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ADMISSION GUIDELINES Student admission All students provisionally offered admission at IIT Palakkad should report at the Academic Building, IIT Palakkad on Thursday July 28, 2016. Students are required to bring all necessary original certificates and documents. Registration and confirmation of admission will be done from 9.30 am to 5.00 pm on July 28, 2016. It is important that students reach IIT Palakkad within the time slot given, so that admission process can be completed without difficulty. The location of the temporary campus of IIT Palakkad and directions to reach are given in General Information page.

If a student cannot report in person, he/she may authorize his/her parent/guardian to complete the registration on his/her behalf. It is important that the parent/guardian carries the authorization letter. If a student fails to register, it will be presumed that he/she is NOT interested in joining IIT Palakkad. Documents to be submitted Students are required to submit the original and two copies of the following documents/ certificates. 1) Provisional Admission letter. 2) Original Admit card of JEE (Advanced) 2016. 3) Original certificate of date of birth. 4) Original certificates of Class 10 and Class 12. 5) Students belonging to SC/ST/OBC-NCL or PD category, the category and/or PD certificate as

per the format in the JOSAA portal. 6) Aadhar Card 7) Duly filled Medical examination forms (Annexures III and IV). 8) Proof of payment of Institute and Hostel fees (printout of the receipt from online portal). 9) Letter of Declaration, Undertaking and Bio-data (forms will be provided during registration). 10) Two recent passport size colour photographs. Fees to be paid All fees should be paid online only. Demand drafts/cheques will not be accepted. The Link for online payment is: https://www.onlinesbi.com/prelogin/icollecthome.htm?corpID=644327 Students can pay fee online from 19.07.2016. Fees should be paid before the students arrive for registration. As a proof of payment, a printout of the receipt (remittance form) should be submitted at the time of registration. Excess amount will be refunded to those if the advance fee paid (at the reporting centre) is more than what is given in Annexure I (Split-up of fees). Students need to enter the JEE (Advanced) Roll No in the portal for online fee payment. All other details including the fee to be paid will appear automatically. A help file and a FAQ file for online fee payment is given in the IIT Palakkad website and students are advised to read them before making the payment. Summary of the fees for different student categories is given below.

Institute fees per semester

Particulars Hostellers Day Scholars GE/BC-NCL SC/ST/PD GE/BC-NCL SC/ST/PD

Amount to be paid 69350 --- 68600 --- Amount to be refunded --- 5650 --- 6400

Hostel fees and mess charges per semester

Particulars Hostellers Day Scholars GE/BC-NCL SC/ST/PD GE/BC-NCL SC/ST/PD

Amount to be paid 23150 23150 --- ---

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Orientation There will be an orientation programme at 10.30 am on Friday July 29, 2016 at the institute Auditorium. It is necessary that all registered students attend the orientation program. Details of the programme will be given during admission. Students are required to assemble at the venue by 10.00 am. English proficiency test The medium of instruction is in English. In order to assess if the students have sufficient background in English language, an English proficiency test will be conducted on Saturday, July 30, 2016. All students admitted to IIT Palakkad are required to take the test. English language improvement classes will be arranged for those who fail to clear the test. Commencement of Classes Classes will commence on Monday, August 01, 2016. The timetable and the academic calendar can be downloaded from the IIT Palakkad website. Other useful information The weather at Palakkad is generally pleasant. The monsoon season starts in June and lasts till the end of August. It rains intermittently during this period and therefore it is good to have umbrella/raincoats. During monsoon, weather is cooler but there is no need for winter clothing. The weather is hot in March to May and the temperature can reach above 35°C. List of Enclosures 1. General information. 2. Hostel rules and regulations. 3. Annexure I: Split-up of fee structure. 4. Annexure II: Estimate of the expenses for four years. 5. Annexure III: Declaration of medical history. 6. Annexure IV: Health certificate. 7. Annexure V: Partial list of hotels at Palakkad.

