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Training Course (2019) on
Molecular Diagnostics & Disease Informatics in Health Care
at
ICMR-National Institute for Research in Reproductive Health,
Indian Council of Medical Research
Jehangir Merwanji Street, Parel, Mumbai - 400 012
Sponsored by
Department of Health Research
Government of India

6th May –31st May 2019

APPLICATION FORM

Name Upload Photograph (less than 2Mb)
Address for correspondence
Contact No.  
Residence (with STD code)
Mobile
Email ID
Date of Birth (dd/mm/yyyy) Age (Years)
Gender
Educational Qualifications (In chronological order) Bachelors degree onwards:
Degree
Specialization
University
Percentage/Grade
Passing year

Total Work Experience (in years)

Present job and Designation :
Name of organization:
Total period in the present job:
Extramural Research Grants handled if any –

Title of the Project

Funding Agency

Year

Accommodation Requested:
(For outstation candidates)

Reasons for applying for the course and future plans (Max. 150 words):

Forwarded by Institute Head/Department Head:

If yes, Forwarding letter (a scanned copy) in pdf format:

      

In case of any problem with submission, kindly contact workshop coordinator at strubio@nirrh.res.in