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APPLICATION FORM FOR THE MEMBERS OF THE
FACULTY FOR
PARTICIPATION IN CONFERENCE SYMPOSIUM /
SEMINARS ETC.
ABROAD AT THE INSTITUTE’S TRAVEL COSTS.
NOTE :
(1) This facility will be available only to
those faculty members who have served this Institute for a minimum
period of three years and who have more than three years of service to
look forward to, at the Institute.
(2) This
facility will be granted to those faculty members who have not availed
of the same during the last two financial years on the pattern i.e. one
full grant (as per entitlement) and one token grant for a two year
period. (as approved by SFC on 05.07.94/ & by GB on
13.05.95/05.06.95/ )
(3) Those who are selected for such a
support will be required to submit to the Director, a detailed report of
the conferences, they have attended and other activities, in which they
participated so that the Institute may derive benefits from such
participation in the conferences etc.
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1. |
Name & designation of the Officer
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2. |
(a)
Date of Birth
(b)
Date of joining in the
AIIMS
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3. |
Country to be visited
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4. |
Purpose of visit
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5. |
Actual date of Conference/Meeting
(Documentary
evidence may kindly be submitted)
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6. |
Proposed date of departure from India
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7. |
i) Category of Conference
a)
Is an international conference / seminar etc?
b)
Is it an annual event of that particular country / region
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ii) Is he/she presenting paper
(oral/poster) / delivering a lecture ?
iii) Is he/she chairing a
session ?
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8. |
Whether he/she is actively engaged in
Research in the subject matter of the
Conference/symposium/seminar alongwith the brief description of
the research in which he/she is engaged and the subject
Matter of the
Conference /seminar/ symposium.
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9. |
His/her specific contribution in the
research as mentioned in Col. (7) above.
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10. |
How will his/her participation in the
Conference/symposium/seminar in Question make a valuable
contribution at the conferences/symposium/seminar Projecting the
image of the Institute abroad. |
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11. |
How will his/her participation in
Conference/symposium/seminar in Question help in his/her work at
this Institute.
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12. |
The specific details of travel costs,
Registration fee and maintenance etc. (separately) travel by
shortest route to be arranged directly with Air India
Corporation is permissible.
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- Air-fare
by Air India Rs.
________________
- Regn. Fee (if any) Rs.
________________
- Maintenance Rs.
________________
= TOTAL Rs.
________________
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13. |
Indicate whether he/she has applied
for financial assistance to any other Governmental agencies for
the purpose.
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14. |
Indicate the month and year when he
availed financial assistance from the institute last.
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15. |
Evidence of invitation letter and
acceptance of his/her paper in the above conference etc.
(Original of Photostat copy should be (enclosed). In case no
invitation letter or acceptance of paper has so far been
received, please indicate the date by which the same is likely
to receive.
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16. |
Require to submit a copy of the
abstract of paper accepted for presentation at the scientific
meetings / congress etc.
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Certified that the particulars furnished
above by me are correct to the best of my knowledge and nothing has
been concealed.
Signature of applicant
Date :
Remarks of the forwarding Officer
S I G N A T U R E
D A T E :
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