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GENERAL INFORMATION Introduction IIT Palakkad, established in 2015, is dedicated to creating an environment wherein students and faculty can dream, think and innovate to craft a better future for the world. IIT Palakkad is one of the new IITs being mentored by IIT Madras. It is currently functioning from a temporary campus, located about 25 km from the Palakkad railway station. With a fully functional academic setting including well-equipped laboratories, class rooms and computing facilities, modern hostels for girls and boys, and sports and fitness amenities, the temporary campus is ideally setup for the bright young minds of our country. A vibrant permanent campus with world-class sustainable green buildings is expected to be ready in a couple of years, occupying 500 acres of land bordering the Sahya mountain range and adjacent to the Coimbatore-Kanyakumari national highway. Location of the Temporary Campus The Temporary campus of IIT Palakkad is located in the Ahalia health, heritage and knowledge village campus, Kozhipara, Palakkad. The Ahalia campus is spread over a wide area; IIT Palakkad is situated about 2 km from the Ahalia campus entrance. Signboards have been placed at suitable points within the campus to provide easy guidance.

Connectivity By Air The closest major airport is at Coimbatore and is located about 45 km from the Ahalia campus. Pre-Paid taxis can be hired to reach Ahalia campus.

By Train The easiest way to reach Palakkad, the nearest town, is by train. Palakkad Junction is well connected to almost all parts of India. Travelling by train to Palakkad junction is also the most economical way of reaching IIT Palakkad. The Ahalia campus is about 20 km from Palakkad Junction. It is convenient to hire a taxi or take a pre-paid auto from Palakkad Junction to reach the Ahalia campus.

By Road The nearest bus stand is the Palakkad Municipal Bus Stand, at Palakkad. It is well connected to major cities in Kerala and Tamil Nadu by highways. The Ahalia campus is about 25 km from the bus stand and taxis can be hired to reach the Ahalia campus. The nearest bus stand is the Palakkad Municipal Bus Stand, at Palakkad. It is well connected to major cities in Kerala and Tamil Nadu by Highways. Ahalia campus is about 25 km from the bus stand and taxis can be hired to reach Ahalia campus.

Shuttle Service Free shuttle will be available every one hour, starting from 9.00 am, outside Palakkad Railway Station on July 28, 2016. The shuttle will run between Palakkad railway junction and IIT Palakkad academic block/hostel. Academics IIT Palakkad offers a B.Tech Programme in four branches: Civil Engineering, Computer Science and Engineering, Electrical Engineering and Mechanical Engineering. The yearly intake is about 120 students, equally distributed in all four branches. The young and energetic faculty of IIT Palakkad is joined by experienced academics from IIT Madras and eminent scientists from national scientific organizations to provide a high quality academic experience. In addition, teaching assistants are assigned to every course to help the faculty during tutorial hours and additional interactive sessions slotted in the evenings. Currently, the curriculum is set by an academic council consisting of senior professors from IIT Madras and is based on the 2014 curriculum of IIT Madras. Students can refer to the file on B.Tech Ordnances and Regulations downloadable from IIT Palakkad website. B.Tech Ordinances and Regulations of IIT Madras are followed in IIT Palakkad.

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Grading Policy IIT Palakkad has a grading policy based on continuous assessment. Grades are awarded on a 10 point scale denoted S, A, B, C, D, E and U, with E being the minimum grade to pass a subject. The respective credits are 10, 9, 8, 7, 6, 4 and 0. Academic performance at the end of the first semester is quantified by a Grade Point Average (abbreviated GPA), which is a weighted average of the grades obtained in courses that are completed successfully. From the second semester onwards, a Cumulative grade point average (CGPA), which is a weighted average of the grades secured in all semesters, is given in addition. Branch Change IIT Palakkad allows students to change their branch based on their academic performance during their first semester. The change comes into effect at the end of their first year. The main criterion for change of branch, apart from academic performance, is the restriction on students strength. Students can refer to the file on B.Tech Ordnances and Regulations for further details. Scholarships Merit-Cum-Means scholarships, Institute free studentships and Scholarships for SC/ST are available to the students of IIT Palakkad, as per the Government of India norms. The details are given in the following three tables. Students who wish to avail these scholarships should submit the duly filled relevant forms (downloadable from IIT Palakkad website) within two weeks of joining. SC/ST Scholarship: SC/ST scholarship awarded to SC/ST students whose parental income less than Rs.4.5 Lakhs per annum Eligibility Parental Annual Income ≤ Rs.4.5 Lakhs (renewal every semester –

subject to a minimum GPA of 5 in the passed subjects). Tuition Fees Exemption from the payment of tuition fees. Mess Charges Free Messing – Basic Menu Pocket Allowance Rs.250/- per month Hostel Seat Rent Waiver

