Advanced Training in Mathematics School for Lecturers (ATML)

in Linear Algebra

(Funded by National Board for Higher Mathematics)

Department of Mathematics, IIT Guwahati, Assam

05 July 2010 to 17 July 2010

Personal Details

Full Name

First Name

Middle Name

Last Name

Date Of Birth

dd

mm

yyyy

Gender (M/F):

Age

in years as on 1 May 2010 :

Email ID

Phone

Moblie:

Professional Details

Name and Address of college/University where employed

Position

Is the Position Permanent?

Yes/No

Date of Joining

Date of passing NET/SET Examination:(Attach copy of certificate)

DD

MM

YYYY

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

(Specify here)

Areas of interest:

(Specify here)

Postal Address :

(SPECIFY POSTAL ADDRESS HEREIN CAPITAL LETTERS, WITH PIN-CODE)

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

(Specify here)

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

1)

2)

Whether any workshops in Mathematics attended earlier?

Any other-relevant information:

Academic record:

University/Institute

Year Of Passing

Overall % Score

% in Mathematics

S.S.C.

B.Sc. or B.A.

M.Sc. or M.A

Certified that I have verified the records and found the above information correct.

Signature of the applicant

Signature of the Principal/Head of Dept.
With Institute Seal