Application Proforma for
Academic Encouragement Award
Instituted by Sri SriSankardev’s Birth Anniversary Celebration Committee
Staff Club, CSIR-North East Institute of Science and Technology
Jorhat 785006 : Assam / signed passport size photograph of the applicant
  1. Name of the applicant :

  1. Date of birth:

  1. Name of the parents :

Father’sname :
Mother’s name :
  1. Address for communication :

Mobile No :
E-mail :
  1. Permanent Address :
  1. Details of contribution/activity on ‘Development and expansion of handicrafts’ with relevance to Sankari Culture :

Contd……2

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  1. Research activity, if any with complete details and documentary evidence :
  1. Publications (please enclose copy) :
  1. Talks delivered :
  1. Impact/probable impact of the work of the applicant in the society(in 300 words) :

Signature of the applicant

Date :

** The applicant may use additional sheets for the details of his/her work.

  1. Reference of one renowned person of the locality :

Signature : ______

Name: ______

Address :______

Phone No: ______

(in case of PhD Scholar the reference must be the guide of his/her research work)

Contd……3

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General terms and conditions :

(i)The applicant must be a citizen of India.

(ii)The award will be given to one person only.

(iii)Desirable educational qualification : Graduate in any discipline or equivalent.

(iv)Incomplete applications/applications without the required certificates/documents are liable to be rejected.

(v)Second class train or bus fare (to & fro) will be provided for attending the award ceremony at CSIR-NEIST residential campus. Accommodation for one person will be provided, if needed.

How to apply:

(i) Eligible candidates are required to apply by speed or registered post.

(ii) The application reached the following address MrsAlokanandaSengupta, Advisor, Award Committee, and Head, RPBD Division, CSIR-North East Institute of Science and Technology, Jorhat 785006, Assam, on or before 18 October 2017.A advance copy may be sent through email also. The e-mails are ,

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