Institute Merit-cum-Means (MCM) Scholarship: MCM scholarship are awarded to 25% of the admitted students of GE/BC-NCL students Eligibility Parental Annual Income ≤ Rs.4.5 Lakhs (renewal every semester –

subject to a minimum GPA of 5 in the passed subjects). Tuition Fees Exemption from the payment of tuition fees. Allowance Rs.1000/- per month

Institute Free Studentship:

Vidhyalakshmi Educational Loan IIT Palakkad will be entering into an MOU with banks to provide interest free educational loans to students whose parental income is less than Nine Lakhs per annum. The loan under this scheme covers only the Tuition fee payable by the student as per his/her eligibility and is subject to the satisfactory performance of the student in the institute.

Free studentship: Beyond 25% limit, for further 10% of the admitted GE/BC-NCL students Eligibility Parental Annual Income ≤ Rs.4.5 Lakhs (renewal every semester –

subject to a minimum GPA of 5 in the passed subjects). Tuition Fees Exemption from the payment of tuition fees, irrespective of parental

income and performance.

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Bank Account and Educational Loan All residents must open a bank account. Arrangements have already been made for this purpose with State Bank of India (SBI) and Canara Bank. A Canara bank branch situated about 100 yards from the Academic building. These two banks will have a kiosk at the ground floor of the dining hall for a few days starting from July 28, 2016. Students can open a zero bank balance account. They can also avail educational loan. For the latter purpose, an estimate of the expenses for the four years is given in Annexure II, which the students can use while approaching the banks for loan. Further information is available at the IIT Palakkad website. Facilities: IIT Palakkad has a central library with a barcode based book-borrowing system. Apart from text and reference books, the library has a collection of magazines and newspapers. Provision is available for Internet access from within the library. The institute has a well-equipped computer room where access to ebooks and course materials is provided through moodle. The computer room and library are accessible from 8 am till midnight on weekdays. The institute has several classrooms and an auditorium, all of which are equipped with WiFi enabled state of the art multimedia facilities. All student laboratories are well established and have the latest equipment. In addition, there is an innovation center with several facilities including a 3D printer, CNC machines and other equipment where students can spend their time to transform their ideas into reality.

The sports facilities currently available include table tennis, volleyball and basketball courts. Coaches are available for football and cricket. The serene atmosphere of the Ahalia campus is ideal for cross-country running. Health Care All students are covered under a group medical insurance scheme. In addition, IIT Palakkad has access to the good health and emergency care facilities available in the Ahalia integrated campus. The medical facilities include a general hospital with a diabetes research centre, an eye hospital, a children and women’s hospital, an ayurvedic hospital and a traditional rejuvenation centre. When there is a need, referrals are made to hospitals at Palakkad and Coimbatore.

Medical Check-Up All students are advised to undergo medical check-ups and a certificate of the same, in a prescribed format (see annexure III and IV), should be brought during admission. Accommodation IIT Palakkad is fully residential with separate hostels for girls and boys. All students selected for IIT Palakkad will be provided accommodation in IIT Palakkad hostels on twin-sharing basis. The hostel buildings and the academic building are within a radius of three hundred meters. Almost all the rooms are bath-attached. The hostels have a spacious dining hall and a well-equipped recreational area, an indoor games area and a fitness centre. The common space in the hostel is WiFi enabled. Other amenities provided include a Reverse Osmosis based drinking water system and a heavy duty washing machine in each floor of the hostels.

