1. Application for: Select Application Code SRF - 1 RA - 3 2. Subject Code: Select Subject Code Organic Chemical Sciences - CHEM - 21 Inorganic & Analytical Chemical Sciences - CHEM - 22 Physical Chemical Sciences - CHEM - 23 Material Sciences - CHEM - 24 Earth, Ocean, Environmental, Atmosphere & Planetary Science - EARTH - 31 Aeronautical, Civil, Mechanical, Chemical & Metallurgical Engineering Sciences - ENG - 41 Agro-, Bio-, Physico-, Chemico-, & Food-, Leather & Textile Technology - ENG - 42 Electrical, Electronics, Instrumentation & Computer Engineering Sciences - ENG - 43 General Biology, Genetics & Molecular Biology - GEN BIO - 13 Environmental Sciences - ENVIRON - 32 Biochemistry, Biophysics, Immunology, Microbiology & Physiology of Living Systems - LIFE - 12 Mathematical (Mathematics, Operations Research, Statistics) Sciences - MATH - 51 Medical & Pharmaceutical Sciences - MEDIC - 11 Astronomy/Astro Physics/Nuclear Physics/Particle Physics/Plasma Physics - PHYS - 61 Atomic & Molecular Physics / Optics / Spectroscopy / Quantum Informatics / Theoretical Physics - PHYS - 62 Condensed Matter Physic - PHYS - 63 Material Physics - PHYS - 64 Science & Technology Studies (R & D Management & Planning, MIS, Manpower Planning etc.) - STS - 71 Trans Disciplinary Research - TDR -81
3. Category, Which the Candidate Belongs To: GEN SC ST OBC PH 4. Gender: Male Female 5. Marital Status Married Unmarried 6. Number of Previous Attempts: 7. Date of Birth (dd/mm/yyyy) / / 8. Age as on last date of Application Applicant First Name Middle Name Last Name 10. Father's/Husband's Name: 11. Proposed Place of Work:
12. Educational Qualifications (B.Sc. or equivalent onwards including Ph.D.) * Convert grade points into marks .If % of marks not applicable write:"-" Degree Subject Year of Passing Duration Marks * Univ./ Inst. 13. If holding an MBBS degree. indicate the date of internship completed: (dd/mm/yyyy): 14. a). CSIR-UGC JRF NET Exam? Yes No if 'Yes' then Enter Year (b). GATE Exam? Yes No if 'Yes' then Enter Year Score:
* Convert grade points into marks .If % of marks not applicable write:"-"
15. (a). Research Papers published/ accepted in standard refereed journals as listed in SCI journal citation reports: (b). Patents: Journal Name (Appropriately abbreviated) No. of papers
Write your complete mailing address including your Name clearly and in Capital Letters only. Name Address City State Pin code Email Phone Mobile
16. Title of the proposed project: 17.(a). If registered for Ph.D./MD/MDS degree give the date of registration: (dd/mm/yyyy) (b). If submitted thesis for Ph.D./MD/MDS degree give the date of submission: / / (dd/mm/yyyy) (c). If you have been awarded/submitted the Ph.D. degree/thesis give here title of your Ph.D. thesis:
18. Give yearwise details of your occupation after obtaining the qualifying degree in the following format: (a). If a recipient of any Traineeship /Assistantship /Fellowship /Associateship etc. ** if continue then enter dash(-)i.e -/-/-(dd/mm/yyyy) Name of the Fellowship/ Associateship Supporting Agency Name From ** To ** Stipend per Month Name of Host Instt. / / / / / / / / / / / / / / / / If holding an equivalent fellowship, give reasons for applying: (b). If employed give the following details: Designation Place of Work From ** To ** Total Emoluments / / / / / / / / c). If unemployed or without fellowship: Unemployed Unemployed Working without Fellowship From ** To ** From ** To ** / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / The combined information given in (a), (b) and (c) should match total period spent from the time of obtaining qualifying degree till last date of application. Unaccounted period, if any, may lead to rejection.
** if continue then enter dash(-)i.e -/-/-(dd/mm/yyyy)
19. Give here the Name, Designation & Address of your proposed Guide/Supervisor: Name: Department: Univ./Instt.: City: State:
