-~isrc --

SPACE APPLICATIONS CENTRE, ISRO

Ahmedabad, Gujarat-380058

Application for Scientific Research and Training

(Website: www.sac.gov.in/Vyom/srtd/)

3f~'ffltp Jram~M
Please type or write In CAPITAL Letters

For Office Use only (/

1' .. •t1" • t...,,,.,--i·.
i . ; ,.. /'
Application No.
' : '.

Date of Receipt • I '

, : r
k. .
. ,
\. *?
.'·~ ~:.
1. Personal Details

-.:m:I' Name -~ffl~ Mr./Ms. DH4f_l/ P!trf-L- '

~ ~ /cllQ
Date ofBirth (DD / MM /YYYY) z.rl o 6 / 2.-002.-
ffi1f Gender(Tick appropriately) ~ ~ ~ / F e male

Nationality (Indian/Foreign/Dual)
J.NDr/+fV
'Qcl1 Permanent Address: .4 <H /t MW Dfl - M~G:.ftf,?. - I lrrJ K P-.OlrO f3HMU;a
oPPO SI.re HD P-c 8/HVK

Communication Address
PLH -R 9 GBSID£S av l8 lt:I. 1£ KRA P~Pol~.: ,
Offr.(,f. oPPOSI..Tt t,.O {.,N (Fj" N E:./!:.RI rJ(x lOU.tfi.f

3IT'clR ffl ~- Aadhar Card No. G:26(, 2-~q, 6360

~Phone No. b3~'3g ::f-<J'2--Q...1
!

fi@~Email!D d hJi l{J , p{ty ())--d~ ed.u Qi r1

- V

2. Do you have any relative among the staff of SAC/I SRO (Yes/No)? .. NO ........... .
If yes, please give the following particulars:

Name of the Relative Relationship with the Candidate Designation

Website: www.sac.gov.infVyom/srtd/
 3. 3ftcrr Educatton Quallftcatton:

Qldtlif>il
~qflrll, ~a~m;q q;-rqlf "~frci;
Specialization/ Thesis University/Institution with city %/CGPA/Rank
Course Year of
Title and state name if any
Passing
~.°ttPhD

Postgraduate
3;n,11 CoMPllrfR ia NL N-IHt.OA-8/'rD UNTV SIT'/ :2-02-lt
Undergraduate u, A-ND £,N(J..rNUP..rNIJ,

4. Mention prior research experience (if any)

... N1;.1,,,·················· ·················7 ······ ······· ······················· ·· ················· ···················· ·········· ····························

-------------------------------------- -..---------································--······--·--------------·················--··········-·························

5. 3nt1ctfhnl'Qffl/~ Mention your core technical skills/competencies (Analytical etc.)

~;~t;-!_·t;I.C.$.;..T?..ltr.!.1: ....~L~V..ITT!B.U ...~-'?...:~~Q..t\pHMS...7 .. !if:BN ..JTl![K., .. ~:~ft'e~rl'I"'

6. ~<li'T~/Proposed Research Topic

7: ' Brief Description of Research

__________ _.___________ J·-----~--...... ,. ............... -----··················--------------- ---------··-·························-·-·------------------------------

••• • • • • • •••••••••••• • •••••••• t ••• • • • •••••••••• • ••••• ••• •••••••••• • ••• • ••• ••• ••••• • •••••••• • •••••••••• • • • •• • ••• • ••••••••• •• •••• •• ••••••••• •• • • ••••••• • ••••••••••••• •

8. q;rq31crRJ,..(10+ ........ -)~~cf>l4wHAi ctftftrf¾L/---/--··

Research duration (10+ 11.:. ).weeks with starting Date. L ,/ .. 1.../ .Ml:?l-t -

~?-,z~ ~ ;
IO /tlJ/ 9,C ').-3 ,,.
1;W Jffi~i\iW!~mrR~ftll<lllf q;f'~
~~tral[&f<clt/T~ Recommendation by Head of Department/Institution/Principal
Signature of the applicant with Date
with seal and date

9. Emergency Contact Details CJ 8 rg- q O&--9 T

3fT'Q"&"T "ctft~-!l m "Gl'R tJ fcNm-lfUA/cf>lqfci1qt11ftcrn' <fj"f {-lfa"~lJiFJ
Contact E-mail & Phone of HOD/ Office/ Family in case of Emergency

Website: www.sac.gov.infVyom/srtd/
Instructions to the Candidate

• Candidate shall submit duly filled, signed and scanned PDF copy with name
ShortN ame_Degree_Subject_Duration_ProposedJoi ningDate _Un iversityShortN ame_ Un iversityCity.pdf of
t his form to srtd@ sac.isro.gov.in with subject as YourShortName_SRTD_Application_MobileNo
A copy of ema il to Head of Inst itut e/Placement office of institute, in case of submission
through e-ma il. Incomplete form, in any aspect, shall be rejected .

Exp: Mail-subject should be like Arvtnd__SRTD_ftpplicatlon_9999999999

Exp: File-Name should be like Arvtnd...Mtecb_Meclt.20Weeks_10Aug2022_CSAUJ{anpur.pdf

• It is advised to submit your Application well in advance, typically 1 month prior to expected
date of start of training, t o enable due processing of the application.

• Candidate shall carry followi ng documents at t he time of reporting.

- Passport size photograph (2 Nos.)
- Bon afide Certificate {Original and 1 Copy)
- University/Institute ID Card (2 Copies)
- Aadhar Card, if available (2 Copies)

Terms & Conditions

• SAC {ISRO) reserves the right to ask for original documents, for verification purpose only.

• No Fee is charged to the Candidate for Research/Training project.

• No stipend or any other form of monetary compensation is provided to the Candidate.

• Candidate shall not undertake any parallel assignment during the period of search/training
at SAC {ISRO).

• Candidate, during the research/training period, shall abide by extant policies and guidelines
of DOS/ISRO, as applicable.

• SAC {ISRO) reserves the right to terminate the research/training project, at any point, if the
candidate is found in violation of any of the rules and regulations of SAC {ISRO)

I hereby declare that all details furnished by me in this application are true, complete and
correct to the best of my knowledge and belief. I understand that in the event of any
information being found false, incomplete or incorrect, my candidature is liable to be
cancelled.

I have read above instructions and accept terms & conditions mentioned in this form .

() p~'),oQ..~
~1101•
ft:ljq,~~ 31'llt4f~~&R'
Signature of the applicant with date

Website: www.sac.gov.in/Vyom/srtd/