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National Institute of Science Communication and Information Resources (NISCAIR)

Application Form for Participation in Short Term Course

Course Title:
______________________________________________________________
The Chosen Batch with dates:
________________________________________________
Name of the Applicant (in full, in BLOCK letters)
Mr/Mrs./Ms.
_____________________________________________________________
Address: _____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Phone No. ________________Fax No. ___________________ E-Mail:
________________
Date of Birth :
_____________________________________________________________
Qualifications (Starting from Graduation)
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Computer Courses attended:
__________________________________________________
Sponsoring Organization(if
any)_________________________________________________
Organization Address
______________________________________________________
______________________________________________________
______________________________________________________
Designation: ___________________ Period of Service: __________________

Whether Accommodation facility needed(Yes/ No):


________________________________

Demand Draft No.______ _________________________ Date:


______________
Amount: _______________________________ Drawn on:
__________________________
Payable to Director, NISCAIR, New Delhi.

Date:
Signature
Mail to :
Marketing and Customer Services Division
National Institute of Science Communication and Information Resources (NISCAIR)
14, Satsang Vihar Marg
Spl. Institutional Area
New Mehrauli Road
New Delhi - 110 067

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