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Application Form

This document is an application form for internship, dissertation, or project work at CSIR-NEIST, Jorhat. It requires personal information, educational background, and details about the proposed work period and nature. The applicant must also declare the truthfulness of the information provided and can indicate a preferred department or scientist.

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mgopb0lte
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11 views1 page

Application Form

This document is an application form for internship, dissertation, or project work at CSIR-NEIST, Jorhat. It requires personal information, educational background, and details about the proposed work period and nature. The applicant must also declare the truthfulness of the information provided and can indicate a preferred department or scientist.

Uploaded by

mgopb0lte
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Application form

For Internship/Dissertation/Project Work at CSIR-NEIST, Jorhat-6

1 Name of thestudent(inBlock letters)


Passport
2 Father’s/Mother’sname Photograph
3 Date of birth(DD/MM/YYYY)
4 Nationality
5 Religion
6 Sex Male/Female/Others
7 Category SC/ST/OBC/UR / PWD
8 Address for communication
(in block letters)

9 Mobile No.
10 Email address (in block letters)
11 Course undertaken Semester/Year:
(Specialization /Stream/ Branch, in case of M
Sc/ B Tech etc.)
12 Name of the Institute/ College / University
13 Name of the Affiliated University
14 Address of the Institute/ College

15 Expected period of proposed internship From…………….…………………… To……………………………………..


training/ dissertation/ project work
16 Nature of Work Internship / Dissertation/ Project Work
17 Educational /Professional/ Technical Qualification ( from 10th onwards)
Examination Name of the Duration of Year of % of Marks Division/ Subjects/
Passed Board/Universit Degree/Diplom Passing Class Specialization/ Branch
y a
10th

12th

18 Are you ward of any CSIR-Employee Yes/No If yes, name of the employee:
Designation, Division, Institute
19 Preferred Department/ Centre/ Scientist of
CSIR-NEIST, if any
20 Declaration: I here by declare that all the entries made by me in this application are true to the best of my knowledge and belief

Place
Date
Signature of the Applicant

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