Application Form for Internship

1. Name of the candidate *(in full)
2. Date of Birth * [DD/MM/YYYY]
        Age *    
3. Sex *
4. Address for Correspondence *
5. Permanent residential address *
6. Contact No.     Res :
        Mobile :*        
7. Email address *
8. Pursuing Degree/Course*
9. Date of start [MM/YY]*
         Date of Completion [MM/YY]*        
10. Name of the Institute and its Affliation*
11. Academic Qualifications [From 10+2] onwards*
ADD Qualification
12. Achievements [if any]: State-level Medals, Scholarships, Prizes or any other Award, Distincation or Honour won :
13. Other Qualification [if any] :
14. Research Training / Experience [if any]:
15. State exact period of internship requested*: From
16. Discipline in which internship at NCDIR is sought:*

17. Specify learning objectives during internship at NCDIR:


List of enclosures required to be submitted with the Application (Only .pdf file format are allowed)
1. Photo (Size: <20 KB)
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2. Certificate of Graduate Degree / Diploma
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3. Mark sheet of Postgraduate Degree / Diploma
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4. Concept note of work to be taken up during internship (2 pages)
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