KEMHRC Internship/PhD
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KEM Hospital Research Centre, Pune (KEMHRC)
Application Form for Internship / PGDCR / PhD
Personal Details
Educational Details
Logistics and Support
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Application for
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PhD
Masters
Under Graduate
Internship
PGDCR
Others
Name of Applicant
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Gender
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Male
Female
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Permanent Address (Write full address)
Country Code
India (+91)
United States (+1)
United Kingdom (+44)
France (+33)
Germany (+49)
Japan (+81)
China (+86)
Australia (+61)
Brazil (+55)
Russia (+7)
South Africa (+27)
South Korea (+82)
Spain (+34)
Italy (+39)
Mexico (+52)
Phone No (Student)
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Email ID (Of Student)
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Please enter a valid email address.
Nationality
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Indian
Foreigner
For foreign students, do you need assistance in visa process?
Yes
No
Date of Birth
You must be at least 16 years old.
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Affiliation (Name and Address of University / Institute)
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Email ID (Of Institute)
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Please enter a valid email address.
Country Code
India (+91)
United States (+1)
United Kingdom (+44)
France (+33)
Germany (+49)
Japan (+81)
China (+86)
Australia (+61)
Brazil (+55)
Russia (+7)
South Africa (+27)
South Korea (+82)
Spain (+34)
Italy (+39)
Mexico (+52)
Phone No (Institute)
Education Details (Write latest first)
Degree
Year of Passing
Subject
University/Institute
*
*
*
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Area / Topic of research / dissertation / project / thesis / PGDCR / Internship
Statement of purpose (What fascinates you to undertake the mentioned study topic)(Max : 500 Words)
Name of Department to Work With
*
Select
Pediatrics
Diabetes
KEMHRC, Pune
KEMHRC, Vadu
KEMHRC, CHRU
Others
Not Sure
How did you come to know about us?(Max : 200 Words)
Name of Supervisor from your University / Institute
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Do you need a translator/field facilitator, especially if you cannot communicate in Marathi or Hindi Language?
*
Yes
No
What is your expected duration of study / internship / PhD / PGDCR?
*
From-to Date
Period in Months
From Date
To Date
Do you have Sponsorship or Funding?
Yes
No
Name of the Sponsor / Funding agency
What does Funding cover?
Food
Accomodation
Travel
Project Cost
Do you need assistance for paid accomodation?
Yes
No
Any other assistance needed? (Maximum 200 words)
Upload Your CV (PDF or Word, Max 5MB)
File must be less than 5MB and of type PDF or Word.
Upload Your Image (Max 2MB)
File must be less than 2MB and of type JPG, JPEG, or PNG.
All above information is true to the best of my knowledge. I have read the policy for encouraging academics at KEMHRC, Pune and shall abide by the rules, regulations and responsibilities mentioned in the policy.
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