27/10/2016

Admission Acknowledgment Receipt

Application Form for Ph.D (Sciences) Admission at AcSIR

Headquarters: Training & Development Complex, CSIR Campus,
CSIR Road, Taramani, Chennai - 600113

Coordination Office: CSIR-Central Road Research Institute,

CRRI P.O., Delhi-Mathura Road, New Delhi - 110025

Official Information
Form No : 19213
: Jan-2017
: Ph.D (Sciences)
:

Session
Programme Applied For
CSIR Lab Preferences

(1)CSIR-National Physical Laboratory (CSIR-NPL), New Delhi

(2)CSIR-Institute of Minerals & Materials Technology (CSIR-IMMT),
Bhubaneswar
(3)CSIR-Central Glass & Ceramic Research Institute (CSIR-CGCRI),
Kolkata

Currently working in CSIR Lab?

: No

Relevant research/teaching experience in

Months

:0

No. of papers published/accepted in SCI

journals

:0

Total impact factor generated

:0

Personal Information
Name
Category
Are You Physically
Handicapped ?
Gender
Permanent Address

Present Address
Nationality
E-mail
AlternateE-mail
Mobile No.
Phone No.
Date of Birth
Father's Full Name
Mother's Full Name

: MANISH KUMAR MOHANTA

: OBC
: NO
: Male
: Address :AT/PO BHOLPADA VIA SAHARPADA
: Country :INDIA State :Orissa
: City : Kendujhar Pin Code :758016
: Address :AT/PO BHOLPADA, VIA SAHARPADA, DIST KEONJHAR,
ODISHA, 758016
: Country :INDIA State :Orissa
: City : Kendujhar Pin Code :758016
: INDIAN
: manishkmr484@gmail.com
: manishbabu484@gmail.com
: 9643212837
: 91-9643212837
: 22/01/1995
: Kamala kanta mohanta
: DURMILA MANI MOHANTA

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Admission Acknowledgment Receipt

Educational / Professional Qualifications:

Qualification
10th
12th
B.Sc
M.Sc

Stream/Subject(s)

88
86.83

Evaluation
System
Percentage
Percentage

Year of
Passing
2009
2011

78.80

Percentage

2014

8.9

CGPA

2016

CGPA/%

ALL
PCM
PHYSICS (H), CHEM,
MATH
APPLIED PHYSICS

Board/University
ODISHA BOARD
CHSE, ODISHA
UTKAL
UNIVERSITY
ISM, DHANBAD

Fellowship Details:
Fellowship
CSIR-NET
JRF

Subject
PHYSICAL
SCIENCES

Registration/Ref.Letter Date of Exam/Ref.Letter

Rank Percentile Score
No.
Date
502915

19/06/2016

221

34.56

DECLARATION
I MANISH KUMAR MOHANTA confirm that I have submitted only one application for the online admission process and
declare that all the statements made in this application form are true, complete and correct to the best of my knowledge
and belief and nothing has been concealed/ distorted. I understand that in the event of any information being found false
or incorrect at any stage, my candidature/ admission is liable to be cancelled/ terminated without notice.

Place: ________________
Date: ________________

Candidate's Signature
(Manish kumar mohanta )

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Admission Acknowledgment Receipt

Only for Industry/ Project Sponsered Candidates

Endorsement by the Competent Authority of the Employing Organization
The facts stated in this application have been verified and found correct. This organization/ department has no
objection in Mr / Ms MANISH KUMAR MOHANTA applying for M. Tech./Ph.D. programme of AcSIR in
(specialisation/cluster)________________________________

at

CSIR-

___________________________________________ (lab) as a sponsored candidate.

Only for Project Sponsered Candidates

Project Name

Lab Name

Project Start Date

Project Completion Date

I endorse that the organisation agrees to all the academic and administrative requirements for completion of
the course by the student.
Signature
Date: _____________________
Name & Designation
Place: _____________________
Seal of Organization
Note: Please do not send this form to us, you will be required to bring it only in case you are called for
interview. However in case of Industry/Project sponsored candidates, need to send the application form to the
respective coordinator of the lab applied with due endorsement from the competent authority of the sponsoring
organization.
Checklist for Appearing in Interview, if Short-listed:

1. Two Printed copies of the submitted application form

2. Two copies of their recent passport size photograph
3. Originals along with two copies of each of the following documents:
1. Post-graduate or Graduate provisional or degree certificate
2. Detailed mark sheet(s) / transcripts showing the final CGPA or percentage of the above
3. Matriculation/secondary school certificate (in support of date of birth).
4. SC/ST/OBC/PH candidates are required to produce the requisite "Certificate" issued by the
competent authority.
5. Award of Fellowship related document

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