(Annexure -I) INDIAN COUNCIL OF SOCIAL SCIENCE RESEARCH

Application Form For Doctoral Fellowship 1. 2. Name of the Applicant Address of the organization through which application is forwarded

Mailing Address of the applicant

Telephone & Email of applicant 3 4 Age Mention whether you are (Tick one or more box, as applicable. Enclose relevant certificates as annexure III)

General ST Woman Physically Handicapped

SC OBC Minority

Please mention whether you are from (Tick one or more box, as applicable. For Educationally Backward Districts, see the list on ICSSR website)

North East States Educationally backward districts

Type of Institution from where the scholarship is applied from

Central University

(Please enclose information as annexure IV State University given with this form for applications forwarded from non -public funded institutions) ICSSR Research Institute Other public funded research institute Public Deemed University Private Deemed University State Private University

Government College Aided Private College Unaided Private College Other category of NGOs Other (please specify)

Educational Qualifications and academic attainments of the applicant (Please enclose a brief CV as annexure I)

Indicate if received any ICSSR grant previously (Please tick)

Ongoing

Completed

Research Projects Fellowships Seminar Grant International Travel Publication Grant

If completed, specify Date of Completion Report submitted Yes No

10

Subject for Post Graduation

11

Applying under (Please enclose salary certificate from employer Salary Protection Scheme as annexure V, if applying under salary protection scheme) Regular Doctoral Scheme If already registered for PhD, specify the topic (Please enclose a copy of approved synopsis as annexure II )

12

13

If already registered, please specify details of University/Institute (Please provide complete address)

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Name and address of the Supervisor

15

Whether you have qualified NET/JRF (if yes, enclose the copy of certificate)

Yes

No

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Details of publications, if any

Declaration

If any of the above information supplied by me is proved to be incorrect my fellowship may be cancelled. If selected, I shall work on whole time basis and shall not accept any employment or fellowship (paid or otherwise) without prior approval of the ICSSR.

(Signature of the Candidate)

Forwarding letter from University/College/Institute It is certified that the university/institute/college is recognized and funds received from the ICSSR will be duly disbursed to the scholar and the audited statement of accounts will be submitted. Necessary infrastructure facilities to the research work on the topic are available in the university/college/institute.

Signature of the Supervisor (if applicable) Seal

Place: Date: Signature (Name of the Registrar/Principal/Director with seal)

Enclosures Annexure-I Annexure -II CV of applicant Abstract and research proposal/synopsis as approved by the University/institution

Annexure -III Duly Attested .SC/ST/OBC/PH certificate, if applicable Annexure -IV Applications to be forwarded by Non-Public Institutions, as per prescribed format along with No Objection and Salary Certificate from the Employer, if applicable (See Annexure-IV) Annexure V Salary certificate from the employer, if applying under salary protection scheme, if applicable (See Annexure-V)