Director

{OFFICE OF TRAINING & PLACEMENT}

Internship Request Form
Paste your
1. Particulars of Applicant self attested
good quality
Name: __________________________________________________ colour
Father’s Name: ___________________________________________ photograph
D.O.B. of Candidate: _______________________________________
Name of Branch at UG/PG Level ______________________________
here
Correspondence Address Permanent Address
_________________________ _______________________
_________________________ _______________________
_________________________ _______________________
Mobile No. _______________ E mail _________________

2. Qualifications
Sr. No. Class/Year/Semester Institute/University Academic Year Percentage/Grade
Completed upto last semester
appeared

3. Name of the Department/Centre where Training/Internship is to be undertaken

______________________________________________________________________________

4. Project Area/Title of your interest _________________________________________________

5. Time duration of Training/Internship from ______________ to_____________________

6. Reporting Date: __________________

7. Whether Hostel required : Yes/No _______________

8. Name of specific equipment/software required for training (if any) ______________________

9. Name of Faculty mentor if consent was taken earlier : ______________________

I shall abide by all rules & regulations of NIT Hamirpur (HP) during my stay in the Institute.

Signature of Candidate with date

Recommendations of the concerned HOD with seal

Signature of TPO with seal