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Fellowship Application Form
Home > Fellowship Form
In Memory of Late Dr. M.C. Nahata – Pioneer in Optometry and Vision Care
SECTION A: PERSONAL DETAILS
Full Name
Date of Birth
Gender
Male
Female
Other
Nationality
Email ID
Mobile Number
Permanent Address
Correspondence Address
Passport Sized Photo
SECTION B: EDUCATION & PROFESSIONAL BACKGROUND
Qualification
Institution Name
Year of Passing
Grade / % / GPA
Undergraduate Degree
Postgraduate Degree
Others (Diplomas, Certifications)
Current Affiliation
Student
Faculty
Researcher
NGO Professional
Other
Current Institution / Organization
Designation
SECTION C: FELLOWSHIP PROPOSAL DETAILS
Proposed Research Title / Project Name
Research / Project Summary (100–150 words)
Objectives of the Project
Relevance to Low Vision / Eye Health / Youth Empowerment (as applicable)
Proposed Duration
3 Months
6 Months
1 Year
Other
Expected Outcomes
Preferred Start Date
SECTION D: ADDITIONAL DOCUMENTS TO BE ATTACHED
Updated Curriculum Vitae (CV)
Recommendation Letter from Institution / Supervisor
Research Proposal (Detailed: up to 2 pages)
Proof of Enrollment / Employment
Copy of Academic Certificates
Government-issued ID Proof
SECTION E: DECLARATION
Diclaration
I hereby declare that all the information furnished above is true to the best of my knowledge. I understand that if any part is found to be incorrect, my application may be rejected.
Submit
