APPLICATION FORM

Form No.: Registration No.:

A. PERSONAL INFORMATION
Name of Applicant Mr/ Miss/Mrs
Father’s Name
Nationality
Category UR/OBC/SC/ST/PWD Photograph
Date of Birth
Permanent Address

Corresponding Address

Mobile No.
E-mail
B. ACADEMIC INFORMATION
Qualification Name of Course Subject / CGPA Class/ Year of CGPA
the Duration Specialization Out Division Passing till
Board/ of 10 / which
University Appearing Sem

C. SUPPORTING INFORMATION

Write Up on the research interest (150 - 200 words) :

 Statement of Purpose (150 - 200 words) :

CSIR Lab 1.
Preferences 2.
3.

DECLARATION

I ________________ hereby declare that all the statements made in this application are true
and complete to the best of my knowledge and nothing has been concealed/ distorted. I am
aware that, if at any time I am found to have concealed/ distorted any material/ information,
my tenure as Summer Trainee at participating CSIR Lab is liable to be terminated without
notice.

Reference:
(From the current Head of the Institute with email
& Contact No.)

________________________
(Signature)

Place: ________________

Date: _________________

CONTACT: CSIR-SRTP 2020 Secretariat, Email: csirsrtp@nesit.res.in/ csirsrtp@gmail.com,

Mobile: 9435514978, 7086064300, 9613854521, 9957031635

HEADQUARTER: COUNCIL OF SCIENTIFIC & INDUSTRIAL RESEARCHANUSANDHAN BHAWAN, 2RAFI

AHMED KIDWAI MARG, NEW DELHI-110001

COORDINATING OFFICE: CSIR-NORTH EAST INSTITUTE OF SCIENCE & TECHNOLOGY, JORHAT – 785006,
ASSAM, INDIA