Elliptic Curves and Cryptology

Advanced Training in Mathematics Schools

Workshop on Elliptic Curves and Cryptology

Funded by National Board for Higher Mathematics
Venue- The Institute of Mathematical Sciences, Chennai
21 July - 2 August, 2008

Application for Participation in Workshop on Elliptic Curves and Cryptology
(Last Date of Application: 12th May, 2008)
The list of selected participants will be displayed at the website: www.imsc.res.in on 20th May,2008.

NAME (in capitals):

Date of Birth:

Gender(M/F):

Age:

Scholarship(s) held: NBHM/ CSIR/ UGC/ Others:

Area of interest:

Name and Address of the affiliated Institute:

Postal Address:

e-mail:(Please write email address legibly)

Phone:

Date of Joining Ph.D. programme:

Current courses of study (M.Phil./Ph.D.):

Names of two teachers who have given recommendations
(to be sent along with the form or by e-mail):

ATM SCHOOLS attended before:

Whether any other workshops in Mathematics attended earlier?

Any other-relevant information:

Academic record:

	University/ Institute	Year of passing	Overall % score	% in Mathematics
B.Sc. or B.A.
M.Sc. or M.A.
Other

Signature of the applicant

(To be certified by the Head of the Institute or by a teacher)
Certified that I have verified the records and found the above information correct.

Signature of the Head of the Institute or a Teacher
With Institute Seal

pdf version of the form Mail this application to:

R. Balasubramanian

The Institute of Mathematical Sciences

CIT Campus, Taramani

Chennai 600 013,

email: balu at imsc.res.in

Phone: 044-2254 3100, 2254 1856,Fax: 044-2254 1586