Homi Bhabha National Institute Regd. Office: Training School Complex, 2nd floor, Anushaktinagar, Mumbai 400 094 Application for Recognition as Faculty / M. Tech. Guide / PG Teacher Applicant’s Name Date of birth (dd/mm/yyyy) Male / Female (Tick the correct one) PAN card Number Residential Address Name of the Constituent Institution (CI) to BARC / IGCAR / RRCAT / VECC / SINP / IPR / TMC / IMSc / HRI / IoP / which the applicant belongs NISER Office Address with Contact nos. & Email Address Designation If from BARC Training School (TS) (a) Location of BARC TS & Discipline (b) Year of Graduation from BARC TS If not from BARC TS, date (dd/mm/yyyy) & mode of joining CI Present status of the applicant (if any) PG Teacher / M.Tech Guide / Faculty of ___________________Sciences The applicant desires to be recognized as (Tick any one) Faculty M. Tech. Guide PG Teacher (Tick any one) Discipline under which the applicant desires to register Chemical Sciences Engineering Sciences Physical Sciences Health Sciences Life Sciences Mathematical Sciences Strategic Studies Educational Qualifications (graduation degree onwards) (Attach self attested photo copies of all Mark Sheets and Degree Certificates) S. No. Degree Year % Marks Subjects University Title of Ph.D. Thesis: Applicant’s Research Area & Experience:
Homi Bhabha National Institute Regd. Office: Training School Complex, 2nd floor, Anushaktinagar, Mumbai 400 094 Application for Recognition as Faculty / M. Tech. Guide / PG Teacher Applicant’s Name Date of birth (dd/mm/yyyy) Male / Female (Tick the correct one) PAN card Number Residential Address Name of the Constituent Institution (CI) to which the applicant belongs BARC / IGCAR / RRCAT / VECC / SINP / IPR / TMC / IMSc / HRI / IoP / NISER Office Address with Contact nos. & Email Address Designation If from BARC Training School (TS) (a) Location of BARC TS & Discipline (b) Year of Graduation from BARC TS If not from BARC TS, date (dd/mm/yyyy) & mode of joining CI Present status of the applicant (if any) PG Teacher / M.Tech Guide / Faculty of ___________________Sciences The applicant desires to be recognized as (Tick any one) Faculty M. Tech. Guide PG Teacher Discipline under which the applicant desires to register (Tick any one) Chemical Sciences Engineering Sciences Physical Sciences Health Sciences Life Sciences Mathematical Sciences Strategic Studies Educational Qualifications (graduation degree onwards) (Attach self attested photo copies of all Mark Sheets and Degree Certificates) S. No. Degree Year % Marks Subjects University Title of Applicant’s Ph.D. Thesis: Research Area & Experience:
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