Application Form For SURGE 2018 For NON IITK Indian Students

Full Name:
Gender:
Guardian's Full Name: 
Date of Birth
(As per official records ):
PRESENT ADDRESS PERMANENT ADDRESS*: Same as Address for Present Mailing
Address (Click if applicable)
Address 1: 
Address 1: 
Address 2: 
Address 2:
City: 
City: 
State: 
State: 
Pincode: 
Pincode: 
Country: 
Country: 
PROGRAM CATEGORY
Please consider my application in categories mentioned below (more than one option can be chosen)
Institute Funded
Self Funded
Project Funded
CONTACT DETAILS EMERGENCY CONTACT DETAILS
Cell No: +91
Name: 
Phone No: +91
Phone No:
Email Id: 
Email Id: 
AFFILIATED ENROLLMENT DETAILS SUGGESTED FIELD of RESEARCH @ IIT KANPUR
Name of the Institute: 
Department: 
Program of Study: 
Cumulative Performance Index
(CPI): 
OR PERCENTAGE
Year of Study:
Sub-Topic
Within the department you are applying at IITK, please indicate which sub-topic you would like to work in. For Example; if you are applying Electrical Engineering, your subtopic could be "Power & Control".
Department at Non-IITK::
Sub-Topic One
Sub-Topic Two
RECOMMENDER ONE RECOMMENDER TWO
*(People familiar with your academic work from your institution only)
Name: 
Name: 
Contact No: 
Contact No: 
Email: 
Email: 
Designation: 
Designation: 
Recommendation Letter: 
(Letter should be in pdf format)
Recommendation Letter: 
(Letter should be in pdf format)
* Scanned copy of Two signed recommendation letters from Professors of your institute as per the format given in the attached link. Recommendation Letter
Upload passport size recent photograph (Photo should be in jpg format)
* Maximum File Size allowed : 1 MB
So, please check the size of image before uploading.
 

(* Maximum File Size allowed : 3 MB)

PROPOSED RESEARCH (A one page document not exceeding 500 words detailing what broad area you want to work, and a specific research problem that you want to undertake in 8 weeks. Note that depending on the interest of your mentor, you may end up working on a different problem.)In case you are a MTech student please upload title and synopsis of your thesis.

Marks/TRANSCRIPTS(scanned or soft copy)*Current

Upload PDF
APPLICATION FEE: Non-Refundable amount of 100 Rs. is required as application Fees.
Verification code:*
STUDENT DECLARATION:

I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. In the event of the information being found false or incorrect or any ineligibility being detected before or after the selection, my candidature is liable to be cancelled and action initiated against me.