Application Form (Revised Aug 2011)

Proposal Identification Number
HIGHER EDUCATION COMMISSION

H-9, Islamabad (Pakistan)
Passport Size Photograph here
INTERNATIONAL RESEARCH SUPPORT INITIATIVE PROGRAMME (IRSIP)

Please read the following statements carefully and answer in Yes or No only. It is mandatory to answer all the questions otherwise application will not be entertained. 1. 2. 3. 4. 5. 6. 7. 8. Are you enrolled in a public sector or private sector Pakistani university for PhD? Are you a full time AJK/Pakistani national PhD student? Are you exempted from PhD course work?
(Scholars who had enrolled for PhD before July 2005 are exempted)
Yes Yes Yes Yes Yes Yes Yes Yes
No No No No No No No No
If No, have you completed the course work? Have you passed the subject test required for admission/ conversion to PhD (see note below for details)? Is your topic of PhD research approved by BASR/DASR or university equivalent body? Are you actively engaged in PhD thesis related research work? Have you been invited/ accepted by a research group or foreign university to conduct your PhD thesis related research?
Note I: a) International GRE subject test offered by ETS or Local GRE subject test offered by NTS. b) HEC approved departmental test for subjects for which ETS/NTS subject test is not available. Note II: If your answer to all the above questions is yes except question no 3, then please proceed to the next page and fill up the application as per instructions given at the end of the application form. In case your answer to any of the above questions is No (except for question no 3), we regret that you are not eligible for this research fellowship. Name: - ______________________________
Signature: -____________________________ CNIC Number: -_______________________ Date: - _______________________________
DOCUMENT CHECKLIST: (PLEASE ATTACH THE DOCUMENTS IN THE ORDER MENTIONED BELOW) Page 1 of 7
APPLICATION SET 1:
I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII.
Application form Foreign university acceptance letter(s), in order of preference CV(s) of proposed foreign supervisor(s) BASR/DASR approval showing approved PhD research topic PhD thesis synopsis (complete) Local PhD supervisor recommendation letter CV of local PhD supervisor NOC from concerned HEC officer (if already availing any other HEC scholarship) NOC from department/organisation (if employed/ on study leave) CV of applicant Copy of passport Copies of academic documents including PhD coursework transcript showing credit hours and grades obtained in each course. Copy of GRE result certificate/card from ETS / NTS
Annexure-1 Annexure-2 Annexure-3 Annexure-4 Annexure-5 Annexure-6 Annexure-7 Annexure-8 Annexure-9 Annexure-10 Annexure-11 Annexure-12 Annexure-13
APPLICATION SET 2:
I. II. III. IV.
Application form Foreign university acceptance letter(s), in order of preference CV(s) of proposed foreign supervisor(s) PhD thesis synopsis (complete)
Annexure-1 Annexure-2 Annexure-3 Annexure-4
Note:
Both sets are to be properly bound (ring/spiral/other). All annexures to the application sets are to be properly labelled (tagged).
Page 2 of 7
PERSONAL INFORMATION
1. 2. 3. 5. Name Father Name CNIC No Domicile (Dist & Province) Current Address 7. 8. 9. 10.
(to be used for correspondence)
4. 6.
Date of birth Gender (M/F)
Permanent Address E-mail (s) Contact Nos: Mobile: Fax No: Home: Office:
11.
ACADEMIC QUALIFICATIONS Year Grade/ Division Field/ Subject Board/ University
Degree Matric Intermediate Bachelor Masters M.Phil 12.
DETAIL OF COURSES TAKEN AT M.Phil LEVEL Date/Semester Course Type

Core/ Elective
Course name
Instructor name
Total credits of course
GPA
13.
DETAIL OF COURSES TAKEN AT PhD LEVEL (also attach transcript) Date/Semester Course Type
Core/ Elective
Course name
Instructor name
Total credits of course
GPA
Page 3 of 7
14. iii15.
Provide international/Local GRE score: ETS GRE subject NTS GRE subject Subject Subject Score Score Test Date Test Date
List scholarships or fellowships held at present or in the past (Give source or sponsor, amount, where held and duration). Indicate any academic honours or prizes which you have received, with titles and dates. List any books, articles or theses published by you, especially in your area of study (Give title, place and date of publication). List professional societies, fraternities or other organizations in which you now hold membership or in which you have been active in the past (indicate if you have held an elective office). Teaching experience: (include any teaching positions you have held or currently hold) Occupational experience: (list positions held, beginning with the most recent employment, if any) Title/ Type of work Duration From To
16.
17.
18.
19. 20.
Name and address of employer
DOCTORAL PROGRAM INFORMATION

