Advanced Training School for Lecturers

in Partial Differential Equations

(Funded by National Board for Higher Mathematics)

At T.I.F.R. Centre for Applicable Mathematics,Bangalore

13 - 24 December 2010

Personal Details

Full Name

First Name

Middle Name

Last Name

Date Of Birth

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Age

in years as on 1 May 2010 :

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Moblie:

Professional Details

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Position

Is the Position Permanent?

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Date of Joining

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Postal Address :

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

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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:

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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