Accommodation for students will be available from July 28, 2016. Only students can stay in the hostels. For the stay of parents and other accompanying people, a list of hotels in and around Palakkad is given in Annexure V. Hostel Rules and Regulations Hostel rules and regulations are given along with this document. All students are required to submit a duly filled Bio-data form and an Undertaking at the time of admission. The forms will be given at the time of admission.

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INDIAN INSTITUTE OF TECHNOLOGY PALAKAD HOSTEL RULES AND REGULATIONS

Hostel accommodation Indian Institute of Technology Palakkad is a fully residential institute and all registered students are required to reside in the hostels. There are separate hostels for boys and girls with amenities such as common room, indoor games room and a spacious dining area. All the rooms in the hostels have attached bathrooms. Each room will be shared by two students and is furnished with cots, tables, chairs and cupboards, tube lights, ceiling fan and electrical sockets for using laptops and charging cell phones. Students are advised to bring a pad-lock for a cupboard, mattress, bed-sheets, pillow, buckets, mugs, scientific calculator, umbrella/raincoat, etc. Allotment Conditions Resident should submit a duly filled personal data form to the hostel office every year at the time of admission to hostel. The hostel office should be immediately intimated as and when any change occurs in the details provided in the personal data form. Rooms once allotted to the students for an academic year will not be changed except on special situations. Those who wish to seek exemption from residing in the hostel will have to make specific application separately for every semester, in the prescribed form available at the hostel office. Lock and Key Every hostel room has a lock and each of the two occupants will be given a key, at the time of admission. If the residents of a room choose to have their own lock, they are free to do so. However, they should surrender the lock and keys given to them to the hostel office. In the event of loss of key, the hostel office should be immediately intimated. In any case, the resident should not break open the lock. Timings All residents are required to be back in the hostels by 7.00 pm. If any resident wishes to be away from the hostel during weekend, holidays or any other time, he/she should take prior permission from the hostel authorities. Use of vehicles Use of powered vehicles (two wheelers and cars) is prohibited. Powered vehicles brought to the hostels will be confiscated. Residents are encouraged to use bicycles. Bicycles should be parked only in the space provided for cycle parking in an orderly fashion, both at the academic and in the hostel premises. Use of appliances The power handling capacities of the electrical systems in hostels are limited. Therefore overloading can result in tripping of main power supply. Overloading can also lead to fire accidents. Usage of Iron press, hot plates, heaters, immersion-heating rods, induction stoves, and similar cooking appliances are prohibited inside the hostel room. Cooking is not allowed in the hostels. Use of desk lamps, computers and small audio systems are permitted, provided the combined power requirement does not exceed the electrical socket specification. Maintenance and upkeep It is the responsibility of the inmates of the room to keep the room neat and clean. Lack of cleanliness will attract fine. Maintenance of hostel property is the collective responsibility of the residents of the hostel. If a room is damaged or its furnishings are damaged/lost, the residents are financially responsible. Deliberate destruction of the hostel property will attract penalty ranging from fine to expulsion from the hostel.

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Alterations The residents are not allowed to move any furniture from its pre-allotted place. Decoration of the rooms like curtaining the windows is encouraged. However, painting/scribbling on the walls, doors and windowpanes are not allowed. When the resident moves out, the room must be returned in the state in which it was allotted to the resident. Noise Levels Every resident of the hostel has the right to a quiet and peaceful atmosphere. From10.00 pm to 6.00 am, the level of noise from the actions of a resident should be sufficiently low so that the activities of the fellow residents are not disturbed. The rest of the time the noise level should not be a nuisance to other fellow residents. Smoking and Drinking Alcohol Smoking, consumption of alcohol and use of narcotic drugs or any other intoxicant is strictly prohibited. Entering the hostel premises in intoxicated/inebriated state is disallowed and any violation will attract severe penalty including expulsion from the hostel. Ragging Ragging is banned and it is a punishable offence. Ragging incidences will be reported to the local police station and action will be taken as per the law prevailing in the State. The punishment may include expulsion from the institute. Resident Property The residents are responsible for the safekeeping of their personal belongings. They are advised to keep under lock all valuable items such as, Jewelry, Laptops, Mobile phone, etc. They should lock their rooms when not present even for a short time. Residents should take prior permission from the hostel authorities before taking any belongings out of the hostel. Hostel office cannot assume responsibility for the loss/damage of residents' property. Hostel Activities Overnight stay of the residents in a room not allotted to them is not permitted. All residents should be conscious of the environment and should not litter indiscriminately. They should use the trashcans to dispose of waste. Residents should not arrange any picnic outside without specific permission of the hostel authorities. Residents should not arrange any function or meeting within the hostel premises, within the institute campus or outside without specific permission of the hostel authorities. Residents should not indulge in antisocial, antinational or any other undesirable activities within or outside the hostel zone. Such activities attract severe penalty.

