National Institute of Science Communication and Information Resources (NISCAIR)
Application Form for Participation in Short Term Course
Course Title.........................................................................................................................................
The Chosen Batch with dates
1.
......................................................................................................
Name of the Applicant (in full, in BLOCK letters)
Mr./Dr./Mrs./Ms...................................................................................................
2.
Address: ....................................................................................................................................
.........................................................................
PIN Code......................................
Telephone Nos. ....................................................................
Fax No............................................. E-Mail Address ..................................................................
3
Date of Birth ...........................................................................................................................
4.
Qualifications (Starting from Graduation)
Degree
University
Year
(1) Academic
(2) Professional
(3) Computer Courses attended
5.
Sponsoring Organisation, if any,
Organisation Address............................................................................................................
6.
Details of Present Post
Designation ........................................ Period of Service....................................................
7.
Whether Accommodation facility needed
8.
Course Fee payment details
Yes/No
[Link]....................................Date.................................Amount....................................................
(DD should be drawn in favour of Director, NISCAIR payable at New Delhi)
Place :
Date:
Signature
Mail to :
In-Charge
Training Division
National Institute of Science Communication and Information Resources (NISCAIR)
14, Satsang Vihar Marg
New Delhi - 110 067
Candidate's