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Application Attestation Form

This document is an application attestation form for students applying to the Short Term Studentship (STS) 2017 program run by the Indian Council of Medical Research (ICMR). It contains fields for the student's reference ID, name, medical college, proposed research title, and guide's name. The student certifies that they are providing true information to the best of their knowledge, submitting only one application, and that the research proposal is original work done under their guide's supervision. The guide also certifies that the student is not an intern and that they will provide facilities and guidance, and that the proposal is original. Signatures are required from the student, guide, head of the student's department and head of their

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chanpreet12
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1K views

Application Attestation Form

This document is an application attestation form for students applying to the Short Term Studentship (STS) 2017 program run by the Indian Council of Medical Research (ICMR). It contains fields for the student's reference ID, name, medical college, proposed research title, and guide's name. The student certifies that they are providing true information to the best of their knowledge, submitting only one application, and that the research proposal is original work done under their guide's supervision. The guide also certifies that the student is not an intern and that they will provide facilities and guidance, and that the proposal is original. Signatures are required from the student, guide, head of the student's department and head of their

Uploaded by

chanpreet12
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION ATTESTATION FORM (AAF) STS 2017

Reference ID: ..
Name of the Student: ..
Name of the Guide: .
Name of Medical College
..
Title of the STS Proposal: .. ..
..
...................

Paste passport size


photograph

Certificate to be signed by the Student


I certify that I am an MBBS student and am here by providing true information in the online
application form for STS 2017 best to my knowledge. I am submitting only one application for STS 2017. In
the event any information is found to be false, my studentship may be cancelled. I also certify that the research
proposal is an original work prepared under the guidance of my Guide. I have read the Research Misconduct
and Plagiarism guidelines and will abide by the same. I understand that after evaluation of my proposal, I may
or may not be selected and I shall abide by the decision of ICMR.
If selected, I agree to obtain prior ethical approval before initiating my research; I shall follow all
instructions provided on ICMR website for carrying out the research, preparation and submission of STS
report. I also understand that if I am unable to complete my project & submit the report before the last date, no
certificate or stipend will be awarded to me. I have gone through all the Instructions and Terms & Conditions
for STS 2017 provided on ICMR website and will abide by them.

Signature of Student:________________ Name of the Student:_________________________________


Date: ___________
Certificate to be signed by the Guide
I agree to accept the applicant Mr./Ms.__________________________________ studying in MBBSI/II/III. I certify that he/she is not an intern or student of other courses and I will offer him/her all facilities and
guidance for carrying out research. I also certify that the proposal is an original submission prepared by the
student under my guidance. I confirm that neither me and nor my student have committed plagiarism in
preparing this proposal and will not initiate work withut an ethical approval. I am forwarding only one STS
2017 student application and if selected, shall provide required facilities to enable early completion of research
work and its submission in time.
Signature of Guide: _________________

Name :_________________________
Designation: ____________________
Department: ____________________
Attested By

Signature of Head of Department

Signature of Head of Medical College

(Name in Block letters with seal)

(Name in Block letters with seal)

Fill form completely & check it before submission.

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