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NATIONAL INSTITUTE OF TECHNOLOGY
ROURKELA – 769 008
No. NITR/AC/2020/M/ 1137 Dated: November 3, 2020
DETAILS OF ADMISSION PROCESS FOR FIRST SEMESTER 2020
Academic Year 2020–2021 for the B. Tech, B. Arch, Int. MSc and Dual Degree
programmes under JoSAA
After the successful payment of the partial admission fee at JoSAA, make the remaining
payment at NIT Rourkela also at the link mentioned below. The fee structure for different
categories mentioned in this document. (Page No. 4 to 5)
https://www.onlinesbi.com/sbicollect/icollecthome.htm?corpID=1509159
There are four categories in the above link. Choose your option accordingly and proceed for
making the payment.
IMPORTANT:
Please mention the fee amount separately you paid to JoSAA and NIT Rourkela while filling up
eapplication after making payment. (If you have any doubt in making payment and completing
application, you can watch this video at https://youtu.be/MfcmGn6xCB0)
After making payment, all the students are advised to fill necessary details at NIT Rourkela
online portal: http://eapplication.nitrkl.ac.in from 16
th
to 21
st
of November, 2020. Students are
NOT required to report physically to take admission at NIT Rourkela.
Important: Those students who are willing to participate in CSAB should not fill up
the enrollment form during November 16-21, 2020 and also don’t upload any document
in http://eapplication.nitrkl.ac.in. They should finish all the formalities during 25th to
30th of November 2020.
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Students (not participating in CSAB) are required to upload documents in the e-application form
(Merge all documents into one .pdf file of max. 5MB). If students are not able to upload, they
can submit the following documents scanned copies to [email protected] with a copy to
[email protected]. However, hard copies of all the documents must be submitted during
physical reporting, failing which their admission will be cancelled.
The date of physical reporting will be intimated later. The student is required to provide the
following documents:
1. Provisional Admission Letter from JoSAA/Score Card.
2. Admission fee receipt paid at JoSAA and NIT Rourkela
3. Examination / Birth Certificate for proof of date of birth.
4. Mark-sheet & Certificates of all Examinations starting from HSC (10
th
) onwards.
5. School (College) Leaving / Migration Certificates (any one) in case it is not issued by the
school/Board, from the Institution last attended.
6. Conduct / Character Certificate from the Institution last attended.
7. Reservation Category certificate (if applicable) (Annexures enclosed - As per JoSAA
format & rules)
8. Complete Postal Address with Mobile No. & Email ID (on A4 paper)
9. Identity Proof / I-Card
10. Medical Fitness Certificate
11. Income Certificate of Parents (Issued after April 01, 2020) (if applicable) (In case mother
is not working, affidavit to be submitted for NO INCOME)
Income Certificate is not required from SC/ST/PH/Family Income above 5 Lakhs
students.
Income Certificate is to be submitted only by student who has income less than 1
Lakh or in-between 1-5 Lakhs.
12. Undertaking by Student & Parent against Ragging (form enclosed) and other
undertakings
Print the “Online Enrollment Form” obtained from http://eapplication.nitrkl.ac.in.
(Keep the print out safely. When asked, submit it at acad.ug@nitrkl.acin)
Important for Physically Handicapped Students:
Physically handicapped students are required to submit the affidavit (sample attached) on Non-
judicial stamp paper and upload the same along with other documents.
Refund Rule: In case of withdrawal after taking admission, only mess fee will be refunded and
all other fees deposited will be forfeited.
Procedure for Admission:
Step–1:
Fill up the e-application form in the NIT Rourkela website and upload all
documents in the form. Please attach all documents in sequence.
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Step–2:
The documents will be verified by the Institute officials. The official will intimate
students through email, if there is any issue in the certificates of the students.
Please keep checking your mail.
Step–3:
On successful completion of Admission process, you will be generated a Roll No.
You will be notified your Roll No. through email and instructions will be given
regarding online classes and registration through faculty advisor.
