‘Visvesvaraya PhD Scheme for Electronics IT’ ofDeitY, GoI
Name of the applicant / : /
Date of Birth / :
Contact Address / :
Phone No. / :
Email / :
Gender / :
Nationality / :
Category / : / ◻SC / ◻ST
◻OBC / ◻GEN
Whether Differently Abled / : / ◻Yes / ◻No
AADHAAR Number (if available) / :
Name of the institute currently working with / :
Name of the Department / :
Current Designation / :
Whether employed in a Regular Position or in a position on Regular Scale / : / ◻Yes No
Date of Joining the Institute / :
Educational qualification (Since Xth)
(In reverse chronological order)
Examination passed / College/University / Subjects / Marks (%) or Grade / Year of Passing
Work experience: Total Years : Months:
(In reverse chronological order)
Organization Name address / Position Held / Nature of Job
(Regular/contract) / From / To / Summary of work profile
Area of Research ( ESDM or IT/ITES or Both ) / :
Major achievements / Awards (year wise) / :
Number of PhDs supervising currently
[ Please provide the number here. Attach a separate sheet for details or include it in resume ] / : / Under Visvesvaraya scheme / :
Others / :
Number of PhDs already awarded under supervision [ Please provide the number here. Attach a separate sheet for Details or include it in resume ] / :
Patents Filed [Please provide the number here. Attach a separate sheet for Details or include it in resume] / :
Number of books and books chapters published [Please provide the number here.Attach a separate sheet for Details or include it in resume] / : / Books / :
Book chapter / :
Number of papers published in Journals [Please provide the number here. Attach a separate sheet for Details or include it in resume] [Bifurcate for international and national journals] / : / International / :
National / :
Number of conference publications [Please provide the number here. Attach a separate sheet for Details or include it in resume] [Bifurcate for international and nationalconferences] / : / International :
National :
Current Areas of research being undertaken [Please provide a brief description here. Attach a separate sheet for Details or include it in resume ] / :
Proposed areas of research for the next 5 Yearsunder fellowship of the Visvesvaraya PhD scheme [Please provide a brief description hereand attach a separate sheet for Details or include it in resume ] / :
Likely Output from the above research with time frames[Please provide a brief description here and attach a separate sheet for Details or include it in resume ] / :
A brief write-up highlighting the novelty of the research being carried out [Attach a separate sheet if needed] / :
Infrastructural facility available in the institute such as the lab and other facilities[Please provide a brief description here. Attach a separate sheet if needed] / :
Membership of Societies with membership grades (wherever applicable) / :
Additional Information if any [Attach a separate sheet if needed or include it in resume] / :
I have carefully gone through the terms and conditions governing the Young Faculty Research Fellowship underthe Visvesvaraya PhD scheme and undertake to comply with them. I am well aware that the application along with the resume submitted by me will also be assessed by the Selection Committee at the time of selection for the fellowship.
Signature of the applicant Date:
Place:
Endorsement by the nodal officer of the institute for the
Visvesvaraya PhD scheme with stamp Date:
Place:
Endorsement by the Institutional Head with the stamp Date:
Place:
Please tick the checkbox whichever is appropriate.
Please write NA against the fields, which are not applicable.
Enclosure: Please attach the relevant documents and mention their names here.