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Summer Internship Application Form 2018

The document is an application form for an internship program at the Indian Institute of Technology Ropar. It requests information such as the applicant's name, department, research topic, duration of internship, supervisor's name, source of funding, educational qualifications, publications, health declaration, and contact details. The applicant must also arrange to send two recommendation letters to their supervisor before the deadline.

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saurabh verma
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39 views

Summer Internship Application Form 2018

The document is an application form for an internship program at the Indian Institute of Technology Ropar. It requests information such as the applicant's name, department, research topic, duration of internship, supervisor's name, source of funding, educational qualifications, publications, health declaration, and contact details. The applicant must also arrange to send two recommendation letters to their supervisor before the deadline.

Uploaded by

saurabh verma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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भारतीयप्रौद्योगिकी संस्थान रोपड़

INDIAN INSTITUTE OF TECHNOLOGY ROPAR


नंिल मािग ,रूपनिर,पंजाब-140001 / Nangal Road, Rupnagar, Punjab-140001
दू रभाष/Tele:+91-1881-227088, फ़ेक्स/Fax: +91-1881-223395
SummerInternship Application Form– 2018

Application Date: Insert Passport size


1)Name of the Applicant photo

2) Providing Department /
School/Center
3) Research Topic

4) Duration Start Date: End Date:


5) Supervisor's Name
6) Source of fellowship

7) Tenure of fellowship

8) Amount per month


9) Name & Address of
the Institution/ University
10) Department

11) Degree Pursuing

12) Programme Duration


13) Subject Specialization
(if any)
14) Category
(General/OBC/SC/ST)
15) Gender

16) Mother's Name

17) Father's Name

18) Religion

19) Marital Status


20) If Person with Disability:
21) Type of disability
Address for Correspondence Permanent Address
22) Address Details

23) Contact Details •Mobile No.: Contact no. of parent with STD
code:
24) Educational Qualification (Starting from 10th onwards and upto last degree obtained)
%Marks /
Examination Subjects/ Discipline/ Division/
Board/University Year CGPA /
Passed Specialization Class
Equivalent

10th

10+2

25) Publication in referred Journals (if any):


26) List of Attachments:1.Transcripts,2.Resume,3.Bonafide Certificate,4.Identity Card
27) Health Declaration :
Do you have any physical illness or have you been currently undergoing any medical treatment/ been
treated/ been diagnosed of any illness which may affect your studies?
Do you have any chronic (long lasting or persistent) medical condition that requires treatment or
medication?
N.B.:Any medical expenses during the internship period will be borne by the candidate himself/herself.
IIT Ropar will not be responsible towards any medical expenses.
28) Arrange to send two recommendation letters to supervisor before due date

Place: _______________
Signature of the Applicant
Date: ________________

Sign and Scan Application.


Send It To Your Supervisor Before Due Date with Attachments (S. No. 26)
_____________________________________________________________________________________
For Office Use

Category:

Remarks, if any:

Signature of Supervisor with Date

Department/Center

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