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APPLICATION FORM
COUNCIL OF SCIENTIFIC AND INDUSTRIAL RESEARCH


1. Application for:
2. Subject Code:
3. Category, Which the Candidate Belongs To:
GEN       SC       ST       OBC       PH
4. Gender:
Male Female
5. Number of Previous Attempts:
6. Marital Status
Married   Unmarried
7. Date of Birth(dd/mm/yyyy)
/ /
8. Age as on last date of Application
9. Name of 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.)
Degree
Subject
Year of Passing
Duration of Course
% Marks Secured
(after converting grade points)
If % of marks not applicable write:" - "
Univ./ Inst.
13. If holding an MBBS degree. indicate the date of internship completed:   / / (dd/mm/yyyy):
14. Have you qualified:
(a). CSIR-UGC JRF NET Exam? Yes    No     if 'Yes' then Enter Year  
(b). GATE Exam? Yes     No     if 'Yes' then Enter Year    Score:
15. (a). Research Papers published/ accepted in standard refereed journals as listed in SCI journal citation reports: 
(b). Patents:  
Give below the bibliographic details of the papers published/accepted in SCI journals.
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)
17.(b). If submitted thesis for Ph.D./MD/MDS degree give the date of submission: / / (dd/mm/yyyy)
17.(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.
Name of the
Fellowship/
Associateship
Supporting Agency Name
From
(dd/mm/yyyy)
To
(dd/mm/yyyy) if continue then enter dash(-) i.e -/-/-
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
(dd/mm/yyyy)
To
(dd/mm/yyyy).
if continue then enter dash(-) i.e -/-/-
Total Emoluments
/ / / /
/ / / /
(c). If unemployed or without fellowship:
Unemployed
Working without Fellowship
From
(dd/mm/yyyy)
To
(dd/mm/yyyy).
if continue then enter dash(-) i.e -/-/-
From
(dd/mm/yyyy)
To
(dd/mm/yyyy).
if continue then enter dash(-) i.e -/-/-
/ / / / / / / /
/ / / / / / / /
/ / / / / / / /
/ / / / / / / /
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.
19. Give here the Name, Designation & Address of your proposed Guide/Supervisor:
Name:
Department:
Univ./Instt.:
City:
State: