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UNIVERSITYOFKERALA

ApplicationforSpecialFinancialAssistancetoSC/STResearchScholars
1.NameoftheApplicant

(inblockletters)

4.PermanentHouseAddress

5.AddressforCommunication

7.WhetherbelongingtoSC/ST

8.AgeandDateofBirth

2.WhetherbelongingtotheState
OfKerala

3.PlaceofBirthwiththenameof
District

6.Religion&Community
(AttachattestedcopyofSSLC
BookandCasteCertificate)

9.NameandAddressoftheResearch
Centreinwhichthecandidateis

WorkingasafulltimeResearch
Scholar
10.AcademicQualifications
(Attachattestedcopiesofthe

DegreeCertificateandMarkList)
Examination
Passedatthe
P.G.Level

Nameofthe
Subjects
University/College

Reg.No/year
Ofpassing

11.DateofRegistrationforPh.DResearch
(AttachacopyoftheUniversityOrder
grantingregistration)

%of
marks
secured

Class/Distinction
Securedinthe
exam

12.Subject&TopicofResearch

13.DateofCommencementofthepresent
ResearchProgramme

14.TotalperiodofResearchExperience
ason31.07.2011.

Years

Months

15.TeachingExperienceifany,atCollege/
School(AttachcopyoftheExperience

Certificate)
16.Detailsofpublishedpapers,ifanyin
recognizedjournals
Titleofthepaperpublished

NameoftheJournal

Dateofpublication

17.WhetherapplyingfortheSpecial
FinancialAssistanceforthefirsttime

18.Amountofgrantrequiredandthe
Subjectofthesame

19.Ifanyinstalmentofthegrantwasreceived
bythecandidatepreviously,statewhether:
theUtilizationCertificateinrespectofthat
amounthadbeensubmitted.
20.DatedSignatureoftheCandidate

21.RecommendationoftheSupervising
TeacherwithSignature,Nameand

OfficialAddress
22.CounterSignatureoftheHeadofthe
Department/Institutionalwithseal
Station:
Date:

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