1. Family Name:
Given Names:
2. Sex:
3. Marital Status:

4. Date of Birth:

5. Place of Birth:
6. Present Nationality:
7. Permanent Address:
8. Present Address:
Telephone No.: Telephone No.:
Fax No.: Fax No.:
9. In case of emergency, notify:
Telephone No.:
10. Knowledge of Languages:
  Read Write Speak
Language EasilyNot Easily Easily Not Easily Easily Not Easily
English  Easily Not Easily  Easily Not Easily  Easily Not Easily
Hindi  Easily Not Easily  Easily Not Easily  Easily Not Easily
Bengali  Easily Not Easily  Easily Not Easily  Easily Not Easily

(Please Specify)
 Easily Not Easily  Easily Not Easily  Easily Not Easily
11. Word Processing/ Computer Skills:  Yes No
12. Higher Education (College/ University)
Name/ Place and Country
Attended From/To Degrees Major Subject of Study
Mo./Year Mo./ Year Obtained
      Degrees Expected  
13. Employment: Please describe any previous practical experience you may have had, giving full
details of your duties.
14. Career Plans:
15. Other Relevant Information:
a) University Scholarships or Academic Distinction:
b) Publications (if any):
c) Have you ever applied for regular employement ?  Yes No
If Yes, Please give dates and name of Agency:

d) Have you ever been arrested, indicted, or summoned into Court as a defendant in a criminal proceeding, or convicted, fined, or imprisoned for the violation of any law (excluding minor traffic violation)?  Yes No
16. Internship Period:
Please indicate your availability for Internship (periods of upto a maximum of six months)
17. Preferred Work Assignment:
Please indicate by numbering in order of preference three main areas in which you would like to be considered for an internship.
 Agriculture Demography Engineering Journalism Sociology Translation & Terminology  Computer Science Economics Environment Mass Media Statistics  International Relations Energy Finance Political Economy Public Administration
18. Endorsement Institution (ATTACH FILE)
(Submit original of endorsement letter with this application)
19. References:
Please list three persons not related to you, who are familiar with your character and
Full Name and Title Address Business or Occupation
20. I certify that the foregoing statement and answers are true, complete and correct to the best of
my knowledge and belief.
Upload Signature       Date:


  1. I accept the internship which has been awarded to me by the SPAN and I am aware of the following:
    1. That the SPAN will not pay me for my internship and that all the expenses connected with it must be borne by me;
    2. That the SPAN accepts no responsibility for costs arising from accidents and/or illness incurred during my internship. The signature of this form is an undertaking that costs arising from accidents and/or illness incurred during internship are at my own expense;
    3. That I am not eligible for employment either during the period of my internship or for the months immediately following the expiration date thereof.
  2. I undertake the following obligations with respect to the SPAN:
    1. to conduct myself at all times in a manner compatible with my responsibilities as the holder of a SPAN Internship;
    2. to keep confidential any and all unpublished information made known to me by the accepting Division during the course of my internship and not to publish any reports or papers on the basis of information obtained during the program, except with the explicit authorization of the SPAN;
    3. to provide written notice in case of illness or other unavoidable circumstances which might prevent me from completing the internship;
    4. to complete the internship evaluation questionnaire at the end of my internship and to submit it to the personnel Section;


Name of Intern: