NISER Summer Internship/ Dissertation Project Work 2024 - Apply Now

रा#ीय िव*ान िश-ा एव अनसधान सं4ान, भुवने8र

National Institute of Science Education and Research, Bhubaneswar जैिवक िव*ान िवRालय / School of Biological Sciences

Application Form for Internship / Short-Term & Long-Term (Dissertation) Project Work at SBS - NISER

Please choose whichever one is applicable:

Applying for:

(A) Internship/Short-Term Project Work

(B) Long-Term (Dissertation) Project Work

Paste your

Page 4 of 6 Annexure –

1

Name of the Student 1

passport 2 Date of Birth (DD/MM/YY) _ _ / _ _ / 20 _ _ size photograph 3 Age _ _ Years 4 Father/Mother's Name 5 Gender Male/ Female 6 Address for Communication Pin code:________________ Phone No.___________________ E-Mail ID ______________________________________________ 7 Permanent Address Pin code:____________ Phone No._________________ 8. Details of University/ Institution studied (Bachelor’s level and above) Attach copies of certificates & mark sheets. Degree Discipline University/ College Year Average Marks/CGPA Class 9 Presently Pursuing the Degree & Major 10 Year/ month of joining the College/ institute 11 Expected Year/ month of degree completion 12 Name of the College & Place 13 Name of the university (college affiliation)

recent

*NB:

I certify that the

if desired, will be

of the Applicant)

subject to availability on a chargeable basis only.

FOR THE USE OF Principal Investigator/FACULTY

Certified that the entries made by the student have been verified from the submitted documents. The student is selected for Internship / Short Term Project Work / Long-Term Dissertation Project Work following the criteria as decided by the undersigned and recommended for approval.

Signature of Faculty/Project Supervisor

Chairperson of the School:

1. Approved / Not Approved for Internship / Short-Term Project work

2. Recommended for Director’s Approval for Long-Term / 6 Months Dissertation Project Work

Signature of SBS Chairperson

Approved / Not Approved DIRECTOR

for the above-mentioned period is available & booked / Not Available.

Page 5 of 6 14 Title of the project 15 Name of the Project Supervisor 16 Duration of the Project From : _ _ / _ _ / 2 0 _ _ To: _ _ / _ _ / 20 _ _ 17 Is Bonafide-Cum-No Objection Certificate from the parent institute attached? YES/ NO Name: Name of local guardian (if any in Address:________________________________________________ 18 Bhubaneswar/Jatni) Address with Contact No. Pin code:________________ Phone No.___________________ E-Mail ID 19 NISER hostel accommodation* required (On payment basis only) YES/ NO If Yes, From :_ _ / _ _ / 2 0 _ _To:_ _ / _ _ / 2 0 _ _ 20 Avail Library/ Computer Centre Facilities YES/ NO

above information

furnished

true and correct. Date: _ _ / _ _ / 20 _ _

I

is

Place: (Full Signature

Accommodation,

provided

hostel

Warden/Chief

Accommodation in the NISER

Hostel In-Charge

Warden

FORMAT FOR BONAFIDE-CUM-NO OBJECTION CERTIFICATE

No: ______________

To, The Director, NISER, Bhubaneswar

Date:_________2024

This is to certify that Ms./Mr. __name of the student Roll No._____________ is a bona fide student of __name of the institution / University pursuing the course of __name of degree course_____. The Institute / University does not have any objection for doing the Internship / Short Term Project Work / Long-Term Dissertation Project Work at the School of Biological Sciences in National Institute of Science Education & Research, Bhubaneswar, during ___________to ____________. I am forwarding/recommending this application for the same

(Should be issued by the competent authority (like Director/Dean/HOD/Registrar as the case may be)

Signature:___________________

Name:

SEAL / STAMP

Page 6 of 6 Annexure – 2

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