Advanced Instructional School

on Numerical Linear Algebra

(Funded by National Board for Higher Mathematics)

At IIT Guwahati

2 Dec 2010 to 22 Dec 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