Application No: CYD302393

INDIAN INSTITUTE OF TECHNOLOGY ROORKEE

APPLICATION FOR ADMISSION TO Ph.D. PROGRAMMES
FOR AUTUMN SEMESTER 2012-13
1. Separate Application should be used for each Department/Centre. 2. Enclose attested copies of all certificates with this Application. Bring original certificates at the time of Interview/Test and Admission. 3. Giving false information will lead to cancellation of Admission. 4. Application incomplete in any respect, is liable to be rejected. 5. Candidates who are in the final year of their qualifying examination can be considered for admission only if they complete the requirement of their final examination including VivaVoce before the registration date.

A Passport Size Photograph should be pasted in this space

Name of Department/Centre in which admission is sought : CYD - Chemistry

Details of Fee Paid :

Proposed Status: If PART TIME

Challan Transection ID. M352443 Dated 22-Mar-2012 Amount 200 Branch Name 3093 hauz khas Full Time : No : No : No

a) Whether working in a project at IIT Roorkee? b) Are you an employee of IIT Roorkee? c) Are you working in a Org./Univ./Inst. Approved by IIT Roorkee as Research Centre?

NAME : vartika dhyani Gender : Female Nationality : Indian Fathers Name : sohan lal dhyani Mothers Name : rekha dhyani Address for Correspondence : saikripa, 14-bigha, muni-ki-reti, rishikesh, tehri garhwal Pin Code : 249201 Mobile No. : 8802546095 Fax No. : Category :GEN Telephone No.: 01352434478 e-mail address : dhyaanchand@gmail.com Person with disability (PD) : No Date of Birth : 11-Apr-1989

ACADEMIC RECORD
Details of marks/grades secured in the examinations passed. Exam Passed 10th Standard Duration Subjects Institute/Universit Year of Passing 2004 Marks Obtained 466.00 Max % of Marks Marks 600.00 77.67

1 yr

12th Standard

2 yr

B.Sc M.Sc

3 yr 2 yr

eng , hindi,maths, sst ,science, economics, eng, hindi,physics, chemistry, biology ZBC chemistry

osn rishikesh

osn rishikesh

2006

369.00

500.00

73.80

hnb garhwal university hnb garhwal university

2009 2011

1,344.00 1,800.00 783.00 1,200.00 0.00 0.00

74.60 65.25 0.00

Details of Marks/ Grade Point Average secured in the Qualifying Degree Examinations

Name of the qualifying Degree Programme: M.Sc Discipline/ Specialization: chemistry Whether qualifying degree examination Passed: Yes Year of passing: 2011 Name of the University/Institute: hnb garhwal university
Semester/Year Fourth Marks/CGPA Obtained Max Marks/Scale Semester/Yearly System

783.000

1200.000

Year System

GPA/ CGPA / Marks Obtained 783.000 Out of 1200.000 point scale/Max.Marks Medium of Instruction at Qualifying Examination level : English Relevant National Level examination qualified : CSIR/UGC NET Year appeared csir net dec 2011 Valid Upto feb 2014 GATE / Other score 92.00 Discipline Chosen in GATE/NET/CEED: chemical sciences Awards and Scholarships, if any : ugc jrf

Any other relevant information which you want to furnish : Research Experience Years 0 No. of papers published 0 Teaching Experience (UG/PG Level) Years 0, 0 (Attach list giving details) Professional Experience Years 0 Whether you were a student at IIT Roorkee previously and discontinued studies? No If Yes, give particulars of the Name of Academic Programme & Department , Year(s) and the reasons for discontinuing the programme :

Proposed Broad Area of Research :chemistry Give Sub-Areas of Proposed research priority wise : 1. organometallics chemistry 2. coordination compounds 3. bioinorganic chemistry 4. paragraph on how your qualifications/ experience etc. are relevant to the proposed field of your research The ensuing statement of purpose is meant to put forth my aspiration to pursue my career through research in chemistry at this esteemed institute, as well as description of plans subsequent to my masters. I want to attain the highest level of education and transcend new scope for research in organometallics, coordination and bio inorganic. Organometallics has always fascinated me and I am keen to continue my academic pursuit in this field. I have always cherished a dream to become a researcher. organometallics is emerging field and has vast application in industry especially in production of polyethylene, acetic acid, polymers, alcohols etc. nowadays it is also used in medicines to cure various disease. Overall I can say that research in organometallics would be very fruitful to man kind and would be of high impact factor. Employment Record : Organisation Post From To Duration Pay Scale Nature of Duties Presently Working

Employed candidates seeking admission as full time / part time / sponsored category must submit Application through their employer on the proforma given below. NO OBJECTION / SPONSORSHIP CERTIFICATE (Required from Full Time / Part Time / Sponsored candidates only)

The undersigned is pleased to sponsor Mr./ Ms. vartika dhyani who is working in this organisation for the last ....................... years and is presently holding the rank/ position of .............................................. for pursuing Ph .D. programme in the Department of ................................................................................................................ with

specialisation in the following areas 1. .................................................... 2. .................................................... 3. .................................................... His/ Her conduct and character is good. The Institution/ Organisation would allow/relieve him/her immediately for joining the above course, if selected for admission. The Institution/ Organisation also agrees to PAY/ NOT PAY the contingent/ all expenses stipulated by the Institute. This is further certified that the sponsorship for admission will not be withdrawn midway till completion of the Ph .D. programme.

Place : ............................................. Date : ..............................................

Signature of the Head of the Institution/ Organisation with seal Name .......................................................................... Designation .....................................................................

UNDERTAKING
I, vartika dhyani S/o, /D/o
sohan lal dhyani hereby undertake to abide by rules and regulations in vogue from

time to time, and shall not indulge in any act of indiscipline. The factual information given by me are correct .If at any time the information provided by me is found to be incorrect, my admission be cancelled.

Date: ................................

Signature of Candidate

Check List
i) Attested copies of the qualifying degree/ certificate and marks sheet showing the required % of marks/CGPA. ii) Proof from the University/Head of the Institution of having appeared/passed in the qualifying Degree Exam. iii) Attested Copy of GATE Score Card and its Admit Card /Equivalent National Test certificate. iv) Attested Copy of SC/ST/OBC/PD certificate. v) Certificates pertaining to No Objection/ Sponsorship on the proforma of the Application Form.

Note : Original Certificates will be required for verification on at the time of registration by the Institute.