Step–4:
Each student will be assigned one Faculty Advisor who will guide you through the
registration process.
Step–5:
Each student will be provided an Institute Email Id through their registered mail
Id.
Step–6:
Online classes will be conducted online in the Microsoft Teams App
(https://play.google.com/store/apps/details?id=com.microsoft.teams), till the
situation normalizes. Each student will be assigned a User-Id and Password
through their mail. Please keep checking your mail (provided in the e-application
portal).
Step–7:
Students need to attend all classes online in Microsoft Teams App instantly after
they get their Roll No., Microsoft Teams App User-Id and Password.
For further details on admission related queries, please contact anyone of the following:
1. Prof. Nihar Ranjan Mishra, Associate Dean, NIT Rourkela
Email: [email protected], Mobile: 9437462037
2. Shri Ashis Kumar Behera, Assistant Registrar (Academic – Research), NIT Rourkela
Email: [email protected], Phone: 0661-2462031
3. Shri D. P. Tripathi, Assistant Registrar (Academic–UG & PG), NIT Rourkela
Email: [email protected], Phone: 0661-2462037
The ONLINE classes will be commencing from 1st December, 2020 (tentatively).
Notes:
1. All admissions given are strictly provisional and subject to verification of original
documents during physical reporting to NIT Rourkela, date for which intimated later.
2. Students admitted to any course at NIT Rourkela shall not be eligible to pursue
simultaneously any other full time course in this or in any other University/Institution.
3. Student who has been granted admission to a particular course shall not be allowed
to change the course. Branch change may be possible if one scores a minimum CGPA
of 8.5 after completion of first two semesters subject to fulfillment of other terms and
conditions.
4. Only those students who are found medically fit shall be admitted to different
programmes at NIT Rourkela.
5. Students admitted to NIT Rourkela will be governed by the rules of the Institute and
have to abide by the same.
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Fee to be paid by STUDENTS at the time of admission
B.Tech. / B. Arch. / Dual Degree
SC / ST / PWD
Fee Components
1
st
Semester Fee (INR)
Tuition Fee*
0
Admission Fee (one time)
2500
Other fees (Exam, Library, Electricity etc.)
5000
Student Activity Fee***
500
Medical Fee
2000
Hostel Seat Rent
5000
Caution Money (One time refundable)
10000
Institute Emergency Fund (Onetime fee to be directly deposited into
corpus fund at the time of admission)
12500
Hall Establishment Fee
5000
Mess Dues (Approximately)
17500
Total
60000
You might have paid at JoSAA
33000**
Total to be paid at the time of admission to NIT Rourkela
27000
* If family income is less than 1 Lakh, Income Certificate to be produced.
** Out of Rs. 35000 (paid at JoSAA), Rs. 2000 deducted as processing fee by JoSAA
*** Usually SAC Fee is INR 2000 per semester. Due to COVID-19, it has been
reduced to INR 500 for Autumn-2020 only.
GEN / GEN-EWS / OBC-NCL/ Family Income (in between 1-5 lakhs)
Fee Components
1
st
Semester Fee (INR)
Tuition Fee*
20833
Admission Fee (one time)
2500
Other fees (Exam, Library, Electricity etc.)
5000
Student Activity Fee***
500
Medical Fee
2000
Hostel Seat Rent
5000
Caution Money (One time refundable)
10000
Institute Emergency Fund (Onetime fee to be directly deposited into
corpus fund at the time of admission)
12500
Hall Establishment Fee
5000
Mess Dues (Approximately)
17500
Total
80833
You might have paid at JoSAA
73000**
Total to be paid at the time of admission to NIT Rourkela
7833
* If family income is in between 1 – 5 Lakhs, Income Certificate to be produced.
** Out of Rs. 75000 (paid at JoSAA), Rs. 2000 deducted as processing fee by JoSAA
*** Usually SAC Fee is INR 2000 per semester. Due to COVID-19, it has been
reduced to INR 500 for Autumn-2020 only.
