4/30/22, 4:18 PM IIT-INTERNSHIPAPPLICATION

Internship Application  

Application Number:  INT/ES/SUM/2022/0281       Applied Date: 30-

04-2022 11:09 AM
1)  Name of the Applicant MR. AYUSH KUMAR
2)  Internship Type Summer
3)  School Electrical Sciences
4)  Area / Topic of interest Computer Science
5)  Duration 12-05-2022 To 12-06-2022
6)  Source of Finance No
7)  Duration of Finance NIL
8)  Amount per month NIL
9)  Name of the Institution/
Shri Mata Vaishno Devi University
University
Sub-Post Office, Network Centre, Katra, Jammu and
10)  Institution Address
Kashmir 182320
11)  Department/ School Electronics and communication
12)  Degree Pursuing B.Tech
13)  Current Semester/Year Semester-6
14)  Programme Duration 2019-23
15)  Subject Specialization Electronics and communication
16)  Name and Contact Details of HOD/HOS
Name DR. Manish Sabraj
Address SMVDU campus, kakrayal, katra
Email hod.dece@smvdu.ac.in
Phone 9419738830
17)  Category OBC
18)  Gender Male
19)  Mother's Name Sarita Kumari
20)  Father's Name Sanjay Kumar Ray
21)  Nationality Indian
22)  Religion Hindu
23)  Marital Status Un-Married
24)  If Person with Disability No
25)  Type of disability
26)  Address Details
Address for Correspondence Permanent Address
Fatehpur, gaya, bihar, Gaya, Bihar, Fatehpur, gaya, bihar, Gaya, Bihar,
India, 824232 India, 824232
Mobile No.:9906283090 Phone No.:9906283090
27)  Educational Qualification (Starting from 10th onwards and upto last degree
obtained)
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4/30/22, 4:18 PM IIT-INTERNSHIPAPPLICATION

Examination Board/University Year Subjects/ Discipline/ Division/ %Marks /

Passed Specialization Class CGPA /
Equivalent
English, Hindi, Science,
HSC BSEB 2017 History, Mathematics, 1st 77
Sanskrit
Physics, Chemistry, Math,
yes BSEB 2019 1st 75.2
English, Hindi
Shri Mata
Electronics and
pursuing Vaishno Devi 2023 1st 7.47
communication
University
NA NA 0 NA NA 0
28)   Any Other Information

29)  List of Attachments

(1) Photograph  (2) Signature  (3) Transcript/Semesterwise grade card  (4) Resume  (5)
Bonafide Certificate  (6) Identity Card  
30)  Health Declaration
Do you have any physical illness or have you been currently undergoing any medical
treatment/ been treated/ been diagnosed of any illness which may affect your studies?
NO
Do you have any chronic (long lasting or persistent) medical condition that requires
treatment or medication? NO
N.B.: Any medical expenses during the internship period will be borne by the candidate
himself/herself. IIT Bhubaneswar will not be responsible towards any medical
expenses. However medical facility is available in IIT Bhubaneswar campus
31)  Criminal/Disciplinary Offence
Have you been convicted of any criminal offence by a court of law in any country? NO

Place: _______________
Date: ________________

Signature of the Applicant

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