Application form for
Short-term Research Grants for
Undergraduate Students of Institutions
affiliated to RGUHS for the year 2024-25
SECTION -A
COMPARATIVE EVALUATION OF
EFFICACY OF CISSUS
QUADRANGULARIS GEL WITH AN
Title of the Research Project
ADJUNCT TO SCALING AND RO0T
PLANING IN TREATMENT OF
PERIODONTITIS - A SPLIT MOUTH
CLINICAL STUDY
Full Name of the Student
(all capitals& as mentioned in the marks ROSHNI NAGESH MAHASHETTY
card)
S.B. Patil Institute for Dental Sciences and
Name of the Institute
Research, Bidar
Address of the Institute Humnabad Rd, near Bharat Ford Showroom,
Naubad, Bidar, Karnataka 585401
Email mahashettyroshni@gmail.com
Mobile Number 9326926375
Name of the course student studying BDS
Department of Periodontics and oral
Subject
Implantology
Date of Joining eourse 7th April 2021
2nd, & 3rd
Year and Month of passing 1, December 2021 October 2022
yearExamination/s
Second year Third Year
MBBS/BDS/PharmD
No Yes
Presently studying in
Max. Total Secured Percentage %
Marks Marks of marks
DETALS OF MARKS 1 YEAR 453 600 75.5%
SCORED *
/1&2nd
Semester
(OTHER THAN 20d YEAR 800
531 66.3%
PHARMD STUDENTS) (MBBS/BDS /
PharmD
students only)
3rd YEAR
(PharmD
students only)
ENCLOSE PREVIOUS YEAR/S Original markscard Yes / No
MARKSCARD copy
(Kerox copy of original marks card /internet internet result copy Yes / No
result copy /result sheet attested by college
copy) result sheet attested by Yes / No
Head of the
institute/college
STUDENT REGISTER NUMBER 21D2381
(as in the marks card)
UG Intake per year in the institution 40 students
Full Name of the Guide Dr Sharashchandra
Designation of the Guide Professor and Head
Department of the Guide Periodontology and oral implantology
Department of Periodontics
Address of guide for correspondence SB PatilInstitute for Dental Sciences and
Research Centre
Naubad
Bidar-585403
Mobile Number of the Guide 9916508812
Email of the Guide drsharad_004p@yahoo.co.in
NAME OF THE HEAD OF THE Dr Shailendra Mashalkar
INSTITUTE
DESIGNATION OF THE HEAD OF THE Principal
INSTITUTE
Department of Periodontics
ADDRESSOF HEAD OF THE SB Patil Institute for Dental Sciences and
INSTITUTEFOR CORRESPONDENCE Research Centre
Naubad
Bidar-585403
MOBILE NUMBER OF THE HEAD OF 9341778390
THE INSTITUTE
EMAIL OF THE HEAD OF THE principalsbpdch@yhao0.co.in
INSTITUTE
If the Study involves any kind of Human Yes
Trial or Animal trials (Yes/No)
If yes, is the IEC (instituteEthical Yes
committee) certificate obtained? Attach it
with the application.
Research Account Details of the Institute
Name in the Bank AccountSBPatil dental college and hospital, Bidar
Account No: 07012200051762
Bank Name: CANARA Bank, Bidar
Branch Name: Main Branch
IFSC Code: CNRBO010701
Candidates studying in 1year OR studying in final year of any course are
Dot eligible to apply
Signgre ofheaide . Signature of the Student
Da-shasahchada
Signature f the Head ofthe Institution
YGIPAL
3.B. Patil Institute for
ental Science & Research
'AUBAD, BIDAR-585402
skerneteka
Certificate to be signed by the Student
Icertify that I am an MBBS /BDS /B.PHARM / PHARM.D / BAMS / BUMS /BNYS /
B.Sc.NURSING /BHMS /BPT /ALLIED HEALTH SCIENCE COURSES student and Iam
hereby proyiding true information in the online application form for award of Short-term
-
Research Grants for Undergraduate Students 2024-25, to the best of my knowledge. In the
event,any information found to be false, my research grants may be cancelled. I also certify
that the research proposal is an original work prepared under the guidance of my guide. I
confirm that I have not committed "Plagiarism" in preparing this proposal. I understand that
after evaluation of mny research proposal, I may or may not be selected and I shall abide by
the decision of the Research Committee of RGUHS constituted for this purpose. I shall
complete the project in time or face action as per rule.
Signakre of the Student
Certificate to be signed by the Guide
I agree to accept the applicant Mr/Mrs Roshni Nagesh Mahashetty
studying in Third Year
BDS course. (I MBBS / II MBBS Phasel/ BDS / B.
PHARM I PHARM-D / BAMS / BUMS / BNYS / B.Sc.NURSING / BHMS / BPT /
ALLIED HEALTH SCIENCECOURSES). I certify that he/she will be offered all facilities
and guidance by me for carrying-out research. I also certify that the proposal is an original
submission prepared by the student under my guidance. Iconfirm that neither me nor my
student have committed “Plagiarism" in preparing this proposal. I shallprovide required
facilities to enable completion of the research work so that the report is submitted on or
before the last date.
Sighature of the Guide Nane: pr. Shahashehandra
Designation: Proheuo~Ated
Department: Peleodami
Attested by Lmplontolog
Sonhase
Signaturegfthe
Head othINtowjth seal
3.B. Patil Institute for
ntal Science & Research
AUBAD, BIDAR-585402
Kamataka)