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GEN / GEN-EWS / OBC-NCL - Family Income (Less than 1 lakh)
1
st
Semester Fee (INR)
0
2500
5000
500
2000
5000
10000
12500
5000
17500
60000
73000**
Surplus amount of Rs. 13000 will be adjusted in next semester
* If family income is less than 1 Lakh, Income Certificate to be produced.
** Out of Rs. 75000 (paid at JoSAA), Rs. 2000 deducted as processing fee by JoSAA
*** Usually SAC Fee is INR 2000 per semester. Due to COVID-19, it has been
reduced to INR 500 for Autumn-2020 only.
GEN / GEN-EWS / OBC-NCL/ Family Income (Above 5 lakhs)
Fee Components
1
st
Semester Fee (INR)
Tuition Fee
62500
Admission Fee (one time)
2500
Other fees (Exam, Library, Electricity etc.)
5000
Student Activity Fee***
500
Medical Fee
2000
Hostel Seat Rent
5000
Caution Money (One time refundable)
10000
Institute Emergency Fund (Onetime fee to be directly deposited into
corpus fund at the time of admission)
12500
Hall Establishment Fee
5000
Mess Dues (Approximately)
17500
Total
122500
You might have paid at JoSAA
73000**
Total to be paid at the time of admission to NIT Rourkela
49500
** Out of Rs. 75000 (paid at JoSAA), Rs. 2000 deducted as processing fee by JoSAA
*** Usually SAC Fee is INR 2000 per semester. Due to COVID-19, it has been
reduced to INR 500 for Autumn-2020 only.
Integrated M. Sc. (If paid INR 75000 to JoSAA) : NIL
Integrated M.Sc. (If paid INR 35000 to JoSAA) : INR 34500
Important Note:
In case of any discrepancy in the fee, the same shall be adjusted in next
semester.
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National Institute of Technology Rourkela
Admission – 2020
UNDERTAKING by STUDENT
I .………………….……………………………………………….……… son/daughter of
Shri …………………………………………………………… resident of village / town /
city …………………………………………………………..……….district of State / UT
……………………………………………….………… do hereby declare on oath as under:
a. I have been admitted to National Institute of Technology Rourkela in the course
………………………………………………………………
b. That due to COVID-19 pandemic, all documents are processed through online and I have
not been able to submit and verify with original documents physically.
c. I am aware of the fact that non-submission of the Original certificates and mark sheets
after COVID-19 pandemic shall lead to cancellation of my admission and I will not be
entitled for refund of fee paid to the institute except mess fee.
Place:
Date:
Signature of the Student……………………………………….
Name in Capital Letter……..………………………………….
E-Mail…………………………Mobile………………………
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UNDERTAKING by PHYSICALLY HANDICAPPED STUDENT ONLY
(ON Non-JUDICIAL STAMP)
I .………………….……………………………………………….……… son/daughter of
Shri …………………………………………………………… resident of village / town /
city …………………………………………………………..……….district of State / UT
……………………………………………….………… do hereby declare as under that:
d. I have been admitted to National Institute of Technology Rourkela in the course
………………………………………………………………
e. That due to COVID-19 pandemic, all documents are processed through online and I have
not been able to submit and verify with original documents physically.
f. I am aware of the fact that non-submission of the Original certificates and mark sheets
after COVID-19 pandemic shall lead to cancellation of my admission and I will not be
entitled for refund of fee paid to the institute except mess fee.
Place:
Date:
Signature of the Student……………………………………….
Name in Capital Letter……..………………………………….
E-Mail…………………………Mobile………………………
FORM-GEN-EWS
Government of ………………………………….
