Awards for Indo-U.S. Genome Engineering/Editing Technology Initiative (GETin) Program Fellowship Application Format for Fellowship (This application form is only for reference to help the applicants soliciting and collating the required details/ documents/ enclosures. Applications should be submitted using our Online Application Portal, which will open for submissions from 01-08-2017. Hard copies and electronic copies of Application forms will not be accepted. In case of any assistance, please write to us at getin@indousstf.org) INSTRUCTIONS The application should be submitted in the prescribed format. Application should not be more than 20 pages including CVs. Candidates are encouraged to submit the application along with supporting documents as a single pdf document. Applications in subject-fields other than those specified in the advertisement will not be considered. Please ensure to attach the following two enclosures: Acceptance letter/certificate from host institute in the United States. Statement from the current employer as per the format indicated on Page 6. Two recommendation letters 1
APPLICATION SECTION I 1. Name (First name, Middle name, Surname): 2. Contact details (Postal address, Phone numbers and e-mail): 3. Date of birth (dd/mm/yy) and age (as on.): 4. Gender (Male/Female): 5. Parent Institution (Name, Address and Phone number): 6. Designation: 7. Employment [Do you hold a regular position in your institute? (Yes/No)]: 8. Passport details: Passport number: Place of issue: Date of issue: Date of expiry: 9. Academic qualifications: EDUCATIONAL QUALIFICATIONS (10 th Standard onwards) Examination/ Degree University/ Board Institute/ College/ School Duration (from mm/yy to mm/yy) Subjects studied/ Specialization Percent -age/ CGPA/ Rank 2
10. Employment history: EMPLOYMENT DETAILS (Please provide details of your work experience starting with the current Organisation and going back to previous organizations in reverse chronological order) Duration Name and Designation (from Address of and Brief job description/nature of work mm/yy to Organization Department mm/yy) 11. Honours and awards received: 3
APPLICATION SECTION II 1. Proposed Topic/Title of research: 2. Host institute in USA: 3. Host Mentor in USA: 4. Contact of the U.S. Mentor (Postal address, Phone numbers and e-mail): 5. Proposed duration of the fellowship (Months): 6. Brief summary of your current areas of research: 7. Description of scientific work planned including: (not more than 3 pages) (i) Specific need for the joint work (should not be confined only to access to instrumental facilities): (ii) Tangible outcome expected and its relation to present state of knowledge in the field: (iii) Mutual scientific benefit to be accrued to both sides: (iv) Follow up activities that may emerge towards a sustained collaboration: 8. State any other relevant aspects in the application which may be useful for the reviewer to make a qualitative judgment on the application: 9. Details of international fellowships availed in the last three years: S. No. Address of overseas institute Duration Agency which sponsored the visit Brief objective of the work done Achievement/ Outcome 4
10. Details of applications made/ pending for any other international fellowships: S. No. Address of overseas institute Duration Agency Brief objective of the work done 11. Scientific projects with applicant: S. No. Title Grant Period Cost (Rs. in lakhs) Funding Agency 12. List of publications (last five years): 13. List of papers presented in conferences: 14. Brief CV of the applicant and the host US scientist (not more than 2 pages each): 15. References (The references should be provided on the official letter-heads of the Referees). REFERENCES (Please furnish details of persons who can provide an assessment of your suitability for this fellowship) Details Reference 1 Reference 2 Name of Referee: Designation: Organization: Email id: Phone number: Relationship with Applicant 5
STATEMENT FROM THE CURRENT EMPLOYER (This should be given on the official letter-head of the parent institution/organization in the following format): This is to certify that this institution has no objection to the consideration of application for the awards for Indo-U.S. Genome Engineering/Editing Technology Initiative (GETin) Fellowship Program from Mr./Ms./Dr.employee in the (name of the department/institute/ organization) for research/ training in the area of. to be held at..for the duration of months. If the fellowship is awarded to him/her, Mr./Ms./Dr will be relieved from...(name of the institute/organization) duties for said period from the date of his/her joining for research fellowship under award for Indo-U.S. Genome Engineering/Editing Technology Initiative (GETin) Fellowship Program During this period, the continuity of employment on the post presently held by him/her would continue to be applicable and rules governing payment of salary (basic pay and all allowances), leave, medical benefits, gratuity, GPF, GIS, and pension etc. would continue to be applicable during the entire period of fellowship and he/she will join his/her present post on completion of tenure of his/her fellowship. Place: Date: (Head of Institution/Organization) Official seal 6