Application Form - Developing and sustaining India’s capacity for pre-clinical Drug Discovery

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“Train the Educator” course for educators/trainers who provide education, training and continuing professional development in laboratory animal sciences for early career researchers. March 2020 NIPER, Hyderabad

1. Name of the organization *

2. Institution or Company or Industry

3. Name of the Ministry affiliated to Organization:

4. Category

Please write Category in the below formats. 1. Pharmacy 1.a) Pharmacology 1.b) Non-Pharmacology 2. Clinical 2.a) Allopathy 2.b) Ayurvedic 2.c) Unani, Siddha, Homeopathy 3. Food 3.a) Nutrition 3.b) Dietician 4. Veterinary 4.a) Pharmacology 4.b) Non-Pharmacology 5. Industry 5.a) Pre-Clinical 5.b) Clinical 6. Others 6.a) Zoology 6.b) Post Graduate in Science/Technology 6.c) Academic

5. Name of the Candidate

6. Name of the Father/Husband/Guardian/any Legal Representative

7. Nationality

Indian

Other:

8. Official Address:

Please enter full address with City / Town, State and PIN code

9. Email

10. Mobile

11. Office number

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