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Application form for
Short-term Research Grants for
Undergraduate Students of institutions
affiliated to RGUHS for the year 2023-24
SECTION -A
Full Name of the Student
(all capitals & as mentioned in the macks card)
MS.SAVITA S SALABANNAVAR
‘Name of the Institute
SBV'S, JVM'S Grameen Ayurvedic
Medical College, Hospital & Research
Centre, Terdal -
‘Address of the Institute
SBV'S, JVM'S Grameen Ayurvedic
Medical College, Hospital & Research
Centre, Terdal - 587 315 Tq-Jamkhandi,
Dist - Bagalkot
Email salabannavarsavita888(@ gmail.com
Mobile Number - 7349151430
‘Name of the course student studying BAMS III Year
Date of Joining course 25 September 2019
Year and Month of passing 1", 2™ , & 37 2" year-07"
ear Examination/s April 2022
Second year Third Year|
MBBS/BDS/Pharm.D
Presently studying in Yes | No YI No
Max. Total | Secured | Percentage % of
L_ Marks marks
DETAILSOFMARKS | T" YEAR 1050 | TAD
SCORED* Ivar
commen TIAN PHARMD STUDENTS) | Semester
2" YEAR 1250 940 75.20%
{eps
Pharm sant
_| nis
ENCLOSE PREVIOUS YEAR/S Original marks card Yes: XM
MARKS CARD cop: = |
(Xerox copy of original marks card fintemet result | internet result copy Ares,
{as inthe marks card)
copy / result sheet attested by college copy) result sheet attested by
college cop; ie
STUDENT REGISTER NUMBER 1941225
[Full Name of the Guide
Dr.Bharati B Kumbar
Designation of the Guide
Professor
Department of the Guide
Prasuti Tantra & Striroga -2-
‘Address of guide for correspondence
Staff Quarters, Vigyagiri Gurukul Campus,
GAMC, Terdal- 587 315
Mobile Number of the Guide
9449644186
Email of the Guide
cirbharatikumbhar9@email.com
NAME OF THE HEAD OF THE.
INSTITUTE,
~ | Dr. Lingaraddi M Biradar, Principal
SBY'S, JVM'S Grameen Ayurvedic Medical
College, Hospital & Research Centre.
‘Terdal
DESIGNATION OF THE HEAD OF THE
INSTITUTE
Principal/ Professor 10D of Panchakarma
ADDRESS OF HEAD OF THE
INSTITUTE FOR CORRESPONDENCE,
Dr. Cingaraddi M Biradar, Principal
SBV'S, VMS Grameen Ayurvedic Medical
College, Hospital & Research Centre, Terdal
MOBILE NUMBER OF THE HEAD OF
‘THE INSTITUTE
8277714346
| EMAIL OF THE HEAD OF THE
INSTITUTE
gemcterdal@gmail.com
‘Research Account Details of the Institute
‘Name in the Bank Account
PRINCIPAL GAMC TERDAL
‘Account Noz
08182200040058
‘Bank Name:
CANARA BANK
Branch Name:
TERDAL,
IFSC Code:
CNRBOOIO818
shiek
course are not eligible to apply
Ye
Signature of the Guide
Journtow
FR Bina.
Candidates studying in I" year OR studying in final year of any
ee
war
Signatute of the Student
20-2
Signature ofthe Hoa of the Institution
edic Medical Cohege
Eagake
