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Icmr Talent Form

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debopratim panja
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4 views

Icmr Talent Form

Uploaded by

debopratim panja
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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ICMR SCHEME FOR MD/MS-Ph.

D PROGRAMME
INDIAN COUNCIL OF MEDICAL RESEARCH
V. RAMALINGASWAMI BHAWAN, ANSARI NAGAR,
POST BOX 4911, NEW DELHI-110029

NB: The application duly filled is to be sent in duplicate to Director General, (Kind Attn: Head
HRD Division) Indian Council of Medical Research, Ansari Nagar, Post Box No. 4911, New
Delhi-110029 Phone- 26588204 (D); 26588980,26588895-Extn:264,Fax: 91-11-26588204,

GENERAL INFORMATION

Name (in Block Letters) Underline


___________________________________
surname
Postal address for correspondence : ___________________________________

___________________________________
___________________________________
___________________________________
Permanent address : ___________________________________
___________________________________
___________________________________
___________________________________
Date of Birth : ___________________________________

ACADEMIC RECORD:

List serially, the particulars of all examinations passed from Matriculation/Higher Secondary
onwards and enclose attested copies of certificates/degrees for each of the examinations passed and
mark sheets for Graduate and Post Graduate University examinations passed. Explain gaps in
study, if any, by indicating number of failure, attempts
_
Examination Year School/ Aggregate Class Distinction Number Topic
of College/ Division of if
passing Univ. marks attempts any
obtained
Matric/Higher
Secondary

Pre-
Professional

MBBS

MD/MS
3. PARTICULARS OF RESEARCH
Title of MD/MS-PhD thesis

Specialty covered by the Research work


______________________________________________________________________

Provide category: 1. Communicable, 2. Non-communicable disease 3. Basic Medical Sciences 4.


Reproductive Health 5. Nutrition 6. Others
Nature of work that should include -Clinical/Experimental/Both/Community based (Strike off
what is irrelevant). Write about 1000 words that should include objective, Methodology and main
experimental findings:
________________________________________________________________

Name &
Signature of the candidate _____________________________

5. INSTITUTION WHERE MD/MS-PhD IS BEING PURSUED:

Name______________________________________________________

Postal address______________________________________________

Telephone_________________________________________________

Fax_______________________________________________________

Name & Name &


Signature of the Guide Signature of the Principal/ Dean
(Seal bearing Designation & Address) (Seal bearing Designation & Address)

Enclosures: copy of 1. MBBS DEGREE 2. MD/MS-PhD REGISTRATION DOCUMENT

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