PRL VISHWAS Fellowship Application Form
1. Applicant Photo (max. size 500 kB)
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2. Name
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Dr.
Mr.
Ms.
Mrs.
Prefix
First Name
Last Name
3. Present Position
Present Affiliation Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
4. Phone Number
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Please enter a valid phone number.
5. Email
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example@example.com
6. Permanent Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
7. Date of Birth
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Day
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Month
Year
Date
8. Date of Application
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Day
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Month
Year
Date
9. Age - Years
10. Nationality
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11. Educational Qualifications
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Degree
Discipline
University/College
Year of Passing
Average Marks/CGPA/ %
Class
1
2
3
4
5
12. Date of Submission of Thesis
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Day
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Month
Year
Date
13. University/ Institution where Thesis has been submitted:
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14. Date of Award of the degree
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Day
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Month
Year
Date
15. Title of the Ph.D. Thesis
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16. Name of the PhD Supervisor
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First Name
Last Name
Address of the PhD Supervisor
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email of the PhD Supervisor
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example@example.com
Mobile Number of the PhD Supervisor
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Please enter a valid phone number.
17. Employment Details (till date):Pl. state clearly what have you been doing after submitting your thesis (if applicable).
18. If you are an Indian national presently on an assignment abroad, state the likely date of return to India (DD-MM-YYYY).
19. List of Publications: (Pl. attach) Please list the titles & authorship as they appear on the publications. List Journal and Proceedings papers separately. (in PDF format ONLY) [Max. file size 1 MB]
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20. Papers published/accepted in refereed journals/books/conference proceedings to be listed separately. Please do not list the papers under preparation. List Journal and proceedings papers separately.
21. A brief Research Proposal of your proposed research to be done under the PDF Programme at PRL. (in PDF format ONLY) [Max. file size 1 MB] Format of research proposal (4 pages max): 1. Motivation 2. Introduction / background 3. Objectives 4. Methodology 5. Experience relevant to the proposal 6. Expected outcome 7. Timeline (details for the first year) Please give adequate details of what you would like to do vis-à-vis your expertise in terms of experimental/modelling techniques etc. for the proposed work. Candidates, in consultation with a PRL faculty member, should submit a research proposal outlining the research they would undertake during their post-doctoral fellowship tenure.
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22. Give details of collaborating Faculty Member(s) of PRL
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23. Upload a latest CV (in PDF format ONLY) [Max. file size 1 MB]
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Please request your referees (including PhD supervisor and three referees) for confidential references to be sent directly to: Chairperson, VISHWAS Fellowship Committee, PRL, by E-mail at the address pdf@prl.res.in
24. Name of referee 1
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First Name
Last Name
Address of 01 referee
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email of 01 referee
*
example@example.com
Phone Number of 01 referee
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Please enter a valid phone number.
25. Name of referee 2
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First Name
Last Name
Address of 02 referee
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email of 02 referee
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example@example.com
Phone Number of 02 referee
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Please enter a valid phone number.
26. Name of referee 3
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First Name
Last Name
Address of 03 referee
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email of 03 refereeCalculation
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example@example.com
Phone Number of 03 referee
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Please enter a valid phone number.
27. Have you applied for a PDF/ Visiting position at PRL earlier? If yes, give details.
28. Any other details/remarks relevant to the present application
29. Names & addresses of two responsible persons of your locality or two references to whom you are known.
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DECLARATION I hereby declare that the entries made in this application form are correct to the best of my knowledge and belief. If selected, I promise to abide by the rules and discipline of the Institute.
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YES
Place
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Date
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Day
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Month
Year
Date
Signature (can be done by stylus or fingers or mouse)
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* Contact details: E-mail: pdf@prl.res.in (for all correspondence) Tel. No. (91) - 079 - 2631 4869. * Please check the details filled in before clicking the submit button. * After the submission of this form, editing will not be possible.
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