Guests and Visitors In hostels, everyone except the residents is considered as guest by definition. Guests can be permitted only if prior permission is obtained from hostel authorities. Subject to availability, guest rooms may be allotted to guests on payment of required charges. Parents/guardians of the students, however may be permitted by the hostel authorities to visit the room of their ward during the visiting hour, namely 7.00 am to 10.00 pm. All visitors should inform the hostel authorities the purpose of visit and the duration of their stay. Their visit is restricted to the hostel office/lounge. Guests and visitors are not allowed to stay overnight and should leave by 10.00 pm.

Visit of boy students of IIT Palakkad to the Girl’s hostel is restricted to the lounge. Girl students of IIT Palakkad can visit boys hostel for academic purposes. Entry should be with the information to the hostel authorities and is restricted to 10.00 pm.

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ID cards All students should carry their identity cards issued by the institute. Entry to the dining hall is on production of identity cards. Dining The dining timings are as follows

Particulars Timings

Institute working days Weekends/holidays Breakfast 07:00 to 09:00 08:00 to 10:00 Lunch 12:00 to 14:00 12:30 to 14:30 Evening Tea and Snacks 17:00 to 18:00 17:00 to 18:00 Dinner 19:00 to 21:00 19:00 to 21:00

Residents should adhere to the timings and should have food only at the dining hall. No utensil from the dining hall should be taken out. Mess rebate will be considered only when a resident is away on academic/medical grounds for more than three consecutive days with prior approval from the concerned department and hostel office. In addition, the residents should ensure that at least 24 hours prior notice is given in writing to the dining hall supervisor. Rights of Hostel management Any breach of the rules mentioned above will invite an enquiry that will be conducted by the hostel management. If a resident is found guilty, then the hostel management will take disciplinary action that it deems fit. Depending on the case, the management reserves the right to take direct disciplinary action, amounting to expulsion at short notice from the hostel. The hostel management reserves the right to visit and inspect any hostel room at any time without prior intimation. The hostel management reserves the right to completely or partially withdraw the facilities extended to the students. The hostel management reserves its right to change these rules from time to time keeping the students informed through general circulars displayed on the hostel notice boards.

ANNEXUREI

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INDIAN INSTITUTE OF TECHNOLOGY PALAKKAD Fees for students admitted in the academic year 2016-17

Sl. No Items Amount

(Rs.) I. INSTITUTE FEES

A. One time fees 1 Admission fee 150 2 Grade card/Thesis fee 150 3 Provisional certificate 100 4 Medical Exam fee 100 5 Student welfare fund 500 6 Modernization fee 300 7 Alumni Life Membership Fee (NS) 1000 8 Publication fee (NS) 250

Total A 2550 B. Semester fees 1 Tuition fee1 100000 2 Examination fee 350 3 Registration-Enrolment fee 200 4 Gymkhana fee 1000 5 Medical fee 300 6 Hostel Seat Rent2 5000 7 Electricity and Water Charges2 750 8 Student Wellness fee 100 9 Medical Insurance Premium3 1100

Total B 108800 C. Deposits (Refundable) 1 Institute Deposit 1000 2 Library Deposit 1000

