INDIAN INSTITUTE OF SCIENCE EDUCATION AND RESEARCH BHOPAL

APPLICATION FORM – “Understanding SCIENCE”

1. Name: ____________________________________
Please paste a
2. Date of Birth: _______________________________
passport-size
3. Gender: ___________________________________ photograph
4. Father’s name: ______________________________ duly attested by
5. Address: ___________________________________ the school
___________________________________ principal

___________________________________
City: _______________ State _______________
PIN: _______________
6. Email: ____________________
7. Contact number: Landline: _________________ Mobile: ___________________
8. Name of School and Address: __________________________________________
__________________________________________
__________________________________________
__________________________________________
9. Standard passed (Tick whichever is correct) : (i) IX (ii) XI
10. Marks obtained in the past three standards:

Standard Board Aggregate Percentage (Science

Percentage and Maths)

11. Why do you want to attend the summer camp at IISER Bhopal?

_________________________________________________________________________

12. Which is your favourite subject?

 ___________________________________________________________________________

13. What do you wish to do after Class X or XII?

_______________________________________________________________________

14. What do you wish to be in life?

_______________________________________________________________________

I hereby declare that the above furnished information is true to the best of my knowledge.

Signature of Student

Attestation by the Principal

This Form is to be duly filled, attested by the Principal of the school and sent to:

The Co-ordinator, Out-Reach Activity

Indian Institute of Science Education and Research Bhopal

Transit Campus: ITI (Gas Rahat) Building, Govindpura,

Bhopal – 462 023