21. University where enrolled for PhD University Dept/institute Address PhD Registration No Expected PhD Completion date Major
(e.g. chemistry)
22. 23. 25. 27. 29. 30. i-
24. 26. 28.
PhD Starting Date Research topic approval date (by BASR/ DASR/ equivalent body) Field of study
(e.g physical sciences)
Title of PhD research Are you already availing any HEC scholarship? Scholarship Name Yes, If Yes provide following: iiBatch, PIN N o
LOCAL PHD SUPERVISORS DETAILS
Page 4 of 7
31. 32. 34. 35. 36. 37. No I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII. XIV.
Supervisors name Supervisors Phone No Institute/Dept University Address 33. Supervisors e-mail
LIST OF PHD FACULTY IN THE DEPARTMENT/INSTITUTE WHERE ENROLLED FOR PHD

Name Designation
RESEARCH DETAILS
38. 39. Provide details on research conducted in Pakistan so far (minimum 200 words) Goals of proposed visit to foreign university/ institute (minimum 200 words)
40.
Brief justification and plan of study (minimum 200 words)
41.
Which experiment or specific work you want to carry out abroad?
(To be filled in by Local Supervisor) 42. Recommendation by local PhD supervisor justifying the foreign visit of scholar.
43.
Research facilities availability in Pakistan for scholars research topic.
44.
What are the socio-economic benefits of this research?
45.
What is the time span by which country will start benefitting of this research?
Page 5 of 7
46.
How would the scholar conduct his PhD thesis related research if he doesnt get selected for 6 months research abroad?
Supervisor Name:
Signature & stamp:
FOREIGN VISIT INFORMATION

47. LIST OF FOREIGN UNIVERSITIES THAT OFFERED YOU PLACEMENT (In order of priority) Bench Fee Amount (As per offer letter)
No
University
Department
Supervisor name
Country
48.
RECENT 10 RESEARCH PUBLICATIONS BY PROPOSED FOREIGN SUPERVISOR (provide CV also) Supervisor name Publication list
FOR EMPLOYED APPLICANTS ONLY

ATTESTATION BY THE HEAD OF DEPARTMENT This is to Certify that Mr./Ms. ______________________ Son/Daughter of Mr.___________________is regular employee of this Organization as _____________________________Since __________. His/Her educational, employment particulars and other statements as stated in the foregoing columns have been checked and verified with the original documents. It is hereby affirmed that in the event of his/her selection for the award of 'International Research Support Initiative Program', he/she will be released on study leave for the total duration of the research program which on average is 6 months. Date: _____________ Signature: _________________________ Name & Designation: _________________________ (Head of Department/Institution) Full Address: _________________________
Office Stamp:
_________________________
Signature
_________________________ (Please Tick One) Advance copy Forwarded Copy
Page 6 of 7
UNDERTAKING BY THE APPLICANT (compulsory for all candidates)
I Mr./Ms. ______________________ Son/Daughter of Mr .___________________certify that the statements made by me in this form are true, complete and correct to the best of my knowledge and belief. It is solemnly affirmed that I have read and understood the conditions of the award of this program advertised in the press and from the web page of HEC and that the decision of the Selection Committee would be final and binding. I understand that the award will be withdrawn as well as recovery of full amount spent on me along with any penalty in connection with the award if any misrepresentation or omission is discovered even after completion of fellowship award under the 'International Research Support Initiative Program'.
Date: __________________
Applicants Signature___________________________
Page 7 of 7

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Proposal Identification Number

HIGHER EDUCATION COMMISSION

Passport Size Photograph here

INTERNATIONAL RESEARCH SUPPORT INITIATIVE PROGRAMME (IRSIP)

Yes Yes Yes Yes Yes Yes Yes Yes

Signature: -____________________________ CNIC Number: -_______________________ Date: - _______________________________

Annexure-1 Annexure-2 Annexure-3 Annexure-4

Date of birth Gender (M/F)

ACADEMIC QUALIFICATIONS Year Grade/ Division Field/ Subject Board/ University

Degree Matric Intermediate Bachelor Masters M.Phil 12.

DETAIL OF COURSES TAKEN AT M.Phil LEVEL Date/Semester Course Type

Total credits of course

Total credits of course

Name and address of employer

DOCTORAL PROGRAM INFORMATION

22. 23. 25. 27. 29. 30. i-

24. 26. 28.

LOCAL PHD SUPERVISORS DETAILS

LIST OF PHD FACULTY IN THE DEPARTMENT/INSTITUTE WHERE ENROLLED FOR PHD

Brief justification and plan of study (minimum 200 words)

Which experiment or specific work you want to carry out abroad?

Research facilities availability in Pakistan for scholars research topic.

What are the socio-economic benefits of this research?

Signature & stamp:

FOREIGN VISIT INFORMATION

FOR EMPLOYED APPLICANTS ONLY

_________________________ (Please Tick One) Advance copy Forwarded Copy

UNDERTAKING BY THE APPLICANT (compulsory for all candidates)

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Signature: -________________ CNIC Number: -_ Date: - _____________________