(Name & Address of the authority issuing the certificate)
INCOME & ASSET CERTIFICATE TO BE PRODUCED BY ECONOMICALLY
WEAKER SECTIONS
Certificate No. _____________________ Date: ___________________
VALID FOR THE ADMISSION IN ACADEMIC YEAR 2020-2021
1. This is to certify that Shri/Smt./Kumari __________________________
son/daughter/wife of _______________________________ permanent resident of
_________________________, Village/Street ____________________ Post Office
_________________ District ______________ in the State/Union Territory
___________________ Pin Code __________ whose photograph in attested below belongs to
Economically Weaker Sections, since the gross annual income* of his/her “family”** is below
Rs. 8 lakh (Rupees Eight Lakh only) for the financial year _________. His/her family does not
own or possess any of the following assets***:
I. 5 acres of agricultural land and above;
II. Residential flat of 1000 sq. ft. and above;
III. Residential plot of 100 sq. yards and above in notified municipalities;
IV. Residential plot of 200 sq. yards and above in areas other than the notified
municipalities.
2. Shri/Smt./Kumari ________________________ belongs to the ________ caste which is
not recognized as a Schedule Caste, Schedule Tribe and Other Backward Classes (Central List).
Signature with seal of Officer __________________
Name ________________________
Designation _______________
* Note1: Income covered all sources i.e. salary, agricultural, business, profession, etc.
** Note2: The term “Family” for this purpose includes the person, who seeks benefit of reservation,
his/her parents and siblings below the age of 18 years as also his/her spouse and children below the age of
18 years.
*** Note3: The property held by a “Family” in different locations or different places/cities have been
clubbed while applying the land or property holding test to determine EWS status.
Recent Passport size
attested photograph
of the applicant
The income and assets of the families as mentioned
would be required to be certified by an officer not
below the rank of Tehsildar in the States/UTs.
FORM-SC/ST
SC/ST Certificate Format
FORM OF CERTIFICATE TO BE PRODUCED BY SCHEDULED CASTES (SC) AND SCHEDULED
TRIBES (ST) CANDIDATES
1. This is to certify that Shri/ Shirmati/ Kumari* _________________________________________________________
son/daughter*
of _____________________________________ of Village/Town* ________________________________________
District/Division* _________________________________ of State/Union Territory* _____________________________ belongs
to the
_______________________________
Scheduled Caste / Scheduled Tribe* under :-
*
The Constitution (Scheduled Castes) Order, 1950
*
The Constitution (Scheduled Tribes) Order, 1950
*
The Constitution (Scheduled Castes) (Union Territories) Order, 1951
*
The Constitution (Scheduled Tribes) (Union Territories) Order, 1951
[As amended by the Scheduled Castes and Scheduled Tribes Lists (Modification Order) 1956, the Bombay Reorganisation Act, 1960, the Punjab Reorganisation Act,
1966, the State of Himachal Pradesh Act, 1970, the North Eastern Areas (Reorganisation) Act, 1971, the Scheduled Castes and Scheduled Tribes Orders
(Amendment) Act, 1976 and the Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 2002]
*
The Constitution (Jammu and Kashmir) Scheduled Castes Order, 1956;
*
The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959, as amended by the Scheduled Castes and Scheduled Tribes Order (Amendment) Act,
1976;
*
The Constitution (Dadara and Nagar Haveli) Scheduled Castes Order, 1962;
*
The Constitution (Dadara and Nagar Haveli) Scheduled Tribes Order, 1962;
*
The Constitution (Pondicherry) Scheduled Castes Order, 1964;
*
The Constitution (Uttar Pradesh) Scheduled Tribes Order, 1967;
*
The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968;
*
The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968;
*
The Constitution (Nagaland) Scheduled Tribes Order, 1970;
*
The Constitution (Sikkim) Scheduled Castes Order, 1978;
*
The Constitution (Sikkim) Scheduled Tribes Order, 1978;
*
The Constitution (Jammu and Kashmir) Scheduled Tribes Order, 1989;
*
The Constitution (Scheduled Castes) Order (Amendment) Act, 1990;
*
The Constitution (Scheduled Tribes) Order (Amendment) Act, 1991;
*
The Constitution (Scheduled Tribes) Order (Second Amendment) Act, 1991.
