2. a) Academic Qualifications: Certificate/Diploma/ Degree Major Subjects Result Declaration Date Marks Obtained Total Marks CGPA Institution Board/University SSC/Matric HSSC/Intermediate Bachelors (B.A,BSc, Hons. etc.) Masters or equivalent M. Phil GRE/GAT (Subject/General) Medals (Gold/Silver/Bronze) Other (please specify) 2.b) List of scholarships or fellowships held at present or in past (Give source or sponsor, amount, where held & duration 2.c) Indicate any academic honors/medals or prizes which you have received, with titles and dates 3.a) detail for MS/PhD/DPhil Program: Name of University Date of Commencement of Classes Date of Completion University Ref/ID. Code Subject Area Details of Supervisor area Specialization Title of MS/PhD/ DPhil Name Email Contact 3.b) Closing date of admission of the institution: ________________ 3.c) Detail of Courses opted at MS/MPhil/PhD Level Course Name Date/Semester Course Type Core/Elective Total Credits of Course
3.d )Research Publication (Use extra sheet where required): Please attach the copy with your application Sr. No Title of Research paper Area of Research Published in International/Local Journal (Give full name of Journal) Date of Publication Impact Factor of Journal in your paper was published 1 5 6 4) Employment Details Name of Employer with Address (use extra sheets where necessary) Category of Employer(Federal/ Prov Govt, Semi- Govt, Autonomous, Corporation, Private) Designation with Grade (BPS, Group etc. if applicable) Period served Nature of Job (Regular/ Contract etc.) Job details (Teaching, R&D, Service, Technical, other etc) From To Last Drawn Gross Salary: (attach pay slip) (Rs.) ---------------------------/month
5. Family Information: Father’s Information: Full Name: Age: Is your father alive: Yes No If yes please provide the following: Telephone Number: Mobile Number: Address: Is your father currently employed? Yes No Current Employment ( if applicable) Designation: Date of Joining(dd/mm/yy) If retired/unemployed, specify since when (mm/yy): Spouse’s Information (please leave blank if not applicable) Full Name: Age: Telephone Number: Mobile Number: Address: Is your spouse currently employed? Yes No Current Employment (if applicable) Organization: Designation: Date of Joining(dd/mm/yy) 6. Total Income: Please specify monthly income information for each member of your family, including yourself and your spouse (if applicable). Use a separate sheet if needed. Specify monetary values in Rupees. Particulars Monthly Salary From other sources (if any) Total Father: Mother: Guardian: Self: Spouse: Others(s): Total (b) Please specify Annual income information from the sources mentioned below: a. Agriculture Income: Rs. b. Income from Savings (Interests/Dividends): Rs. c. Pension: Rs. d. Real Estate Holdings: Rs. e. Support from Relative(s): Rs. f. Other (please specify): Rs. Annual household income: Rs. Do you foresee a significant increase or decrease in your family income next year? No Yes If yes, please explain: 7. Total Assets: Is the house you live in owned by your family? Yes Year of Purchase: Original Purchase Present market value(Rs.): Price (Rs.): No Please explain why (e.g. living with grandparents, inherited, etc):