Application Form Internship
Application Form Internship
1 Name
2 Institution (Studying/has studied in)
3 Details of course of Study with its
duration
4 Internship duration sought (in months)
5 Proposed earliest date of joining
6 Address for correspondence Address Line 1-
Address Line 2-
City
State
Pin code
Mobile No.
E-Mail
7 Date of Birth (DD/MM/YY)
8 Area of interest/ learning (These will be 1 NRM & Decentralised Governance
at one of the Centres of the institute. 2 Social Sector
Maximum 3 choices be indicated) 3 Economic Development
4 Knowledge Management & e-
Governance
5 Urban Governance
6 Health Management
9 Educational Qualifications (Starting from Class 12th onwards)
Name of Name of Exam Year Percentage/ Main Subjects
Board/University/ Institute Passed CGPA
9.1
9.2
9.3
9.4
9.5
10 Work Experience details, if any
Name of Employer Work Work Domain
Experience
(in Months)
10.1
10.2
10.3
10.4
11 Is the internship request related to present course of
study? If so, please specify (for candidates who are
presently persuing studies)
Place:
Date:
Signature name and seal** of the
Director/Dean/
HOD
For candidates who have passed out during 2017 and 2018*
The applicant has successfully completed his degree/post-graduate programme at the Institute
in……….. and has been found eligible for the award of………..
The application is forwarded.
Place:
Date:
Signature name and seal** of the
Director/Placement Coordinator/ Faculty
writing a reference
(* For the pass out candidate a separate write up can be enclosed and attached)
(** Printed letterhead can also be used)