Kotagiri Kranthi Bhushan has submitted an application form for admission to the MTech program in Electrical Engineering at IIT Kanpur for the 2012-2013 academic year. He obtained a GATE score of 665 in Electrical Engineering in 2012 and is currently in his final year pursuing a BTech in Electrical Engineering from JB Institute of Engineering and Technology, where he has maintained a grade average of 67.9%. If admitted, he will be a self-financed, full-time student under the general category.

1. INDIAN INSTITUTE OF TECHNOLOGY, KANPUR
Application Form For Admissions To Post Graduate 2012-2013
Date:28-MAR-2012
Reference No: IIT/2012-13-I/PG/4044
Application Date: 28-MAR-2012
Application Status: Submitted
1. General Information
Full Name KOTAGIRI KRANTHI BHUSHAN DOB 17-MAR-1991
Place of Birth BICHKUNDA Sex Male Marital Status Single
Father's Name KOTAGIRI VED BHUSHAN Nationality Indian
Address for Corres. H.NO:2-41
NEAR CHAVADI
BICHKUNDA
NIZAMABAD State A.P. PinCode 503306
E-Mail kranthibhushan211@gmail.com Phone 08464275741 Mobile 9494713473
2. Demand Draft Details
DD No. 828670 Amount Rs. 200.0 DD Date 28-MAR-2012
Issued by Bank Name STATE BANK OF INDIA Branch Code 11744
3. Student Category and Course Details
Department Electrical Engg. Admission for Degree MTech Student Status Full Time
Financial Status Self Financed Category General Phy. Handicapped No
Areas of specialization in the Department/Programme
Pref. 1. Power and Control Pref. 2. Microelectronics, VLSI and Display Technology
Pref. 3. Pref. 4.
4. Academic Record/Work Experience
A. GATE,ICMR-JRF,DBT-JRF,CEED,CSIR,UGC-JRF,Other Fellowship Details
Exam Name Exam Discipline Score Rank Exam Year
GATE Electrical Engg. 665.0 644 2012
B. Qualifying Degree already obtained or in Progress
University Name Uni Address 1 Uni Address 2 Rank in University Total Student in Uni
JNTUH HYDERABAD NA NA
Institute Code Institute Name Place Rank in Institute
AP133 J. B. Instituteof Engineering and NA
Technology, Moinabad
Degree Discipline Final Result expected Min. Pass Marks Max. Marks
by
B.Tech. ELECTRICAL ENGINEERING 2012 40.0 100.0
% Marks or Grade Sem. I Sem. II Sem. III Sem. IV Overall/Current
Average 67.4 63.7 73.2 72.6 grade average
Sem. V Sem. VI Sem. VII Sem. VIII 67.9
60.2 70.4 0.0 0.0

2. C. Other Degrees Obtained after 10+2(Do not include the degree listed in 4B)
Degree Discipline University Name & Address Institute Name & Address Marks or Completio
CPI n Year
D. Working Experiences
Duration Employer Position Nature of work
E. Number of Technical Papers(Provide details separately)
Papers Published in Journals 0 Presented in Conference 0
5. Names and addresses of two referees from whom letters of reference have been obtaioned(For Ph.D Only)
1. 2.
Address: Address:
Email: Email:
Declaration by the Applicant
Certified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any wilful misrepresentation of facts
will result in my dismissal from the institute. If admitted, I shall abide by all the rules and regulations of the institute.
Date: Signature:
Checklist (Send Only Attested Copies(Not Original) and mention reference no. on each of the document)
1. Date of Birth (DOB) Certificate or High School (Class Ten) Certificate with 2. SC/ST/OBC Certificate if applicable
DOB(Required for all Candidates)
3. Certificate of Physical Status (Type of disability to be attached) 4. Sponsorship Certificate for Sponsored Candidate
5. GATE/CSIR/UGC Score card 6. Copies of marks/grade sheets
7. The application fee of Rs.200/ for candidates in General/OBC/PD and Rs.100/ 8. Printed copy of Pdf file of your Application Form (If photograph is not
for SC/ST must be paid through demand draft payable to The Registrar IIT loaded, then write reference no at back of self attested passport size photograph
Kanpur at Kanpur.(Note: Send original copy not attested copy) and paste it.).
9. No Objection/relieving Certificate from Employer (For employed candidates) 10. Two letters of reference (For Ph.D. applicants only)
Mailing Address for Applications:
The Convenor, DPGC
Department/Programme of _________________________
(Kindly mentioned the Department name where you are seeking your admission)
Indian Institute of Technology, Kanpur
Kanpur-208016 U.P.