MOBILTY AWARD

Section-A
Personal Information
1. Name of the Applicant:
2. Current employment:
3. Official address:
4. Correspondence address:
5. E-mail: Phone No:
6. Fathers name:
7. Husbands ame:
8. Whether belongs to GEN/OBC/SC/ST:
9. Whether Differently abled:
10. Academic Qualification (Graduation onward):
Sl.No. Degree Year University/Institute Subject Division
1. Graduation
2. Post-graduation
3. Ph.D.
4. Others
11. Area of Expertise (maximum 200 words):

Section-B
Professional Record
1. Employment record in chronological order (enclose supporting documents related to Permanent
Employment):

Sl. No. Name of the Duration Emoluments Nature of Job

Employer From To

2. Salary withdrawn in current position (enclose latest salary slip):

3. Job description of current position:
4. Publications (provide 10 best latest publications with complete details and reprints):
5. Patents and Technology transfer; if any:

Section-C
Mobility Issue
1. Reason for relocation:
2. Present city:
3. City where to relocate:
4. Distance between two cities:
5. Whether applied long term leave at current job/employer:
6. If yes, duratio fro to (enclose copy of the leave):
7. Whether want to quit present job:
8. If yes, mention time frame of resignation:
9. No objection certificate from present employer:
10. Institution selected to implement the award at new city:
 Section-D
Research Proposal
1. Title of the Project:
2. Broad Subject Area:
3. Specific Area:
4. Duration of the Project:
5. Total Project Cost:
6. Origin of the proposal (maximum 1 page) (Scientific rationale for proposed work):
7. Summary of the Proposal:
8. Key words:
9. Objectives:
10. Review of Literature (with references):
10.1 National status:
10.2 International Status:
11. Importance of the proposed work in the context of current status (Highlight novelty of proposal
or knowledge gap which will be filled by proposed study):
12. If the project is location specific, basis for selection of location:
13. Work Plan:
13.1 Methodology (Maximum 5 pages) (the details of how each of the objectives will be
addressed):
13.2 Time Schedule of activities giving milestones through BAR diagram:
13.3 Suggested Plan of action for utilization of research outcome expected from the project:
14. Expected outcome:
15. Innovation:
16. List of Facilities being extended by host institute for the project implementation:
16.1 Infrastructural Facilities:
16.2 Equipment available with the Institute/Department:
17. Budget:
Sl. No. Heads 1st Year 2nd Year 3rd Year 4th Year 5th Year Total
1. PIs salary
2. Manpower, if
any
3. Research grant
(including
consumables,
contingencies,
travel and minor
equipments)
4. Overhead
5. GRAND TOTAL
18. Justification of budget (Item wise):
19. Name and official address of 3 Experts working in the same research area:
20. Details of research grant availed from DST or any other funding agencies:
Sl. Project Title Funding Total Project Duration Output
No. Agency Cost (Publications/
From To Patents)

21. Endorsement from the new host institute (with signature and seal):
22. Any other items:
(Information in the form of Annexure is not allowed, it should be against the respective item)