2.
#
This certificate is issued on the basis of the Scheduled Castes / Scheduled Tribes* Certificate issued to Shri /Shrimati*
_______________________________
father/mother* of Shri /Shrimati /Kumari* ___________________________ of Village/Town*
_____________________________________ in District/Division* _____________________________ of the State State/Union
Territory*________________________________ who belong to the Caste / Tribe* which is recognised as a Scheduled Caste /
Scheduled Tribe* in the State / Union Territory* ____________________issued by the ____________________ dated
________________.
3. Shri/ Shrimati/ Kumari * and / or* his / her* family ordinarily reside(s)** in Village/Town*
of District/Division* of the State Union Territory* of .
Signature:
____________________
Designation ____________________
(with seal of the Office)
Place:
______________
State/Union Territory*
Date:
* Please delete the word(s) which are not applicable.
# Applicable in the case of SC/ST Persons who have migrated from another State/UT.
IMPORTANT NOTES
The term “ordinarily reside(s)**” used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950. Officers
competent to issue Caste/Tribe certificates:
1. District Magistrate / Additional District Magistrate / Collector / Deputy Commissioner / Additional Deputy Commissioner / Deputy Collector / Ist Class
Stipendiary Magistrate / City Magistrate / Sub-Divisional Magistrate / Taluka Magistrate / Executive Magistrate / Extra Assistant Commissioner.
2. Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate.
3. Revenue Officers not below the rank of Tehsildar.
4. Sub-divisional Officer of the area where the candidate and/ or his family normally reside(s).
5. Administrator / Secretary to Administrator / Development Officer (Lakshadweep Island).
6. Certificate issued by any other authority will be rejected.
FORM-OBC-NCL
OBC-NCL Certificate Format
FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD
CLASSES (NCL) APPLYING FOR ADMISSION TO CENTRAL EDUCATIONAL
INSTITUTIONS (CEIs), UNDER THE GOVERNMENT OF INDIA
This is to certify that Shri/Smt./Kum* _____________________________________ Son/
Daughter* of Shri/Smt.* ______________________________________of Village/
Town*___________________________________District/Division* ___________________ in the
State/Union Territory _________________________________ belongs to the
__________________________________ community that is recognized as a backward class
under Government of India**, Ministry of Social Justice and Empowerment’s Resolution No.
__________________________________ dated ___________________***
Shri/Smt./Kum. ________________________________________ and/or ______________
his/her family ordinarily reside(s) in the ________________________________ District/Division of
the _____________________________ State/Union Territory. This is also to certify that he/she
does NOT belong to the persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule
to the Government of India, Department of Personnel & Training O.M. No. 36012/22/93- Estt.
(SCT) dated 08/09/93 which is modified vide OM No. 36033/3/2004 Estt.(Res.) dated
09/03/2004, further modified vide OM No. 36033/3/2004-Estt. (Res.) dated 14/10/2008, again
further modified vide OM No.36036/2/2013-Estt (Res) dtd. 30/05/2014, and again further
modified vide OM No. 36033/1/2013-Estt (Res) dtd. 13/09/2017.
District Magistrate /
Deputy Commissioner /
Any other Competent Authority
Dated:
Seal
* Please delete the word(s) which are not applicable.
** As listed in the Annexure (for FORM-OBC-NCL)
*** The authority issuing the certificate needs to mention the details of Resolution of
Government of India, in which the caste of the candidate is mentioned as OBC.
NOTE:
(a)
The term ‘Ordinarily resides’ used here will have the same meaning as in Section 20 of the
Representation of the People Act, 1950.
