primeministerfellowshipscheme

View Application Form

Personal Details
Details of PhD
Educational Details
Host Institute (PhD) Details
Academic Guide Details
Partner Company Details
Industry Mentor Details
Current Employment /Fellowship Details
Undertakings & Other Documents
Declaration

Personal Details

Prefix*

First Name*

Middle Name

Last Name*

Gender*

Male Female

Date Of Birth*

Email*

Mobile*

Father's Full Name*

Martial Status*

Married Unmarried

Nationality*

Indian Other

Specify Nationality in case of Other

Recent Passport Size Picture*

Complete Permanent Address

Address*

State*

City*

Specify City in case of Other

Pincode*

Complete Postal Address (If Same as Permanent Address)

Address*

State*

City*

Specify City in case of Other

Pincode*

Details of PhD

Date of Enrolment in PhD*

Date of Registration in PhD*

Same as Above

This date may be the same as enrollment date in case of some institute / university rules (Note: A candidate can apply to PM Fellowship if she/he has been registered for PhD for not more than 14 months from the date of submission of application)

PhD Enrolment Certificate*

(Upload Pdf only)

PhD Registration Certificate*

(Upload Pdf only)

Institute where enrolled/registered in PhD *

University

Nature of PhD enrolled/registered in*

Full time Part time

Address*

State*

City*

Specify City in case of Other

Pincode*

Broad Research Area*

Sub-Classification of Research Area*

(E.g. Chemical Engineering, Horiculture)

Research Topic/ Title*

Total Char: 0. Words Char: 200
(Maximum 200 characters)

Research Problem Synopsis*

Total Char: 0. Char left: 300
Please write only a brief version of your research problem (maximum 300 Characters) highlighting the goals and objectives of your research

Upload your Research Problem Synopsis*

(Upload Doc only)

List of Publications

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Educational Details

Details of 10th Board

Board*

CBSE ICSE State Board Other

Subjects Taken*

Year of Passing*

Total Percentage Scored(%)*

Note: In case you received a CGPA or similar score, please convert it to percentage and enter the value in this field.

Upload scan copy of your 10th certificate*

(Upload Pdf only)

Details of 12th Board

Board*

CBSE ICSE State Board Other

Subjects Taken*

Year of Enrollment*

Year of Passing*

Total Percentage Scored(%)*

Note: In case you received a CGPA or similar score, please convert it to percentage and enter the value in this field.

Upload scan copy of your 12th certificate*

(Upload Pdf only)

Details of Graduation Degree

Name of Graduation Degree*

Type of Graduation Degree*

Regular (3 or 4 Years) Integrated (5 Years)

Specialisation*

Subject*

Total Percentage/ CGPA Scored(%)*

Note: In case you received a CGPA or similar score, please convert it to percentage and enter the value in this field.

Institute*

University

Year of Enrollment*

Year of Passing*

Upload scan copy of your Graduation Certificate*

(Upload Pdf only)

I have taken admission in PhD directly after my graduation.

Details of Post Graduation Degree

Name of Post-Graduation Degree*

Specialisation*

Subject*

Total Percentage/ CGPA Scored(%)*

Note: In case you received a CGPA or similar score, please convert it to percentage and enter the value in this field.

Institute*

University

Year Of Enrollment*

Year Of Passing*

Upload scan copy of your Post-Graduation Certificate*

(Upload Pdf only)

Details of Other Degree/Diploma

Name of Other Degree/Diploma

Specialisation

Subject

Total Percentage Scored(%)

Note: In case you received a CGPA or similar score, please convert it to percentage and enter the value in this field.

Institute

University

Year Of Enrollment

Year Of Passing

Upload scan copy of your Other Degree/Diploma Certificate

(Upload Pdf only)

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Host Institute (PhD) Details

Details of PhD Institute

Name of institute where Registered for PhD*

Name of Department*

Address*

State*

City*

Specify City in case of Other

Pincode*

PhD Institute STD Code*

PhD Institute Phone Number*

PhD Institute website*

Upload Profile of Host Institute*

(Upload Pdf only)

Do you avail the hostel facility at your institute?*

Yes No

Address

State

City

Specify City in case of Other

Pincode

Details of PhD Institute Head

Phd Institute Head Name*

PhD Institute Head Designation*

PhD Institute Head Address*

PhD Institute Head State*

PhD Institute Head City*

Specify City in case of Other

PhD Institute Head Pincode*

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Academic Guide Details

Details of the 1st Supervisor/Research Guide for PhD

Prefix*

Full Name*

Designation*

Mobile*

Email*

Bio Data of PhD Supervisor, not exceeding 3 pages*

(Upload Pdf only)

Details of the 2nd Supervisor/Research Guide for PhD

Prefix

Full Name

Designation

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Partner Company Details

Name of Partner Company*

Partner Company Website*

Partner Company′s Year Of Incorporation*

Number of Employees in Partner Company*

Products / Services offered by the Partner Company*

Address*

State*

City*

Specify City in case of Other

Pincode*

Annual Turnover of Partner Company*

Partner Company's Latest Balance Sheet*

(Upload Pdf only)

Partner Company Logo*

Partner Company Profile*

(Upload Pdf only)

Details of Partner Company Head

Partner Company Head Name*

Partner Company Head Designation*

Partner Company Head Address*

State*

City*

Specify City in case of Other

Pincode*

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Industry Mentor Details

Prefix*

Full Name*

Designation*

Mobile*

Email*

Address*

State*

City*

Specify City in case of Other

Pincode*

STD Code*

Phone Number*

Upload Bio-Data of Industry Mentor, not exceeding 3 pages*

(Upload Pdf only)

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Current Employment /Fellowship Details

Currently availing any fellowship?*

Yes No

Name of the agency providing fellowship*

Are you interested in switching over from present fellowship to the PM's Fellowship for Doctoral Research?*

Yes No

Are you currently employed in some job/ assignment?*

Yes No

Name of the employer*

Job / Assignment Description / Designation*

Address*

State*

City*

Specify City in case of Other

Pincode*

Next Previous

Undertakings & Other Documents

Undertaking from the Research Supervisor and Head of the Institute / University*

(Upload Pdf only)

Undertaking from the Industry Partner in the Research Project*

(Upload Pdf only)

Letter from the Industry Partner (on company’s letterhead) on the research problem and the future plans for implementation, if any

(Upload Pdf only)

Next Previous

View Application Form

Welcome

Personal Details

Complete Permanent Address

Complete Postal Address (If Same as Permanent Address)

Details of PhD

Educational Details

Details of 10th Board

Details of 12th Board

Details of Graduation Degree

Details of Post Graduation Degree

Details of Other Degree/Diploma

Host Institute (PhD) Details

Details of PhD Institute

Details of PhD Institute Head

Academic Guide Details

Details of the 1st Supervisor/Research Guide for PhD

Details of the 2nd Supervisor/Research Guide for PhD

Partner Company Details

Details of Partner Company Head

Industry Mentor Details

Current Employment /Fellowship Details

Undertakings & Other Documents

Undertakings & Other Documents

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Your details have been mailed to the Student, They will revert to you shortly. If any query you may contact Mr. Ravi Hira at pm.scheme@cii.in

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