Application Attestation Form (Aaf) Sts - 2017 printable pdf download

APPLICATION ATTESTATION FORM (AAF) STS 2017

Reference ID: ………………………………………………….………….

Name of the Student: ……………………………………………………..

Paste passport size

Name of the Guide: ……………………………………………………….

photograph

Name of Medical College…………………………………………………

………………………………………………………………………..……

Title of the STS Proposal: …………………………………………….. ..

……………………………………………………………………………..

…………………………………………………………………...................

Certificate to be signed by the Student

I certify that I am an MBBS student and am here by providing true information in the online

application form for STS 2017 best to my knowledge. I am submitting only one application for STS 2017. In

the event any information is found to be false, my studentship may be cancelled. I also certify that the research

proposal is an original work prepared under the guidance of my Guide. I have read the Research Misconduct

and Plagiarism guidelines and will abide by the same. I understand that after evaluation of my proposal, I may

or may not be selected and I shall abide by the decision of ICMR.

If selected, I agree to obtain prior ethical approval before initiating my research; I shall follow all

instructions provided on ICMR website for carrying out the research, preparation and submission of STS

report. I also understand that if I am unable to complete my project & submit the report before the last date, no

certificate or stipend will be awarded to me. I have gone through all the Instructions and Terms & Conditions

for STS 2017 provided on ICMR website and will abide by them.

Signature of Student:________________ Name of the Student:_________________________________

Date: ___________

Certificate to be signed by the Guide

I agree to accept the applicant Mr./Ms.__________________________________ studying in MBBS-

I/II/III. I certify that he/she is not an intern or student of other courses and I will offer him/her all facilities and

guidance for carrying out research. I also certify that the proposal is an original submission prepared by the

student under my guidance. I confirm that neither me and nor my student have committed ‘plagiarism’ in

preparing this proposal and will not initiate work withut an ethical approval. I am forwarding only one STS

2017 student application and if selected, shall provide required facilities to enable early completion of research

work and its submission in time.

Signature of Guide: _________________

Name :_________________________

Designation: ____________________

Department: ____________________

Attested By

Signature of Head of Department

Signature of Head of Medical College

(Name in Block letters with seal)

Fill form completely & check it before submission.

Application Attestation Form (Aaf) Sts - 2017