INDIAN INSTITUTE OF TECHNOLOGY (INDIAN SCHOOL OF MINES) DHANBAD
Form No: PH01
APPROVAL FOR ACADEMIC WORKS OUTSIDE THE INSTITUTE
(NOT APPLICABLE FOR INDUSTRIAL / RESEARCH INTERNSHIP)
PART A
1. Name of Scholar
2. Admission No. Date of PhD Admission
(DD/MM/YYYY)
Registration Status of the Part-
3. Full-Time External
Scholar (Put √ Mark) Time
4. Department
5. Date of DSC Meeting (if applicable)
(DD/MM/YYYY)
6. Type of Academic Work (Tick any one):
Presenting research work in a conference / symposium etc.* (Attach paper acceptance letter).
Conference / symposium to be attended:
i. Paper title:
Authors:
Name of the presenting author:
Attending a conference / symposium etc. without any accepted paper (Attach invitation letter).**
ii
Conference / symposium to be attended:
Attending project meeting (Attach invitation letter).
iii.
Project title:
Attending course work / workshop / training / short courses etc (Attach invitation letter).
iv.
Workshop / training / short courses etc to be attended:
Attending research labs / institute / industry for experimental / research work (Attach invitation letter).
v.
Research lab / institute / industry to be visited:
Field visit / Sample collection inside the territory of an organization (Attach invitation letter).
vi
Organization to be visited:
vii. Field visit / Sample collection in an open area (Attach Tour plan)
Others
viii.
Details of academic work:
*Only the presenting author is allowed.
**Not applicable for the full time research scholars availing institute fellowship.
7. Proposed Duration and Type of Academic Visit:
From (DD/MM/YYYY) To (DD/MM/YYYY)
Type of Leave Required (Tick any one): ALCW ALND
Academic Leave balance: ALCW ALND
• In case of short term visits (not more than 15 days) DSC recommendation is not mandatory. Supervisor can give the necessary
observations and recommendations. For Long term visits (more than 15 days) DSC recommendation should be provided.
• ALCW is allowed for short term visits under point 6(i)-6(vii). ALND is allowed for long term visits under point 6(iv)-6(vii).
In specific cases, when sufficient ALCW is not available, ALND can be availed for short term visits under point 6(iv)-6(vii).
Signature of the Student with Date:
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8. Specific observations made by the Supervisor / DSC (if space is not sufficient, please attach separate sheet):
9. Recommendation of the Supervisor / DSC (if space is not sufficient, please attach separate sheet):
Signature of Supervisor / DSC Members present:
Name (Department) Position Signature Name (Department) Position Signature
Supervisor Chairperson
Member Member
(Dept.) (Dept.)
Member Member
(Sister (Sister Dept.)
Dept.)
Co-Supervisor, External Co-
if any Supervisor
Forwarded by Convener, DPGC (Name & Signature):____________________________________________
For Office Use only
Checked Fee details ☐ Yes ☐ No
Verified Fellowship details, if applicable ☐ Yes ☐ No
Observations, if any
Dealing Assistant AR (Academic - (PG) / DR (Academic)
Recommended / Approved by
Associate Dean (Academic – PG)
Date: ________________
Approved by
Dean (Academic)
Date: ________________
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INDIAN INSTITUTE OF TECHNOLOGY (INDIAN SCHOOL OF MINES) DHANBAD
PART B
(To be filled in case reimbursement is required from Institute / External research fellowship contingency
head. For reimbursement from project head and other travel grants, separate tour approval should be
obtained from Dean (R&D))
(a) Name:
1. (b) Admission No.:
(c) Department:
2. (a) Place(s) to be visited:
(b) Persons to be contacted:
(a) Proposed date & time starting from the institute:
3.
(DD/MM/YYYY)
(b) Proposed date & time return to the institute:
4.
(DD/MM/YYYY)
5. Type of academic work: (as per type of academic
mentioned in Sl. No. 6 of PH01-PART A)
6. Mode of transport:
Budget-head from which expenditure to be met: (i) Institute research fellowship contingency
(Tick any one) head
7.
(ii) External research fellowship (e,g, PMRF
/ UGC / QIP) contingency head
Date(s) & time of absence from tour program for
8. personal purpose & type of leave, if any planned to
be availed while on tour:
Any other relevant information:
9.
Declaration:
(a) The information provided is true.
10. (b) I am the sole presenting author of the paper (Strike through if not applicable).
Signature of the student with date:
11. Forwarding by the supervisor:
Signature:
Name:
Department:
Recommendation by the HoD / HoC:
12. Signature:
Name:
Department:
Verification / Comments of AR (PG):
13.
Approval of the Associate Dean (Academics-PG):
Approved as per institute rule / Not-approved.
14.
Leave Type: ALCW / ALND
[Soft copy of this form (PH01-PART B) should be attached during leave application through MIS. The hard copy should be
submitted to the account section during claiming reimbursement.]
AD(PG) > AR (PG) > HOD > SUPERVISOR > STUDENT
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