Instructions to candidates for filling the Application form 1. Each page of the application form should be duly signed by the candidate. 2. All the certificates attached should be self-attested. 3. Candidate should affix a recent passport size photograph on the application form. 4. Impact factors of the articles should be cited according to Sci index not NAAS index. 5. Areas of the proposed research work should be super scribed on the top of envelope while sending in the application. 6. No additional documents need to be send with the application form while applying. 7. Applications not in the above format will be summarily rejected.
8. GOVERNMENT OF INDIA MINISTRY OF SCIENCE & TECHNOLOGY DEPARTMENT OF BIOTECHNOLOGY (DBT) APPLICATION FORM FOR DBT CREST AWARD: 2012-13 (FORMERLY BIOTECHNOLOGY OVERSEAS ASSOCIATESHIP-BTOA) Part-A (Personal bibliography) 1. Applicants Name: (Full name in capital letters) 2. Designation 3. Address of the candidate Telephone No. (office) Telephone no. (Residence) Mobile no. Fax: Email address: 4. Name and address of the parent Institute 5. Father s/ Husband s Name (in full) 6. a. Date of birth (DD/MM/YYYY) (Enclose age proof) b. Age (as on deadline of submission) 7. Nationality 8. Details of the nature of present and past employment (chronological order) Name of the employer Nature of employment Duration of employment 9. a. Area of the proposed research work b. Title of the proposed research work
Part B (Academic details) 1. Academic Qualifications (Bachelor s degree onwards) Name of the College /Institute and University Year of degree awarded Subject(s) of Specialization Percentage of Marks 2. Additional qualifications Name of the College /Institute and University Year of degree awarded Subject(s) of Specialization Percentage of Marks and Distinction 3. National fellowships (CSIR-UGC fellowship, GATE, DBT, ICMR, INSPIRE etc.) Name of the fellowship Year of award Subject
1. Projects handled as Principal Investigator Part-C (Professional experience and publications) Title of the project Year Institutional/Extramural Funding agency 2.a. Research publications in indexed journals during the last five years (enclose a list, exclude presentations in seminars/symposia; attach reprints of 5 research papers which you consider the best). Authors, year of publication Title of Paper Name of the Journal volume, page numbers Impact factor (SCI Index) Cumulative impact factor of 5 publications 2.b. Publication in peer reviewed journal with impact factor of more than 10. 3. Awards/honors (Awards instituted by National academies, DBT (IYBA), CSIR (Shanti Swarup Bhatnagar Award) will be considered. 4. Patents awarded (only awarded patents will be counted) Patent no. Indian/International 5.a. Have you been previously selected for any fellowship/ associateship award (National/overseas) of DBT or any other funding agency? (Please indicate as yes or no) b. Details of your past overseas visits Name of the country/countries visited Purpose of visit Year of visit Duration of visits (dates)
Part- D (Details of the proposed research area/training) 1. Proposed area of research/ training 2. Title of the proposed study 3. Duration of the proposed study 4. a. Proposed overseas host Institution b. Name, designation and contact details of the foreign supervisor (Note: Enclose original copy of the consent letter of host Institute (Mandatory)) 5. Summary of proposed research work indicating Objectives (Preferably in bullet/numbered format) Methodology Work plan Importance of proposed research 6. Financial authority of the Institution in whose name Demand Draft/cheque should be issued alongwith address (Please enclose endorsement of the parent organization) 7. Declaration of the candidate: I (Name of the candidate), S/O or /D/o Sh. (Name of Father/Mother) hereby declare that the details and statements furnished in the Application form (Part A+B+C+D) are correct and true to my knowledge. I have gone through the terms and conditions as enlisted at S. no. 1 to 22 of the DBT CREST Award (2012-13) and in the event of my selection I will abide by the terms and conditions as laid down by Department of Biotechnology, Government of India for availing the Award. Date: Place: (Signature and full Name of the candidate)
Summary Sheet 1. Full name of Candidate 2. Age on deadline of submission 3. Name of the Parent Institution, Contact no. and email address 4. Area of proposed research/training 5. Title of Proposed research/training 6. Proposed Host Institution 7. Proposed duration of Associateship 8. Graduation percentage 9. Post-graduation percentage 10. Ph. D (Yes/No) or no. of years of research experience in case of candidates with M.D/M.S/M.pharma 11. National fellowship as enlisted in Part-B, point 3 of application form (Indicate Yes/No) 12. No. of Institutional Projects handled as Principal Investigator 13. No. of Extramural Projects handled as Principal Investigator 14. Cumulative impact factor of 5 publications as enlisted in Part-C, point 2a of application form according to SCI Index 15. Publication in peer reviewed journal with impact factor of more than 10 (indicate only no. of publications according to SCI Index 16. Awards/honors as enlisted in Part-C, point 3 of application form (Indicate Yes/No) 17. International Patents awarded (Indicate no. only) 18. National Patents awarded (Indicate no. only) Date: Place: (Signature and full Name of the candidate)
Check list (Write Yes/No) 1. Completed Application form 2. Proof of age certificate 3. Endorsement/Approval from Head of Institution 4. Consent letter from Host Institution 5. Signature on each page of the Application form Date: Place: (Signature and full Name of the candidate)