ABHIJYOT Career FORUM

COLLEGE OF ENGINEERING & POLYTECHNIC

JALGAON.
A, University U/S 2f of UGC Act 1956, (Established by Govt. of Sikkim under act No.4 of 2006)

Application for the Grant of Collaborative Industry based Internship point

INSTUCTION: Fill all the sections of form will be rejected . Administrative controller must sign every page of the form

SECTION I
PERERSONAL PROFILE OF ADMINISTRATION HEAD:
1. Name: _________________________________________________________________
2. Fathers Name :______________________________________________________
3. Date of Birth :____________________________________________________________
4. Sex : M
F
5. 5.Nationality:_________________________
6. Full Postal Address:_______________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
District:__________________________________ State:______________________________
Pin Code:
7. Official Communication:
Telephone no.(With STD code) :______________________________ Telefax : ______________
Mobile No.: +91
/+91
Email:_________________________________________________________________________
8. Academic Qualification :( Use separate sheet if, necessary)(starting from highest Qualification)
Sr.No. Course
University / Institution
Year of Completion

9.

Profession & Experience: (Use separate sheet if necessary)(Starting from present and fill last 3 Professions, if, Applicable)

H
kindly enclose a copy photo ID and Address proof.

I declare that all the information given by me is complete and correct to the best of my knowledge. I further declare that I will abide by all the rules of University and associates
and the direction given under the same.

Date:

Administration Head Signature & Seal