Total C 2000 Fees for GE and OBC-NCL students

1 For Hostellers (Rs. 69350)

Grand Total (A+B+C) 113350 Advance fee paid4

44000

Amount Payable 69350

2 For Day Scholars (Rs. 68600)

Grand Total (A+B+C −B6 −B7+II3) 112600 Advance fee paid4

44000

Amount Payable 68600 Fees for SC5/ST5/PD students

1 For Hostellers (Rs. 5650 will be refunded)

Grand Total (A+B+C –B1) 13350 Advance fee paid4 19000

Amount Refundable −5650

2 For Day Scholars (Rs. 6400 will be refunded)

Grand Total (A+B+C−B1−B6−B7+II3) 12600 Advance fee paid4 19000

Amount Refundable −6400 Fees should be paid through online only. Please see IIT Palakkad website for details.

ANNEXUREI

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Link for online payment: https://www.onlinesbi.com/prelogin/icollecthome.htm?corpID=644327 Students can pay fees online from 19.07.2016. Fees should be paid before studentsarriveforregistration. Students are advised to read the help file (downloadable from IIT Palakkad website) before making payment. Note: NS - Non Statutory fee. 1-

a) The SC/ST/PH students shall get complete tuition fee waiver. b) The most economically backward students (whose family income is less than Rs.1 lakh per annum) shall

get full remission of the tuition fee. c) The other economically backward students (whose family income is between Rs.1 lakh to Rs.5 lakh per

annum) shall get remission of 2/3rd of the tuition fee. d) All students shall have access to interest free loan under Vidyalaxmi scheme for the total portion of the

tuition fee payable. 2- For Hostellers only. 3- Projected figure based on previous year. Subject to revision. 4- Rs. 1,000/- deducted towards processing fee at the reporting centre.

II. HOSTEL FEES & MESS CHARGES PER SEMESTER For GE/OBC-NCL/SC/ST/PD students

1 Hostel Admission fee 100 2 Hostel Deposit (NS) – (refundable) 3000 3 Establishment A Charges 5000 4 Establishment B Charges 1000 5 SWD Charges 50 6 Advance Dining Charges5 14000

Total 23150 Fees should be paid only through online. Please see IIT Palakkad website for details.

ANNEXUREII

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INDIAN INSTITUTE OF TECHNOLOGY PALAKKAD

Statement of Expenditure for the B.Tech Programme The following statement of expenditure is issued to facilitate/avail Bank loan/Scholarship. Fees and other charges/expenditures are for the students to be admitted in the academic year 2105-2016. Sl. No Particulars Value in Rs. 1 Admission/Ist semester fee (including insurance) 1,11,350 2 Caution deposit (Institute and Library) 2,000 3 Semester fees payable from IInd to VIIIth semester @ Rs. 1,07,700 x 7 7,53,900 4 Annual Medical insurance premium for 3 years (@ Rs. 1100/- per year)* 3,300 5 Hostel deposit 3,000 6 Hostel admission fee for eight semesters (@ Rs. 100/- per semester) 800 7 Hostel establishment “A” charges for eight semesters (@ Rs. 5000/- per

semester 40,000

8 Hostel establishment “B” charges for eight semesters (@ Rs. 1000/- per semester

8,000

9 Solid waste disposal charges for eight semesters (@ Rs. 50/- per semester) 400 10 Text books (approximately) 40,000 11 Laptop 50,000 12 Boarding charges for four years** 1,60,000 Total 11,72,750 Semester abroad programmes# 2,00,000 Grand Total 13,72,750 * For budgetary purposes, calculations are based on estimate for the current academic year 2016-

17 and for subsequent years. Nominal cost escalation charges have been accounted for.

** Estimate based on current year and includes nominal cost escalation. # A few students who will academically perform well may be permitted by the Institute to pursue

one or two semesters in a foreign University with which IIT Palakkad will have an MOU for doing courses and or project. Specific permission letter will be given by in these cases. Students may be permitted to avail this additional loan provision with the production of: 1) Letter of permission from host University and 2) Letter of permission from the respective officials of IIT Palakkad.

