1. Application Form for SELP Award
SELP- Young Social Scientist Award/ SELP - Best Faculty Award/ Ambethkar
Social Service Award/ Periyar Social Reformer Award
1. Name :
2. Age and date of birth :
3. Community :
4. College / institution :
5. Faculty /department :
6. Designation :
7. Address with phone number and e- mail :
8. Qualification
Degree Specialization Year University Percentage
2. 9. Additional qualification (Diploma/ / Certificate / NET /SELT / Others
Degree Specialization Year University Percentage
10. Teaching experience
Name of the institution
Period
UG/PG Total
From To
11. Research experience
Guideship Guiding Awarded Published Remarks
M.Phil
Ph.D
Others
12. Research projects
Name of the project Completed/
on going
Funding
agency
Fund
received
Duration
3. 13. Books publication
Name of the book Publication Year Reference /
text book
Pages
14. Articles publication
Title of the article Journal /magazine Vol. Author/
coauthor
Year
15. Paper presentation in seminars
Title of the article Name of organization Int.National National Year
16. Seminars / events organized
Seminars / events
organized
National /
International
Sponsor No. of
participants
Year
4. 17. FDP / FIP /Orientation programme attended
FDP / FIP /Orientation
programme
Name of
organization
Duration Days
18. Participation in NSS/ NCC/YRC
NSS/ NCC/YRC Name of organization Periods Years
19. Membership in professional bodies
Professional bodies Nature of membership Periods Years
20.Give your contribution in the field of social service / social reforms (list may enclose)
DECLARATION
I hereby declare that the above in formations furnished are true to the best of my knowledge
Signature of the applicant
CERTIFICATE
Certified that I have verified the facts furnished above and found to be true and
forwarded for consideration
Signature of the principal with seal
Date
