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Internship Application

This document is a form for the Summer Internship Programme at IIT Patna, requiring personal and institutional information from the applicant. It includes sections for parental contact details, references, and a declaration regarding the internship and intellectual property rights. The form must be signed by the student and their guide or head of the institution, confirming adherence to IIT Patna's rules and ethical practices.

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38 views2 pages

Internship Application

This document is a form for the Summer Internship Programme at IIT Patna, requiring personal and institutional information from the applicant. It includes sections for parental contact details, references, and a declaration regarding the internship and intellectual property rights. The form must be signed by the student and their guide or head of the institution, confirming adherence to IIT Patna's rules and ethical practices.

Uploaded by

D3K P
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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भारतीय प्रौद्योगिकी संस्थान पटना

INDIAN INSTITUTE OF TECHNOLOGY PATNA

FORM FOR SUMMER INTERNSHIP PROGRAMME AT IIT PATNA – 20

Personal Information

Correspondence Address:

e-mail:

(If yes attach details in separate sheet)

Parents’/Guardian’s contact information


Name Relation
Address

Phone No. Mobile No.


e-mail

Institute affiliation information


Name of Institution
Address
Degree /Programme Semester/year
CGPA/Marks %:

Reference
Name
Address

E-mail Ph No. Fax No.

Department at IIT Patna


Department of application at IIT Patna
Supervisor(s) Name
Research Topic/Area
Duration of stay at IIT Patna
Hostel accommodation is required?

Applicant’s Signature with Date

The student is selected as summer intern under supervision of Prof. /Dr. ........................................................

(Head-Department of ............................................. )
भारतीय प्रौद्योगिकी सस्ं थान पटना
INDIAN INSTITUTE OF TECHNOLOGY PATNA
KANPA ROAD, BIHTA, PATNA - 800013, BIHAR, INDIA Ph.: + 91-612-3028103

Declaration to be submitted by Project Trainees

The undersigned do hereby declare that:

1. Mr. ………………………….SODO……. …………….. is a……………………(class/batch)


regular student of…………………………………………………………… (name of Institute)

2. He is being permitted to undertake……………………………. semesters (time) project work


at IIT Patna from ……………………(date) to………………………(date).

3. The right of intellectual property generated as an outcome of this project will lie
equally with both the institutes.

4. Mr....................... ………. (name of the student) will abide by all the rules and regulations and
adhere to the discipline of IIT Patna.

5. Mr....................... ………. (name of the student) will follow ethical practices in his conduct
during his entire period of stay in IIT Patna.

Signature of Student: Signature of Guide/HoD/Head of Institution:

Name: Name:
Address: Department:
Contact No.: Date:
Local Guardian (if any):

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