1. Name (in Block Letters): Mr./Ms.
   
2. Designation :
   
3. Office Address :
   
4. Fax/e-mail Address (if any ) :
   
5. Age (in completed years) :
   
6. Qualification :
   
7. Brief description of your current research and application of statistics (Give at most 10 keywords and describe your current needs in statistical methods).

8. Expectation (and/or requirements) from the training :

9. Statistical packages available in your organization and your awareness of it:

10. Signature of candidate with date

ENDORSEMENT

1. This office is sponsoring the candidature of Mr./Ms.
   Designation _________________________ Working at _________________
   for the above Workshop.

2. Office Seal ____________________________________
   Signature of the Sponsoring Authority
   (Name Designation: )
   Date :
   Application dead-line : 17th July, 2006
   (This form may be copied and circulated widely. You can use separate sheet as annexure)
   Web: http://www.isical.ac.in/~psy/ws/ann.html