Institute of Professional Education and Research, Bhopal
DECLARATION
Name :………………………………………………………………………………
Class : ………………………………………………………………………………
Project Area : [Tick which ever is applicable]
Govt./Semi-Govt./ Private/ Self Employment / Cooperative / Non-Govt. Organisation
Proposed Title : ……………………………………………………………………
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Internship Start Dare …………………………. To End Date …………………………….
Students Signature:…………………… Parents Signature: …………………
Parents Name: ………………………………….
Student Name: …………………………………..
Parents Contact No.: …………………………
Student Contact No.: ……………………………
Date: …………………………
Student E-mail Id :………………………………
If you don’t have visiting card fill the following details:
Name of Authorized Person :……………………………
Designation : ……………………………………………..
Office/Institution: …………………………………..……
Contact No.: ……………………….…………….…
Address :………………………………………………….
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Faculty Coordinator