Annexure III

CONFIDENTIAL

Declaration of prior medical and family history of students joining IIT Palakkad

1. Full Name (in capitals) ……………………………………………………………………………………………… 2. Roll No...……………………………………………………………………………………………………………… 3. Name of Parent/Guardian ………………………………………………………………………………………… 4. Personal: Veg. / Non-Veg. 5. Identification Marks : 1)

2)

6. Blood Group : 7. Past Medical/Surgical Treatment: No Yes

7.1 Allergies/Bronchial Asthma/Tuberculosis 7.2 Abdomen including Urinary Tract 7.3 Locomotor system (Spinal/Vertebral column/Joints) 7.4 Cardiovascular system 7.5 Neurological disorders/Psychological disorders 7.6 Sexually-transmitted/Venereal Diseases/Skin 7.7 Hepatitis 7.8 Diabetes 7.9 Rheumatism 7.10 Thyroid disease 7.11 Psychiatric disease

8. Family history of any major illness :No Yes

8.1 Tuberculosis 8.2 Leprosy 8.3 Diabetes 8.4 Hypertension 8.5 Ischemic heart diseases

8.6 Psychiatric illness

8.7 Cancer 9. Are there any prior history of substance abuse If yes, please specify : Smoking / Alcohol / Drugs / Any Other We declare that all the statements above are true and correct to the best of my knowledge. We fully understand that we are responsible for the accuracy of all statements given. We will be responsible for any consequence due to our misinformation, if any. Candidate’s Signature: ……………………………………………………………………………………………….. Parent/Guardian’s Signature: …………………………………………………………………………. Date: Place:

Annexure IV HEALTH CERTFICATE

1. Examination by a General Physician (M.D. in General Medicine)

I, Dr. ………………………………………………………………………………………………………….. after examining (with necessary investigations) Mr./Ms.………………………………………………...Son / Daughterof Mr./Ms. ..........................……………………………………………………..…….………. born on …………………………

CERTIFY: Weight ………. Kg. Height ………. Cm . Blood Pressure ………….. /……………. mm Hg. Girth of Chest: (a) At rest ……………………. : (b) After deep inspiration ……………………….. Cardiovascular System: Heart …………………. Heart Sounds ………………… Respiratory System: Neurological System: Psychological disturbance: Yes / No If yes, specify …………………………………. Past Medical or Surgical Record: Identified allergies: Current treatments: Current vaccination Status (All candidates who do not have adequate active/passive immunity against

diseases mentioned below should take these injections/adult booster dose as recommended, just before

joining the Institute and the date to be mentioned below):

VACCINATION AGAINST DISEASES

1st Injection Last Booster Date Yes / No Date Yes / No

BCG

Diphtheria – Tetanus - Poliomyelitis

Measles, Mumps, Rubella

Hepatitis B

Hepatitis A

Meningitis

Typhoid

Chicken Pox

Candidate’s Signature : …………………………………………………………….

INVESTIGATIONS 1. *Electrocardiogram Date ……..................... Result …………………… 2. *Chest X-ray Date ……………………. Result …………………… 3. *Sonography (whole abdomen) Date ………………………Result ………………….. 4. *Urine Date ………………………Result ………………….. 5. *Blood Tests Date …………………….. Result …………………..

a) Blood Sugar (F/PP) Date …………………….. Result …………………... b) Urea/Creatinine Date ………………………Result …………………… c) Peripheral Smear Study/HB% Date ……………………. Result …………………..... d) Lipid Profile Date ……………………. Result ……………………… e) Blood Group/typing (if not known) Date ………………. Result ……………............. f) HBS Ag Date …………………..... Result ……………………… g) HIV – I & II Date ……………………. Result.................................

*All original investigation reports (only) to be attached. Remarks / Special Recommendation, if any: Conclusion :Fit / Unfit to pursue higher education with a very tight academic schedule. Reason : Date : Place :

Signature & Seal

Candidate’s Signature : …………………………………………………………………………….

2. Examination by Ophthalmologist*

Acuity of

Vision

Far Vision Near Vision Colour Vision

Naked Eye

With Glasses

Naked Eye

With Glasses

R.E.

L.E.

