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NATIONAL INSTITUTE OF TECHNOLOGY, ROURKELA

CAREER DEVELOPMENT CENTRE

APPLICATION FOR SUMMER INTERNSHIP (FOR OFFICIAL ALLOTMENT)

1. Name (IN capital): ______________________________________________________________


2. Roll No._________________________ Current Semester_______________________________
3. Hall_______________________________________________ Room No._________________
4. Whatsapp _____________________________Mobile No .______________________________
5. Email ID _____________________________________________________________________
6. Parent Address with Phone No. ___________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
7. CGPA secured up to last Semester Examination : ____________________________________
_____________________________________________________________________________
8. Name of Host Industry/Organization for Internship
_____________________________________________________________________________
_____________________________________________________________________________
9. Other information, if any:

DECLARATION

I do hereby declare that the above information furnished by me is true to the best of my knowledge
and belief. If selected, I will undertake my Summer Training/Internship in the above organization.

Date: _______________ Signature of the student in full

Faculty Advisor & Head of the Department

(Seal)

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