For Non-IISERB Student

भारतीय िवज्ञान िशक्षा एवं अनस

ु ंधान सं थान भोपाल
Indian Institute of Science Education and Research Bhopal

Application Form for Dissertation

1. Full Name (Ms./Mr.): …………………………….………………………………

2. Programme of Study (Example B.Sc./M.Sc.): …………………….…….…….....

3. Year of study: ...……………………………..……………………………………

4. Parent Institute: …………………………………………………………………..

5. Name and department of the faculty contacted for Dissertation in IISER Bhopal:

………………………………………………………………………..………………………………………

6. Dates of Dissertation proposed: From………………….…...…….To: ……….…………………………….

7. Address for Correspondence: …………………………………………………………….…………….……

………………………………………………………………………………………………………………..

…………………………… Contact No. (Self) :…………………...(Parent/Guardian):…………..…..…...

E-mail :…………………………...…………………………………………………………………………..

8. Do you require hostel & mess facility: Yes/No.

9. Area of research interest: ……………………………………………………………………………………

I agree to abide by all rules and regulations of IISER Bhopal and pay the required fees.

Signature of Candidate

I agree to guide (Ms./Mr.) ………………………………………………………. …………………………………

for Dissertation for the above mentioned period at IISER Bhopal.

Date: Name, Signature and seal of the

Place: Faculty Member

Recommended Approved

Head of Department Dean, Academic Affairs

Guidelines:
1. No financial assistance will be provided.
2. Dissertation charges 15000/- per semester. Additionally, ~1000/- per month will be charged for hostel seat rent,
water and electricity charges. (Cooler, if used by student, will be charged separately). These charges will be levied
in the multiples of 15 days. No intermittent charges will be applicable. This is subject to revision from time to time.
3. The above charges are payable online, in advance, before the start of Dissertation.
4. Institute does not guarantee for any hostel accommodation which is subject to availability only.
5. Mess will be charged as per actual rates, payable to the mess contractor.
6. After successful completion of dissertation, certificate will be issued by Faculty In-charge.

Request for Hostel Accommodation

Name: ………….……………………………………..…….……………………..…………………..……………

Duration of Dissertation: From ………….….……………………...…. To …………..……………………….

Signature of Student Name and Signature of Guide

Date: ……………………..

Hostel Approval

Allotted Room No: …………………. Hostel No: ………………..

Signature of Hostel Caretaker Dean, Students’ Affairs