APPLICATION FORM FOR INTERNSHIP PROGRAMME ON

ARCHIVAL DOCUMENTATION/PROJECTS ETC.

To, Dated Dispur the............................'20........

The Director, Assam State Archives
Dispur, Guwahati-6

Sir,
I hereby apply for enrolment as Internship Student in the Assam State Archives for which
necessary NOC issued by our College/Institution has been submitted for your favourable
consideration. The required information are furnished below :

1. Name : Shri/Smti/Kumari : .............................................................................................

2. Father's/Guardian's Name : .............................................................................................
3. Present Address : .............................................................................................
................................................................................................
................................................................................................
4. Gender (M /F) : .............................................................................................
5. Date of Birth : .............................................................................................
6. Course of Study & Year : .............................................................................................
7. Name of the College/Institution : .............................................................................................
(with postal address) ................................................................................................
...............................................................................................

8. NOC enclosed (Yes / No) : .............................................................................................

9. Period of training : From........................................ To ......................................
10. Contact No. : .............................................................................................
11. E-mail ID : .............................................................................................

DECLARATION :

I hereby declare that the information furnished above are true to the best of my
knowledge and belief. I also agree to comply with the rules and regulations in force during the
period of my internship programme in Assam State Archives.

Date : ................................... Signature of the Candidate/Student