This document contains an application form for a training programme. The form requests the applicant's name, contact information, permission from their head of department, address of their institute, proposed subject for dissertation work, date of birth, educational qualifications from secondary school onwards, and a signature. It notes that hard copies should be addressed to the Head of HRD at CSIR-IMMT and that applications will be rejected if incomplete or missing required documents like marksheets, certificates, and permission letters.
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1. APPLICATION FORM FOR TRAINING
PROGRAMME.
1. Name :
2. Address of Correspondence (Email Address & Telephone no.):
3. Certificate of HOD of the Department/Institute for permission to carry out
Dissertation work in our Institute - (Scan copy attached)- Y/N:
4. Address of the Institute :
5. Basic subject (commensurate with the subject mentioned in our website) in which
dissertation work proposed to be carried out:
6. Date of Birth:
7. Educational qualification*
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
1. Secondary Education:
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
2. Higher Secondary Education:
3. Graduation Degree:
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
Hons Hons.
Distinction
(Y/N)
(Continue)
HRD, CSIR-IMMT Page 1
2. 4. Graduation Degree (Engineering):
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
1st semester
2nd semester
3rd semester
4th semester
5th semester
6th semester
7th semester
8th semester
5. Master Degree (Engineering):
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
1st semester
2nd semester
3rd semester
4th semester
GATE score
6. M.Sc.
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
1st semester
2nd semester
3rd semester
4th semester
* Fill up the relevant information only.
* Hard copy addressed to Head- HRD, CSIR- IMMT, P.O-RRL, Acharya Vihar,
Bhubaneswar-751013.
• Mandatory Requirements:
o Attach photocopy of following documents:
HRD, CSIR-IMMT Page 2
3. • Permission letter from HOD
• Marksheet from 10th onwards.
• Pass certificate from 10th onwards.
o Application will be rejected under following conditions:
• Incomplete application.
• Non submission of relevant documents.
Signature of the Applicant
HRD, CSIR-IMMT Page 3
4. • Permission letter from HOD
• Marksheet from 10th onwards.
• Pass certificate from 10th onwards.
o Application will be rejected under following conditions:
• Incomplete application.
• Non submission of relevant documents.
Signature of the Applicant
HRD, CSIR-IMMT Page 3
5. • Permission letter from HOD
• Marksheet from 10th onwards.
• Pass certificate from 10th onwards.
o Application will be rejected under following conditions:
• Incomplete application.
• Non submission of relevant documents.
Signature of the Applicant
HRD, CSIR-IMMT Page 3