NATIONAL INSTITUTE OF TECHNOLOGY SILCHAR Application for

SUMMER RESEARCH FELLOWSHIP PROGRAMME FOR B. TECH STUDENTS

Name Date of birth (DD-MM-YYYY)

Circle one Male / FemalePhotograph

Current mailing information

Address

Tel No. Mobile No. E-mail Parents' / Guardian's contact informationName Relation

Address

Tel No. Mobile No. E-mail College education informationName of Institution

Address

Degree programme Performance at the end of 5th Semester

CGPA________ on 10 point scale. Marks %______

Rank ___________ in class of ________ if any

Research interestArea of interest

Statement of interest

ReferenceName

Address

E-mail: Tel. No Fax no.:

Applicant's Signature

Signature & Date

The applicant is a bonafide student of the department / Institute during the academic year 2014-15.

Signature & Seal of HOD / Dean

Applications sent by candidates directly, without being forwarded by Head of the Department, will not be considered.