Form for Post-Masters & Post-Doc
Panjab University
Chandigarh, Chandigarh
Application for BIRAC Innovation

Fellowship under

University Innovation Cluster (UIC)

PANJAB UNIVERSITY, CHANDIGARH
This Application is divided into 6 parts: Personal profile, Educational qualification, Master/Doctoral

work, Professional experience, References and Project Proposal.

  • All the fields are mandatory.
Personal Profile:
  • Applicant Type Govt. Employed Private Employed Other (Mention
present status)

  • Applicant Name First Name Middle Name Last Name
Date of Birth DD/MM/YY

Marital Status Single/Married

  • Gender Male/Female
Do you belong to SC/ST Yes/No

(attach proof/certificate)

Contact Details:
  • Present Address Address
City/State/Pincode City State Pincode

Tel (With STD Codes) Tel (With STD Codes) Can we contact you at work Yes/No
Home Work

Mobile

Email

1

Permanent Address (if Address
different from present
address)

City/State/ Pincode City State Pincode

Educational Qualification:
Please list details of education in chronological order, starting from matriculation onwards.
Name of the University/ Division/ Field of study / Date of Place/
Examination/Degree Board Subject/s passing

Grade Country

1. Master’s Research Work/Doctoral Work

Publications Authored/Co-Authored/Edited. Please list starting from latest(Please attach a
copy in word/pdf format)
Name of Journal Impact factor Publication Vol , Page
(Thomson Type (Review/ number & Year of
reuters)/ Research) Publication
ISSN No.

2. Book or Book Chapters Authored/Edited

Name of Impact factor (if Date of Publication Title of the
Publication any)/ ISBN No. Publication Type Article

2

3. Seminars/Conferences/Symposia Attended

Name Place National/ Whether
International presented a

paper

oral Poster

4. Patents Filed/Granted

Title of the Patent Inventor Patent No. Technology Brief note on
Patent Application Name/s Area commercial

(if Granted)
No. feasibility (not

more than 150
words)

5. Any other Industry training program attended

Name of the Program Specialized Area Date

6. Award/ Fellowship

S. No. Details

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7. *Research Projects completed/ in Progress (Mandatory)

Research Undertaken

Title of the Project Funding Duration Amount
S. No.

Agency on years sanctioned

Professional Experience: (Latest employment to the first employment)

Dates (Month/Year) Location/Country

(mention dates also)

Employer Name1/ Position Held
Address (with scale of pay, if

in service)

Responsibilities

Dates (Month/Year) Location/Country

Employer Name 2/ Position Held
Address (with scale of pay, if

in service)

Responsibilities

Continue on the table if necessary
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Reference (at least two referee’s):
May we request a Before offer of Fellowship After offer of Fellowship
reference?

Name 1

Job Title/Position

Telephone

Address

Email & mobile No.

Please indicate if this is a Work Reference Academic Reference
work reference or an
academic reference

Name 2

Job Title/Position

Telephone

Address

Email & mobile No.

Please indicate if this is a Work Reference Academic Reference
work reference or an
academic reference

Name 3

Job Title/Position

Telephone

Address

Email & mobile No.

Please indicate if this is a Work Reference Academic Reference
work reference or an
academic reference

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Project Proposal:
Broad Research Area (Tick one) Bioprocess Technology

Healthcare diagnostic

(i) Title of the Proposed Project

(ii) Specific area

(i) Objective (1000 words maximum)

(ii) Need

Commercialization approach (1000 words maximum)

Milestones (six months each) with relevant
deliverables

Envisaged outcome at the end of the project
(Technology licensing/ Start up)

Any industry / mentor collaboration at the
time of application.

(Is there any already identified partner /
mentor? If yes, please provide the details)

Declaration:
I declare that the information I have provided in this application form, to the best of my knowledge
and belief, is correct and complete.

If I include any details that you know to be false or if I withhold relevant information, I may render
myself liable to disqualification form the recruitment process or, if awarded the fellowship, to
withdrawn.

Name of the Applicant Signature

Date:
Please note: Kindly ensure that all the required information is enclosed. It may not be possible to
consider a candidate for want of complete information.
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