(b)
The authorities competent to issue Caste Certificates are indicated below:
(i) District Magistrate/ Additional Magistrate/ Collector/ Deputy Commissioner/ Additional Deputy
Commissioner/ Deputy Collector/ Ist Class Stipendiary Magistrate/ Sub-Divisional magistrate/
Taluka Magistrate/ Executive
Magistrate/ Extra Assistant Commissioner (not below the rank of
Ist Class Stipendiary Magistrate).
(ii) Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate.
(iii) Revenue Officer not below the rank of Tehsildar’ and
(iv) Sub-Divisional Officer of the area where the candidate and/or his family resides
ANNEXURE for FORM-OBC-NCL
Sl. No.
Resolution No.
Date of Notification
1
No.12011/68/93-BCC(C)
13.09.1993
2
No.12011/9/94-BCC
19.10.1994
3
No.12011/7/95-BCC
24.05.1995
4
No.12011/96/94-BCC
09.03.1996
5
No.12011/44/96-BCC
11.12.1996
6
No.12011/13/97-BCC
03.12.1997
7
No.12011/99/94-BCC
11.12.1997
8
No.12011/68/98-BCC
27.10.1999
9
No.12011/88/98-BCC
06.12.1999
10
No.12011/36/99-BCC
04.04.2000
11
No.12011/44/99-BCC
21.09.2000
12
No.12015/9/2000-BCC
06.09.2001
13
No.12011/1/2001-BCC
19.06.2003
14
No.12011/4/2002-BCC
13.01.2004
15
No.12011/9/2004-BCC
16.01.2006
16
No.12011/14/2004-BCC
12.03.2007
17
No.12011/16/2007-BCC
12.10.2007
18
No.12019/6/2005-BCC
30.07.2010
19
No. 12015/2/2007-BCC
18.08.2010
20
No.12015/15/2008-BCC
16.06.2011
21
No.12015/13/2010-BC-II
08.12.2011
22
No.12015/5/2011-BC-II
17.02.2014
FORM-PwD (II)
Form-II
Disability Certificate
(In cases of amputation or complete permanent paralysis of limbs and in cases of blindness)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
(See rule 4)
Certificate No. ________________________________________ Date:
This is to certify that I have carefully examined Shri/Smt./Kum.____________________________
_______________ son/wife/daughter of Shri__________________________________________
Date
of Birth (DD/MM/YY)_______________________ Age ______________ years, male/female
________________ Registration No.
__________________________________
permanent resident of House
No.______________________Ward/Village/ Street____________________________________
Post Office ____________________________ District __________________________________
State ____________________________________, whose photograph is affixed above, and am
satisfied that:
1.
he/she is a case of:
a. locomotor disability
b. blindness
(Please tick as applicable)
2.
the diagnosis in his/her case is ______________________________________
3.
He/ She has______________% (in figure)___________________________________percent
(in words) permanent physical impairment/blindness in relation to his/her ______________
(part of body) as per guidelines (to be specified).
4.
The applicant has submitted the following document as proof of residence:-
Nature of Document
Date of Issue
Details of authority issuing certificate
(Signature and Seal of Authorised Signatory of notified Medical Authority)
FORM-PwD(III)
Form-III
Disability Certificate
(In cases of multiple disabilities)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
(See rule 4)
Certificate No.___________________________________________Date:
This is to certify that I have carefully examined Shri/Smt./Kum.____________________________
________________ son/ wife/daughter of Shri________________________________________
___________ Date of Birth (DD/MM/YY) ___________________________ Age_________ years,
male/female________________ Registration No. _____________________________________
permanent resident of House No. _________________________________ Ward/Village/Street
_____________________________ Post Office _________________________________ District
______________________________ State __________________________________________,
whose photograph is affixed above, and are satisfied that:
1.
He/she is a Case of Multiple Disability. His/her extent of permanent physical impairment/
disability has been evaluated as per guidelines (to be specified) for the disabilities ticked
below, and shown against the relevant disability in the table below:
S. No.
Disability
Affected
Part of Body
Diagnosis
Permanent physical
impairment/mental
disability (in %)
1
Locomotor
disability
@
2
Low vision
#
3
Blindness
Both Eyes
4
Hearing
impairment
£
5
Mental retardation
X
6
Mental-illness
X
@ - e.g. Left/Right/both arms/legs
# - e.g. Single eye/both eyes
£ - e.g. Left/Right/both ears
2.
