Instructions to candidates for filling the Application form
1. Each page of the application form should be duly signed by the candidate.
2. All the certificates attached should be self-attested.
3. Candidate should affix a recent passport size photograph on the application form.
4. Impact factors of the articles should be cited according to Sci index not NAAS index.
5. Areas of the proposed research work should be super scribed on the top of envelope while
sending in the application.
6. No additional documents need to be send with the application form while applying.
7. Applications not in the above format will be summarily rejected.
8.
GOVERNMENT OF INDIA
MINISTRY OF SCIENCE & TECHNOLOGY
DEPARTMENT OF BIOTECHNOLOGY (DBT)
APPLICATION FORM FOR DBT CREST AWARD: 2012-13
(FORMERLY BIOTECHNOLOGY OVERSEAS ASSOCIATESHIP-BTOA)
Part-A (Personal bibliography)
1. Applicants Name:
(Full name in capital letters)
2. Designation
3. Address of the candidate
Telephone No. (office)
Telephone no. (Residence)
Mobile no.
Fax:
Email address:
4. Name and address of the parent Institute
5. Father’s/ Husband’s Name (in full)
6. a. Date of birth (DD/MM/YYYY) (Enclose age proof)
b. Age (as on deadline of submission)
7. Nationality
8. Details of the nature of present and past employment (chronological order)
Name of the employer
Nature of employment
9. a. Area of the proposed research work
b. Title of the proposed research work
Duration of employment
Part –B (Academic details)
1. Academic Qualifications (Bachelor’s degree onwards)
Name of the College
/Institute and
University
Year of degree
awarded
Subject(s) of Specialization
Percentage of
Marks
Subject(s) of Specialization
Percentage of
Marks and
Distinction
2. Additional qualifications
Name of the College
/Institute and
University
Year of degree
awarded
3. National fellowships (CSIR-UGC fellowship, GATE, DBT, ICMR, INSPIRE etc.)
Name of the
fellowship
Year of award
Subject
Part-C (Professional experience and publications)
1. Projects handled as Principal Investigator
Title of the project
Year
Institutional/Extramural Funding agency
2.a. Research publications in indexed journals during the last five years (enclose a list, exclude
presentations in seminars/symposia; attach reprints of 5 research papers which you consider the best).
Authors, year of publication
Title of Paper
Name of the Journal Impact
volume, page numbers
factor (SCI
Index)
Cumulative impact factor of 5 publications
2.b. Publication in peer reviewed journal with impact factor of more than 10.
3. Awards/honors (Awards instituted by National academies, DBT (IYBA), CSIR (Shanti Swarup Bhatnagar
Award) will be considered.
4. Patents awarded (only awarded patents will be counted)
Patent no.
Indian/International
5.a. Have you been previously selected for any fellowship/ associateship award (National/overseas) of
DBT or any other funding agency ? (Please indicate as yes or no)
b. Details of your past overseas visits
Name
of
the Purpose of visit
country/countries
visited
Year of visit
Duration of visits (dates)
Part- D (Details of the proposed research area/training)
1.
2.
3.
4.
Proposed area of research/ training
Title of the proposed study
Duration of the proposed study
a. Proposed overseas host Institution
b. Name, designation and contact details of the foreign supervisor
(Note: Enclose original copy of the consent letter of host Institute (Mandatory))
5. Summary of proposed research work indicating
 Objectives (Preferably in bullet/numbered format)
 Methodology
 Work plan
 Importance of proposed research
6. Financial authority of the Institution in whose name Demand Draft/cheque should be issued
alongwith address (Please enclose endorsement of the parent organization)
7. Declaration of the candidate:
I (Name of the candidate), S/O or /D/o Sh. (Name of Father/Mother) hereby declare that the
details and statements furnished in the Application form (Part A+B+C+D) are correct and
true to my knowledge. I have gone through the terms and conditions as enlisted at S. no. 1
to 22 of the DBT CREST Award (2012-13) and in the event of my selection I will abide by the
terms and conditions as laid down by Department of Biotechnology, Government of India
for availing the Award.
(Signature and full Name of the candidate)
Date:
Place:
Summary Sheet
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Full name of Candidate
Age on deadline of submission
Name of the Parent Institution, Contact no. and
email address
Area of proposed research/training
Title of Proposed research/training
Proposed Host Institution
Proposed duration of Associateship
Graduation percentage
Post-graduation percentage
Ph. D (Yes/No) or no. of years of research
experience in case of candidates with
M.D/M.S/M.pharma
National fellowship as enlisted in Part-B, point 3
of application form (Indicate Yes/No)
No. of Institutional Projects handled as Principal
Investigator
No. of Extramural Projects handled as Principal
Investigator
Cumulative impact factor of 5 publications as
enlisted in Part-C, point 2a of application form
according to SCI Index
Publication in peer reviewed journal with
impact factor of more than 10 (indicate only no.
of publications according to SCI Index
Awards/honors as enlisted in Part-C, point 3 of
application form (Indicate Yes/No)
International Patents awarded (Indicate no.
only)
National Patents awarded (Indicate no. only)
(Signature and full Name of the candidate)
Date:
Place:
1.
2.
3.
4.
5.
Check list (Write Yes/No)
Completed Application form
Proof of age certificate
Endorsement/Approval from Head of Institution
Consent letter from Host Institution
Signature on each page of the Application form
(Signature and full Name of the candidate)
Date:
Place: