APPLICATION FOR DISSERTATION BASED RESEARCH TRAINING PROGRAMME

APPLICATION FOR DISSERTATION BASED RESEARCH TRAINING PROGRAMME
Online Application

1. Statement of purpose *
(Max. 1500 characters with spaces)

1500 left of 1500 characters

2. Research areas of interest*
(Select from: Molecular Biology; Cell Biology; DNA Fingerprinting; Diagnostics; Genetics; Microbiology; Immunology)

Option I*

Option II*

Option III*

Personal Details

3. Complete Name (in Block Letters)*

(As per SSC / CBSE / ICSE)

4. Parent / Spouse name*

5. Date of birth *

(DD-MM-YYYY)

6. Gender *

7. Category*
(Enclose Certificate in case of reserved category)

Address Details

8. Permanent Address

Address*

City:*

District:*

State:*

Pincode:*

Tel. No. / Mobile :*

Alternate Tel. No. / Mobile :

Email:*

Correspondence Address is same as Permanent Address:

9. Address for Correspondence

Address*

City:*

District:*

State:*

Pincode:*

Tel. No. / Mobile :*

10. Educational Qualifications Details

S.S.C / 10^th Standard *

Year of passing*

College / Institute / University*

Whether obtained through Full-Time Regular Course / Part-Time / Correspondence Course / Distance Education Programme*

Subjects*

Division & Marks (%)*

Intermediate / 12th Standard*

Year of passing*

College / Institute / University*

Whether obtained through Full-Time Regular Course / Part-Time / Correspondence Course / Distance Education Programme*

Subjects*

Division & Marks (%)*

Bachelor's Degree*

Year of passing*

College / Institute / University*

Whether obtained through Full-Time Regular Course / Part-Time / Correspondence Course / Distance Education Programme*

Subjects / Specialization*

Division & Marks (%)*

Post Graduate Degree/(if pursuing, provide semester details)

Year of passing

College / Institute / University

Subjects / Specialization

Division & Marks (%)

Other Qualification, If any

Duration / Year

College / Institute / University

Subjects / Specialization

11. Details of Project Trainings, if any

Project / Training I

Title of the Projects, Trainings, Courses, Workshops

Duration / Year

Name of the Institute / Organization

Broad Areas of Coverage

Project / Training II

Title of the Projects, Trainings, Courses, Workshops

Duration / Year

Name of the Institute / Organization

Broad Areas of Coverage

12. Accommodation required? (yes / No)*

Declaration*

I hereby declare that the entries in this form and the additional particulars, if any, furnished herewith are true to the best of my knowledge and belief.

Place:*

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