Application Form

Application ID:IGIDR/IDRC303 Name of Program Applying for:*
M.Phil M.Sc

1Personal Details------------------------------------------------------------------------------------ Name (Full-Name)* Date of Birth* Gender:*
Place of Birth* Marital Status:
Married Unmarried
Are you a Person with Disability:
Yes No

Type of Disability* Percentage of Disability*

Nationality* Upload Your Photo:
2Passport Details------------------------------------------------------------------------------------ Passport Number Issued by: Issued on: Valid till: 3Contact Details------------------------------------------------------------------------------------- Skype ID: Address for Correspondence:

Same as Address for Correspondence (Click if applicable)
Permanent Address:

Mobile Number with Country Code: Alternative Number:
(Mobile No/Telephone No.) Email ID* 4Educational History:*--------------------------------------------------------------------------------- Highest Degree Obtained: Discipline at Graduate level Discipline at Post-Graduate level

Qualification	Examination /Board/Degree	Passing Year	Institution /University Name	Period (From - To) Ex.2005-07	Subjects (Main & Ancillary)	% in aggregate & division	Rank, if any
Class X
Class XII
Graduation - First Year
Graduation - Second Year
Graduation - Third Year
Graduation - Fourth Year(If any)
Graduation - Fifth Year(If any)

Have you studied mathematics at the higher secondary or higher level? * Yes No

Provide details of Examinations appeared, if any:

Examination	Registration Number	Percentile	Month/Year
GATE
GRE
GMAT
TOEFL

Academic Awards (if Any)

Work Research Experience
Yes No

If Yes, provide details, accounting breaks, if any:

Sr. No	From(DD/MM/YY)	To(DD/MM/YY)	Job Profile	Name of Employer	Last Salary Drawn
1
2
3

Have you published or presented an academic paper in any National/International Conference/ Journal: * Yes No

If yes, attach ONE paper that you consider to be the best. Where did you see the advertisement?
5Background Information------------------------------------------------------------------------------------------- Parent's Information*

Information	Father	Mother	Spouse(If Applicable)
Name
Educational Qualification
Occupation
Designation
Name and Place of Organization

Name and address with phone number and email of two academic referees who should have taught you. (Only Candidates short-listed for the skype interview are required to furnish two Referee Reports. The format for the Referee Report will be sent to the shorted listed candidates)

Information	Referee 1	Referee 2
Name
Designation
Address
Tel. no.
Mobile
Email

Write your "Statement of Purpose" in not more than 200 words indicating why you want to join the M.Sc./M.Phil. Programme at the IGIDR and what your future academic/research plans are: *

Any other information that you think will help us to better assess your performance and potential:

Declaration:
I hereby certify that the statements made by me above are, to the best of my knowledge, true, correct, and complete. I understand that any incorrect information or material omission on my part renders me liable to termination without any notice or compensation.
Name of Applicant: