immt

1. APPLICATION FORM FOR TRAINING
PROGRAMME.
1. Name :
2. Address of Correspondence (Email Address & Telephone no.):
3. Certificate of HOD of the Department/Institute for permission to carry out
Dissertation work in our Institute - (Scan copy attached)- Y/N:
4. Address of the Institute :
5. Basic subject (commensurate with the subject mentioned in our website) in which
dissertation work proposed to be carried out:
6. Date of Birth:
7. Educational qualification*
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
1. Secondary Education:
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
2. Higher Secondary Education:
3. Graduation Degree:
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
Hons Hons.
Distinction
(Y/N)
(Continue)
HRD, CSIR-IMMT Page 1

2. 4. Graduation Degree (Engineering):
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
1st semester
2nd semester
3rd semester
4th semester
5th semester
6th semester
7th semester
8th semester
5. Master Degree (Engineering):
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
1st semester
2nd semester
3rd semester
4th semester
GATE score
6. M.Sc.
Name of Exam. Year of Division Marks/ Subject Institute from University/
passing Grade which passed Board
1st semester
2nd semester
3rd semester
4th semester
* Fill up the relevant information only.
* Hard copy addressed to Head- HRD, CSIR- IMMT, P.O-RRL, Acharya Vihar,
Bhubaneswar-751013.
• Mandatory Requirements:
o Attach photocopy of following documents:
HRD, CSIR-IMMT Page 2

3. • Permission letter from HOD
• Marksheet from 10th onwards.
• Pass certificate from 10th onwards.
o Application will be rejected under following conditions:
• Incomplete application.
• Non submission of relevant documents.
Signature of the Applicant
HRD, CSIR-IMMT Page 3

4. • Permission letter from HOD
• Marksheet from 10th onwards.
• Pass certificate from 10th onwards.
o Application will be rejected under following conditions:
• Incomplete application.
• Non submission of relevant documents.
Signature of the Applicant
HRD, CSIR-IMMT Page 3

5. • Permission letter from HOD
• Marksheet from 10th onwards.
• Pass certificate from 10th onwards.
o Application will be rejected under following conditions:
• Incomplete application.
• Non submission of relevant documents.
Signature of the Applicant
HRD, CSIR-IMMT Page 3