Title
*Last Name:
*First Name
Middle Name
*Name of Institute
*Address
*Address 1
*E-mail ID
Sex
*City
* Telephone No.
Fax No.
* Mobile No.
* Date of Birth
*Have you read the criteria & understood the process ?
Yes No
* Is this training a part of your curriculum and is essential for the fullfillment of degree programme ?
*HOD Letter obtained ?
Select the area of interest
Clinical Sciences
Epidemiology & Biostatistics
Pharmacy
Immunology & Serology
Molecular Virology
Microbiology & Clinical Pathology
Social & Behavioural
Latest Degree status
Name of University
Post Graduation Subject
Passing year
Graduation
Graduation Subject
12th School Name
Name of Board
Subject
Passing Year
10th School Name
*Describe your research interest in a short paragraph :
*Attach CV
