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APPLICATION FOR YSRP-2013 1. Name: 2. Date of birth: 3. Gender (M/F): 4. Nationality: 5. Postal address: 6. Phone no. 7. Fax no.

8. E-mail address: 9. Institute: 10. Current course details (Select course/year/discipline from Table 1 and fill Table 2): Table 1 Current course M. Sc. Integrated M. Sc. B.E/ B.Tech. Year First Year Fourth Year Third Year Discipline Physics Physics Engineering Physics/Mechanical Engineering/ Electrical Engineering /Electronics /Metallurgy/ Computer Science/Information Technology. Table 2 Year

Current course

Discipline

11. Date of joining the course: 12. Expected month and year of completion of the current course: 13. Academic record (Attach scanned copy of attested marksheets): M. Sc. (1st year) Integrated M. Sc. (4th year) B.E/ B.Tech. (3rd year) % Marks/CGPA obtained in B. Sc. and M. Sc. (1st semester, if available) % Marks/CGPA obtained till the last exam % Marks/CGPA obtained till the last exam

14. Name and address of the professor recommending the candidate: (Please mention postal address, telephone no., fax no. and e-mail address)

Undertaking: If selected, I would attend the entire 8 weeks programme.

(Signature of the candidate)

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