In the light of the above, his/her overall permanent physical impairment as per guidelines
(to be specified), is as follows:
In figures: _______________________ percent
In words: ________________________________________ percent
3.
The above condition is progressive/ non-progressive/ likely to improve/ not likely to
improve.
4.
Reassessment of disability is:
(i) not necessary
Or
(ii) is recommended/after _________ years ________ months, and therefore this certificate
shall be valid till (DD/MM/YY) ___________________
5.
The applicant has submitted the following document as proof of residence:
Nature of Document
Date of Issue
Details of authority issuing certificate
6.
Signature and seal of the Medical Authority:
Name and Seal of Member
Name of Seal of Member
Name and Seal of the Chairperson
FORM-PwD(IV)
Form-IV
Disability Certificate
(In cases other than those mentioned in Forms II and III)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
(See rule 4)
Certificate No.___________________________________________ Date:
This is to certify that I have carefully examined Shri/Smt./Kum.____________________________
________________ son/ wife/daughter of Shri________________________________________
___________ Date of Birth (DD/MM/YY) ___________________________ Age_________ years,
male/female________________ Registration No. _____________________________________
permanent resident of House No. _________________________________ Ward/Village/Street
_____________________________ Post Office _________________________________ District
______________________________ State __________________________________________,
whose photograph is affixed above, and am satisfied that he/she is a case of disability.
1.
His/her extent of percentage of physical impairment/disability has been evaluated as per
guidelines (to be specified) and is shown against the relevant disability in the table below:
S. No.
Disability
Affected
Part of Body
Diagnosis
Permanent physical
impairment/mental
disability (in %)
1
Locomotor
disability
@
2
Low vision
#
3
Blindness
Both Eyes
4
Hearing
impairment
£
5
Mental retardation
X
6
Mental-illness
X
(Please strike out the disabilities which are not applicable.)
@ - e.g. Left/Right/both arms/legs
# - e.g. Single eye/both eyes
£ - e.g. Left/Right/both ears
2.
The above condition is progressive/ non-progressive/ likely to improve/ not likely to
improve.
3.
Reassessment of disability is:
a. not necessary
Or
b. is recommended/after _________ years ________ months, and therefore this certificate
shall be valid till (DD/MM/YY) ___________________
4.
The applicant has submitted the following document as proof of residence:
Nature of Document
Date of Issue
Details of authority issuing certificate
(Authorised Signatory of notified Medical Authority)
(Name and Seal)
Countersigned
{Countersignature and seal of the
CMO/Medical Superintendent/Head of Government Hospital,
in case the
certificate is issued by a medical authority who is not a government
servant (with
seal)}
Note: In case this certificate is issued by a medical authority who is not a government
servant, it
shall be valid only if countersigned by the Chief Medical Officer of the District. Note: The
principal rules were published in the Gazette of India vide notification number S.O. 908(E),
dated the 31st December, 1996.
Page | 61
ANNEXURE 7
MEDICAL CERTIFICATE
(to be issued by a Registered Medical Practitioner)
GENERAL EXPECTATIONS
Candidates should have good general physique. In particular,
1. Chest measurement should not be less than 70 cm, with satisfactory limits of expansion and contraction.
2. Vision should be normal. In case of defective vision, it should be corrected to 6/9 in both eyes or 6/6 in
the better eye. Colour blind and uniocular(having vision in only one eye)persons are restricted from
admission to certain courses.
3. Hearing should be normal. Defective hearing should be corrected.
4. Heart and lungs should not have any abnormality and there should be no history of mental illness and
epileptic fits.
