The document appears to be an application form for the Novartis Biotechnology Leadership Camp (BioCamp) in 2011. It requests personal details, educational background, professional experience, additional information on academic awards, career experiences, interest in Novartis careers, how the applicant expects to benefit from BioCamp, language skills, other skills/interests, and references. It notes the deadline for applications is June 20, 2011 and selected students will be informed by July 7, 2011. Applicants are asked to email a scanned copy of the completed form to the provided email address.

1. BioCamp 2011
NOVARTIS BIOTECHNOLOGY LEADERSHIP CAMP
Application Form
1. Personal data
Family Name: First Name:______________________________
Mailing Address:____________________________________________________________________________
___________________________________________________________________________________________
Phone:______________________________Mobile:________________________________________________
E-mail: _______________________________________________________
Date of birth: Nationality: Gender Male  Female________________
2. Educational background
Accomplished studies by May 31, 2011:  Bachelor  Master  Doctoral  Post-Doctoral
Academic and educational record:
Institution Subject Degree Date attended Tick the right
(mm/yyyy) percentile class below
_______________________________________ _______________ _______________ _____________ 5%, 10%, 15%, Other
_______________________________________ _______________ _______________ _____________ 5%, 10%, 15%, Other
_______________________________________ _______________ _______________ _____________ 5%, 10%, 15%, Other
_______________________________________ _______________ _______________ _____________ 5%, 10%, 15%, Other
3. Professional experience
Employer Job title Date of employment (mm/yyyy)
_______________________________ _____________________________ _______________________
_______________________________ _____________________________ _______________________
_______________________________ _____________________________ _______________________
4. Additional Information
a. List significant academic awards
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
b. List any significant professional or career related experiences
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
c. Have you attended other leadership camps or related programmes? If yes, give
name of programme, name of institute conducting programme and year
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
d. Would you be interested in a career with Novartis and if yes, what is your area of
interest and how soon would you be available for employment?
___________________________________________________________________________________
___________________________________________________________________________________

2. e. How do you expect to benefit from BioCamp? Include any information you think
is relevant to your application (do not exceed space provided here)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
5. Language skills 6. Other skills & interests
Language Proficiency
____________________ _____________________ ____________________________________
____________________ _____________________ ____________________________________
____________________ _____________________ ____________________________________
7. References
1. Name Institution/Company Job Title Contact No./Email
__________________________________________________________________________________________________________________
2. Name Institution/Company Job Title Contact No./Email
__________________________________________________________________________________________________________________
8. How did you hear about BioCamp?
 Internet  Campus  Poster  Family/Friends  Faculty Member  Other (please specify)
Please ensure that your application form is endorsed here by your current Academic
Institute with name & signature of Head of Institute, date and stamp.
Institute Name: __________________________ Signed by Institute Head, date & stamp: ____________
Deadline for applications is June 20, 2011. Selected students will be informed via e-
mail by July 7, 2011.
Email scanned copy of completed form to biocamp.india@novartis.com
Only completed applications will be considered.