Get Jalma Agra

National JALMA Institute for Leprosy Other Mycobacterial Diseases ICMR PO Box No. 1101 Dr. M. Miyazaki Marg Tajganj AGRA- 282001 Application Form for Training Programmes For office use only Affix a recent passport size photograph Index Acknowledgement No. Applied For Summer training 15 Days From. to Short term training 2 months Project training Six months One year Name of the Candidate. Father s / Guardian s name Date of Birth Sex Category General Full postal address SC ST OBC PH. Phone No with STD code Mobile. E-mail Presently studying in BSc MSc BE M. Tech PhD College City State. University Academic record Exam Passed Year Subject Board/Univ Percentage of marks 10th 12th Graduation Post-Graduation I hereby declared that the above information given by me is true to the best of my knowledge and belief* I am aware that providing incorrect information in the application form may result in cancellation of my candidature any time during the entire period in the Institute. I will abide by all the rules and regulations of the Institute. Date Place. Signature of the candidate Please make sure that you have attached photocopies of the following documents along with the application form* Forwarding letter from the Head of the Institution/Head of the Department Marksheet of 10th Marksheet of Graduation Marksheet of Post-graduation Category Certificate. to Short term training 2 months Project training Six months One year Name of the Candidate. Father s / Guardian s name Date of Birth Sex Category General Full postal address SC ST OBC PH. Phone No with STD code Mobile. E-mail Presently studying in BSc MSc BE M. Tech PhD College City State. Phone No with STD code Mobile. E-mail Presently studying in BSc MSc BE M. Tech PhD College City State. University Academic record Exam Passed Year Subject Board/Univ Percentage of marks 10th 12th Graduation Post-Graduation I hereby declared that the above information given by me is true to the best of my knowledge and belief* I am aware that providing incorrect information in the application form may result in cancellation of my candidature any time during the entire period in the Institute. University Academic record Exam Passed Year Subject Board/Univ Percentage of marks 10th 12th Graduation Post-Graduation I hereby declared that the above information given by me is true to the best of my knowledge and belief* I am aware that providing incorrect information in the application form may result in cancellation of my candidature any time during the entire period in the Institute. I will abide by all the rules and regulations of the Institute. Date Place. Signature of the candidate Please make sure that you have attached photocopies of the following documents along with the application form* Forwarding letter from the Head of the Institution/Head of the Department Marksheet of 10th Marksheet of Graduation Marksheet of Post-graduation Category Certificate. to Short term training 2 months Project training Six months One year Name of the Candidate. Father s / Guardian s name Date of Birth Sex Category General Full postal address SC ST OBC PH. Phone No with STD code Mobile. E-mail Presently studying in BSc MSc BE M. Tech PhD College City State. University Academic record Exam Passed Year Subject Board/Univ Percentage of marks 10th 12th Graduation Post-Graduation I hereby declared that the above information given by me is true to the best of my knowledge and belief* I am aware that providing incorrect information in the application form may result in cancellation of my candidature any time during the entire period in the Institute.