Ass As
Ass As
Ass As
ApplicationforSpecialFinancialAssistancetoSC/STResearchScholars
1.NameoftheApplicant
(inblockletters)
4.PermanentHouseAddress
5.AddressforCommunication
7.WhetherbelongingtoSC/ST
8.AgeandDateofBirth
2.WhetherbelongingtotheState
OfKerala
3.PlaceofBirthwiththenameof
District
6.Religion&Community
(AttachattestedcopyofSSLC
BookandCasteCertificate)
9.NameandAddressoftheResearch
Centreinwhichthecandidateis
WorkingasafulltimeResearch
Scholar
10.AcademicQualifications
(Attachattestedcopiesofthe
DegreeCertificateandMarkList)
Examination
Passedatthe
P.G.Level
Nameofthe
Subjects
University/College
Reg.No/year
Ofpassing
11.DateofRegistrationforPh.DResearch
(AttachacopyoftheUniversityOrder
grantingregistration)
%of
marks
secured
Class/Distinction
Securedinthe
exam
12.Subject&TopicofResearch
13.DateofCommencementofthepresent
ResearchProgramme
14.TotalperiodofResearchExperience
ason31.07.2011.
Years
Months
15.TeachingExperienceifany,atCollege/
School(AttachcopyoftheExperience
Certificate)
16.Detailsofpublishedpapers,ifanyin
recognizedjournals
Titleofthepaperpublished
NameoftheJournal
Dateofpublication
17.WhetherapplyingfortheSpecial
FinancialAssistanceforthefirsttime
18.Amountofgrantrequiredandthe
Subjectofthesame
19.Ifanyinstalmentofthegrantwasreceived
bythecandidatepreviously,statewhether:
theUtilizationCertificateinrespectofthat
amounthadbeensubmitted.
20.DatedSignatureoftheCandidate
21.RecommendationoftheSupervising
TeacherwithSignature,Nameand
OfficialAddress
22.CounterSignatureoftheHeadofthe
Department/Institutionalwithseal
Station:
Date: