Department of Civil Engineering, IIT Kanpur

STudent Enrichment Programme (STEP)

Personal Details
Name
Roll No. CPI
Program at IITK Contact No.
Specialization IITK Address

Thesis Supervisor/ At IITK

Mentor At Destination

Permanent Address

Has any disciplinary action been taken

against you in the past?
(if yes, provide details)
Details of Internship
Destination
Summer Internship/ Semester Exchange/ Conference/ Workshop/ Others
Program Name
Please specify details here
Proposed Dates/ Duration

Additional Comments

Funding Details
Amount Requested under STEP Total Expense involved
Details of support from the destination Support from other sources at IITK
Details of any other current scholarship

Plan for contribution to STEP

Check List of Attachments

 Acceptance from the Destination Institution
 Research Proposal
 Recommendation from IITK Professor
 Latest Academic Transcript
 Copy of Passport
 CV of external supervisor/mentor
 Copy of Academic Leave Application

Signature of Applicant: Date:

Application Form