Permanent

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Date of Birth
Father's Name
Address for Communication:
PERSONAL DETAILS
Telephone no:
INDIAN ASSOCIATION FOR THE CULTIVATION OF SCIENCE
J ADAVPUR, KOLKATA - 700 032
Name of the Student (block letter):
Marital Status:
Appl i cati on Formfor the year 2014-2015
Post B.Sc. Integrated Ph.D. in Chemical Sciences
(In Collaboration with the University of Calcutta)
Mother's Name
(put '' in appropriate box)
(P-2)
Gardian's Name
Local
SC ST PH GC
Educational Details:
Name of
Examination
Board/University Subjects
Year of
Passing
Division/
Marks
% of
Marks*
X
XII
B.Sc.-Ist Year
B.Sc.-2nd Year
B.Sc.- 3rd Year
Date : Signature of the student :
Any other information:
Theinformationprovidedaboveiscorrect tothebest of myknowledgeandbelief. I understandthat incaseanyof
theaboveinformationis foundto beincorrect at anysubsequent time, mycandidaturefor this courseis liableto
becancelled. I further undertaketo abideby the rules and regulations of theInstitute and the Integrated Ph.D.
Programme that are in force from time to time.
D E C L A R A T I O N
* For candidates with Chemistry-honours, please include % marks (in aggegate) obtained in honours papers. For
candidates whose university does not offer honours degree, please include % marks (in aggregate) obtained in
Chemistry, Physics and Mathematics.
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