*Latest Optometrist’s Recommendations, if any to be attached in original. Remarks / Special Recommendation, if any: I, Dr. …….…………………………………………………………………………………………………….. have examined (with necessary investigations) Mr./Ms. …………………………………………………… Son / Daughter of Mr./Ms. ……..…………………………………………………..…….……………………. born on ……………………………… and the above information given to the best of my knowledge are correct and true. Date :

Place : Signature & Seal

3. Examination by ENT Specialist*

Inspection / hearing

*Audiometry Right Ear Left Ear

*Latest Audiometry report to be attached in original. Remarks / Special Recommendations, if any. I, Dr. …….……………………………………………………………………………………………………have examined (with necessary investigations) Mr./Ms. …………………………………………………………. Son / Daughter of Mr./Ms. ……..…………………………………………………..…….…………………… born on ……………………………… and the above information given to the best of my knowledge are correct and true. Date : Place : Signature & Seal

Candidate’s Signature : ………………………………………………………………………

Annexure V

*For information only. Tariffs are taken from hotel website and not all the hotels have kept tariffs in their website.

PARTIAL LIST OF HOTELS AT PALAKKAD* HOTEL INDRAPRASTHA English Church Road, Palakkad-678 001 Phone: 0491 – 2534641, (2-7) 7 lines; Mobile: +91 9496628339 Tariff: INR 1700 to 6000 http://www.hotelindraprastha.com E-mail: info@hotelindraprastha.com KPM TRIPENTA HOTELS PVT LTD Malampuzha, Opposite Rock Garden Palakkad – 678001 Tel: 0491 - 2815210, 20, 26, 27 (4 lines) http://www.kpmhotels.com Email : prasad@kpmhotels.com HOTEL GAZALA HPO Road, Near Head Post Office Palakkad - 678001, Phone: 0491 - 2546581, (2-4) 4 lines http://www.hotelgazala.net Email: hotelgazala@yahoo.com Email: info@hotelgazala.net SRI CHAKRA INTERNATIONAL Krishna Garden Regency, Piruvussala Junction, Opposite to Mc Donald Chandranagar, Palakkad – 678007 Phone: 0491-2570901 (2-5) 5 lines Mobile: 0995420446 SAYOOJAM RESIDENCY Robinson Road, Near Government Hospital, Palakkad - 678001 Phone: 0491 - 2504550, (1) two lines http://www.sayoojyamresidency.com Email: sayoojyamresidency@yahoo.com HOTEL FORT PALACE West Fort Road, Palakkad - 678 001 Phone: +91 491-2534621 (2-5) 5 lines Tariff: INR 1500 to 3750 http://www.fortpalace.com Email: fortpalacehotel@gmail.com KAPILAVASTU, S S Tower, Shornur Road, Near Ksrtc Bus Stand, Palakkad - 678001 Phone: 0491 - 2515897; Mobile: 09387812650 Tariff: 775 to 1100 http://www.kapilavasthu.com Email: enquiry@kapilavastu.com

NILA LODGE Opposite to Railway Station, Ottapalam, Palakkad - 678 001 Phone:0466 - 2244700; Mobile: 08111900361 (2) two lines THE GRAND KERA Mercy College Junction, Next to Prasanna Laxmi Palakkad 678006 Phone: 0491 2536000 (1, 2) three lines Tariff: 2500 to 5000 http://grandkerahotel.com Email:grandkerapalakkad@gmail.com

HOTEL SURYA TOWERS Surya complex, Opp Mission School Palakkad – 678007 Phone: 0491-2503519 Budget hotel, Tariff: INR 538 (double bed room) HOTEL AMBADI Opposite to Telephone Exchange Near Town Bus Stand Palakkad Phone 0491- 531244, 532244 Tariff: INR 900 (double bed room) CROWN LODGE Main Road, Olavakode Palakkad Phone: 0491-558585 Tariff: INR 650 (Non A/C double bed room) INR 957 (A/C double bed room) ROYAL TOURIST HOME College Road, Palakkad 678001 Phone: 0491 2527093; 2527109 Tariff: INR 900 (A/C double bed room) (10% discount for parents/students coming to IIT Palakkad)