NATIONAL INSTITUTE OF TECHNOLOGY SILCHAR

Application for
SUMMER RESEARCH FELLOWSHIP PROGRAMME FOR B.
TECH STUDENTS
Name
Date
of
birth
(DD-MM-YYYY)
Current mailing information

Circle
one

Male / Female
Photograph

Addres
s
Tel No.

Mobile
No.

E-mail
Parents' / Guardian's contact information
Relati
on

Name
Addre
ss
Tel
No.
E-mail
College education information
Name of
Institution

Mobile
No.

Address
Degree
programme
Performance at
the end of 5th
Semester
Research interest
Area of
interest

CGPA________ on 10 point
scale. Marks %______

Rank ___________ in cla

of ________ if any

Statement
of interest
Reference
Name
Addre
ss
Email:
Applicant's Signature
Signature & Date

Tel.
No

Fax
no.:

The applicant is a bonafide student of the department / Institute during the academic
year 2014-15.

Signature & Seal of HOD / Dean

Applications sent by candidates directly, without being forwarded by Head of the
Department, will not be considered.