Application Form

1 Login

2 Profile of Post Graduate

First Name *

Last Name *

Date of Birth *

Age *

Gender *

Email *

Mobile *

Mailing Address *

Country *

State *

City *

Pincode *

IADVL PLM Number *

Brief CV of the Principal Investigator(Post Graduate) (including educational qualifications as a single page) in pdf format *

Degree *

Speciality *

Affiliated Institute / Hospital *

Present professional activities *

Name the IADVL or other research projects that the principal worker was or is engaged in:*

3 Upload Application form Part 1 (PDF document only)

Upload Application form Part 1 (PDF document only) *

4 Upload Application form Part 2 (PDF document only)

Upload Application form Part 2 (PDF document only) *

5 Upload Annexures (PDF or JPEG document) if applicable

MBBS DEGREE form ( pdf / Image )

Certificate that the MD Degree is recognized by MCI/ DNB ( pdf / Image )

Case record form ( pdf / Image )

Questionnaires ( pdf / Image )

Consent forms (in English and local language) ( pdf / Image )

Patient information sheet ( pdf / Image )

CV of Post Graduate including educational qualifications (single page) ( pdf / Image )

CV of Supervisor (single page) ( pdf / Image )

Consent from HOD and head of institute ( pdf / Image )

Ethics committee approval (if obtained) ( pdf / Image )

CTRI registration submission acknowledgement (if obtained) ( pdf / Image )

Consent letter to avail the grant and to be a part of the thesis from the Co- guide/s ( pdf / Image )