1
Name of the candidate:
2
Identification Mark (a mole, scar or birthmark), if any
3
Major illness/operation, if any (specify nature of illness/operation)
4
Height in cm: Weight in kg: Blood Group:
5
Past History
(a) Mental illness
(b) Epileptic Fit
6
Chest (a) Inspiration in cm (b) Expiration in cm
7
Hearing
8
Vision with or
without glasses:
Right Eye
Left Eye
Colour Blindness
Uniocular vision(having
vision in only one eye)
9
Respiratory System
10
Nervous System
11
Heart (a)Sounds (b) Murmur
12
Abdomen
(a) Liver
(b) Spleen
Hernia
Hydrocele
13
Any other defects:
Certificate of Medical Fitness
The candidate fulfils the prescribed standard physical fitness, medical fitness and is FIT for
admission to Engineering/Architecture/ Pharmaceutics/ Science Course
The candidate does not fulfil the prescribed standard of physical fitness/medical fitness
and is unfit/temporarily unfit for admission due to following defects:
__________________ ________________ __________________ _________________
Name of the Doctor Signature Registration number Seal
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Form:
NITR/AC/125
National Institute
of
Technology Rourkela
(An
Institute of National Importance under Ministry of
HRD.
Govt.
of India)
UNDERTAKING BY THE STUDENT AGAINST RAGGING
1.
l,
_____________________
son/daughter/ward
of
Mr./Mrs
have
carefully
read
and
fully understood
the
law
prohibiting
ragging
and
the
directions of
the
Supreme
Court
and
the
Central/State Government
in
this
regard.
2.
I have
received
a
copy
of
the
Regulations
on
Curbing
the
Menace
of
Ragging
at NIT
Rourkela
and
have
carefully
gone
through
it.
3.
I hereby undertake
that,
during
my
studies at
NIT
Rourkela.
• I will not indulge
in
any
behavior
or
act
may
come
under
the
definition of
ragging.
• I will not participate
in
or abet or propagate
ragging
in
any
form.
• I will not hurt anyone physically or psychologically or
cause
any
other
harm.
4.
If I come across
any
act
akin
to
ragging
being
done
to
any
student of
NIT
(including
myself) I
shall
bring
it
to
the
attention of Institution authorities.
5.
I hereby
agree
that if
found
guilty of
any
aspect of
ragging,
I
may
be
punished
as
per
the
provisions of
the
Institute Regulations
mentioned
above
and
I or
as
per
the
law
in
force.
6.
I hereby affirm that I
have
not
been
expelled or debarred froni admission
by
any
institution.
Signed this
_______
day
of
______
month
of
____
Year.
Name:
Signature of
the
Student
Address:
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Fonn:
NITR/AC/126
National Institute
of
Technology Rourkela
(An
Institute of National Importance under Ministry of
HRD
.
Govt.
of India)
UNDERTAKING
BY
PARENT/
GUARDIAN
1.
I,
_________________
Father/Mother/Guardian
of
Mr./Ms.
have
carefully
read
and
fully
understood
the
law
prohibiting
ragging
and
the
directions of
the
Supreme Court
and
the
Central
I
State
Government
in
this
regard
as
well
as
the
NIT
Regulations
on
Curbing
the
Menace
of
Raggin~.
2.
· I assure
you
that
my
son/daughter/ward will
not
indulge
in
any
act of
ragging.
3.
I also
assure
you
that if
my
son
or daughter
comes
across
any
student (including
himself)
being
ragged,
he
will
summarily
bring
the
incident
to
the
attention of
Institute authorities.
4.
I
hereby
agree
that if
he/she
is
found
guilty of
any
aspect of
ragging,
he/she
may
be
punished
as
per
the
provisions of
the
Regulations
mentioned
above
and/or
as
per
the
law
in
force,
as
that I
shall
make
no
effort
to
seek
redressal
of
punishment.
Signed
this
_______
day
of
______
month
of
____
Year.
Name:
Signature of Parent/
Guardian
Address :