification that your responses and assessments are accurate and fair to the best of your knowledge.

Please add (by means of attachment, if needed) any comments that will assist in our making a judgment as to whether the applicant should be accepted to the Internship Program of IIT Delhi

Against which group are you rating the applicant ? For example, all under-graduate students I have taught in the past four years.

Other …………………………………………………………. As Departmental Head / Chair

How long have you known the applicant ? ………… years and………… months

As Research Advisor As Course Advisor As teacher (one course) As teacher (several courses)

(Name)(Line 1)(Line 2)(City) PINState:

PLEASE SIGN, SEAL SECURELY IN A ENVELOPE AND RETURN TO APPLICANT.The contents of this letter are CONFIDENTIAL and must NOT be shown to the Applicant.The letter must be filled in by the Referee in his / her own handwriting.The recommendation is only acceptable in this format ‐ a separate Letter on your Letterhead is not acceptable.Thank you for your time.

1) Would you accept this applicant to your internship program?2) If recommended, would you offer financial assistance if available?

Overall recommendation is:

Full Address of respondent (in capitals)

Signature of Respondent

Date

Place



(Area code)

(Area code)

For Respondent Use Only

Inadequate opportunity to observe

Below average Average Good Superior Out-standing

Growth observed during period

OVERALL RATING

OVERALL RANKING Best student this year Best student in ……. Years Top …….% of students this year Unable to rank

Leadership potential

Integrity

Creative or innovative talent

Imagination / Original thought

Potential for success in chosen area

Initiative

Emotional stability and maturity

Self-reliance and independence

Ability to work with others

Ability to work in multicultural environment

Lab / hands-on skills

Research productivity (papers published/ talks given etc)Ability in oral expression

Ability to write

Motivation towards a career

Analytical Ability

Research Ability

Ability to master academic work

Fundamental knowledge in field

Skill/originality of research work

Phone # (with STD code) Do you know the applicant personally (as a relative / friend etc) ?

No / Yes(specify how)

Respondent Referee's Postal Address:

Please evaluate the applicant by placing a check after each characteristic to be evaluated in the column that most nearly represents your opinion. Compare the applicant with a representative group of students qualified for graduate study to whom you have known and who have had approximately the same amount of experience and training as the applicant. If you lack knowledge to make a definite rating, give your estimate of applicant's ability and also check the column "Inadequate Opportunity to Observe."

On what specific basis do you assign the particular rating given ?

Designation Year / Discipline:

Institution/Employer Desired Area of Work:

Email address (ONLY OFFICIAL EMAIL ADDRESSES

Phone number:

Please answer the following questions (no box should be left unfilled in this table as that will disqualify the recommendation ) : Respondent Referee's Name (FITT/IITD OFFICE to insert) the Handling # here :

Title (Prof. / Dr. / Mr. / Ms.) Applicant Name:



As

Please answer the following:NO NO NO YES YES YES

Not Applicable Not recommended

Un-enthusiastically Fairly strongly Strongly

Enthusiastically, without reservation

Full Address of respondent (in capitals)

(Name)(Line 1)(Line 2)(City) PINState:

Signature of Respondent

Date

Place

PLEASE SIGN, SEAL SECURELY IN A ENVELOPE AND RETURN TO APPLICANT.The contents of this letter are CONFIDENTIAL and must NOT be shown to the Applicant.The letter must be filled in by the Referee in his / her own handwriting.The recommendation is only acceptable in this format ‐ a separate Letter on your Letterhead is not acceptable.Thank you for your time.

What do you consider the applicant's most outstanding talents or characteristics?

What are the applicant's chief weaknesses, or areas for growth ?

1) Would you accept this applicant to your internship program?2) If recommended, would you offer financial assistance if available?

Overall recommendation is:

Please add (by means of attachment, if needed) any comments that will assist in our making a judgment as to whether the applicant should be accepted to the Internship Program of IIT Delhi

Please type your name, understanding that it is legally equivalent to your signature (if this recommendation is sent by electronic means) and constitutes your certification that your responses and assessments are accurate and fair to the best of your knowledge.

………… months As teacher (one course) As teacher (several courses)

As Departmental Head / Chair

Other ………………………………………………………….

Against which group are you rating the applicant ? For example, all under-graduate students I have taught in the past four years.

How long have you known the applicant ? ………… years and As Research Advisor As Course Advisor



s


gipedi-application-part-a.pdf

Documents