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Annexure 1 - Initiation Form of Internship

This document contains an internship initiation form for a student at Oriental College of Technology in Bhopal, India. The form collects contact information for the student, industrial supervisor, and faculty mentor. It requests details on the internship such as title, department, credits, dates, hours per week, and compensation. The student is asked to provide 1-3 goals for the internship and learning objectives. The form requires signatures from the student and faculty mentor.

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Purnima Pandey
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© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
142 views

Annexure 1 - Initiation Form of Internship

This document contains an internship initiation form for a student at Oriental College of Technology in Bhopal, India. The form collects contact information for the student, industrial supervisor, and faculty mentor. It requests details on the internship such as title, department, credits, dates, hours per week, and compensation. The student is asked to provide 1-3 goals for the internship and learning objectives. The form requires signatures from the student and faculty mentor.

Uploaded by

Purnima Pandey
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Phone No.

-0755-2529015, 2529016, 2529057,2529258


Fax: 0755-2529472
E-mail: [email protected],
Website: www.oriental.ac.in/oct-bhopal

Oriental College of Technology, Bhopal


Approved by AICTE, New Delhi & Govt. of M.P., Affiliated to Rajiv Gandhi Proudyogiki Vishwavidyalaya
Address: Oriental Campus, Opp. Patel Nagar, Raisen Road, Bhopal – 462021 (M.P)

INTERNSHIP INITIATION FORM


PART 1: CONTACT INFORMATION

1.1. Student Information


Name: Enrollment No. :
Branch: Sem:
Student’s Phone No.: Email:
Term: ☐ Summer 2021 ☐ Winter 2021
Subject Code:

1.2 Industrial Supervisor


Name: Organization:
Work Phone: Email:
Mobile No.:
Physical Office Address: City:
State: Zip Code
Mailing Address (if different than physical office address):

1.3 Faculty Mentor


Name: Designation:
Phone: email id:

1.4 Academic Credit Information Internship


Title: Department:
Course: Credits:
Beginning Date: Ending Date:
Hours per Week:
Internship is: ☐ Paid ☐ Unpaid

1.5 Student’s Goals for the Internship: The student should identify one to three
professional goals explaining what s/he wants to gain from the internship experience.
PART 2: INTERNSHIP OBJECTIVES / LEARNING ACTIVITIES
2.1 Internship Objectives

2.2 List out about your learning objectives and also give brief information about
internship’s department

Student’s Name
Student’s Signature:
Date:

Faculty Mentor’s Name

Faculty Mentor Signature

Date

Enclosure: Consent letter from Industry.

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