Application format for participation in winter school on

“Data Mining Techniques for Farm Animal Management”

Dec. 8- 28, 2010 at NDRI, Karnal
1. Full name (in block letter): _______________________________
2. Designation: _______________________________
3. Present employer address: _______________________________
4. Address to which reply should: _______________________________
be sent (in block letters) _______________________________
_______________________________
5. Permanent address: _______________________________
6. Date of Birth (DD/MM/YY): ______________
7. Sex (Male/ Female): ______________
8. Teaching/research/professional experience (mention post held) during last 5 years and number of
publications: __________________________________
__________________________________
__________________________________
9. Marital status (Married/Unmarried): ______________
10. Mention if you have participated in any research seminar, Summer/Winter School/Short
Courses, etc. during the previous years under I.C.A.R./Other organizations:

11. Postal order for Rs. 50/- (in favour of Director, NDRI) towards registration (non- refundable).
Postal order No. ________________ Dated ________________
12. Academic record:
Examination Passed Subjects Main/ Year of Class ranks/ University Other
Subsidiary Passing Distinctions Information
Bachelor’s Degree
Master’s Degree
Ph.D.
Other Certificates/
Diplomas etc.

Title of Master’s degree thesis: ______________________________________________

Title of Ph.D. thesis: ______________________________________________
Current area of research: _______________________________________________

Signature of the applicant

Date: _____________
Place: _____________

13. Recommendations of forwarding Institute __________________________________

Signature: ______________
Designation: ______________
Address: ______________
Date: ______________

CERTIFICATE
It is certified that the information was furnished by the office record and was found correct.

Signature and Designation of the sponsoring authority.