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Application Form - Short Term Course On Embedded System

This document is an application form for a Short Term Internship Course on Embedded Systems and Internet of Things (IoT) at Jadavpur University. Applicants must fill out the form in capital letters, provide necessary personal and educational information, and submit required documents. A declaration is included, affirming the truthfulness of the information provided, with a signature required from the applicant.

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sayandipmondal.aeie2022
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25 views2 pages

Application Form - Short Term Course On Embedded System

This document is an application form for a Short Term Internship Course on Embedded Systems and Internet of Things (IoT) at Jadavpur University. Applicants must fill out the form in capital letters, provide necessary personal and educational information, and submit required documents. A declaration is included, affirming the truthfulness of the information provided, with a signature required from the applicant.

Uploaded by

sayandipmondal.aeie2022
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application for Admission Form No.

IC/
For Office use only
Short Term Internship Course on
Passport Size
Embedded Systems and Internet of Photograph
Things (IoT)
Year: IC Centre
Jadavpur University
Batch: juiccentre@gmail.com
Instruction for Applicants
1] Fill up the Application for in CAPITAL letters only. Use black ink to fill up the form.
2] All applications should fill up the form in full. If any item is not applicable, please cross it out or Write “NA”. In the space provided. Incomplete forms
shall be rejected.
3] Applicants are advised to retain a photocopy of the filled in Application Form for future reference.

Name:

Date of Birth: Sex:


[Attested copy of Certificate/Admit Card to be enclosed]

Address for Correspondence: ________________________________________________________

__________________________________________________________________________________

_______________________ City _______________ State ________________ Pin _______________

Phone _____________________ email __________________________________________________

Permanent Address: ________________________________________________________________

__________________________________________________________________________________

_______________________ City _______________ State ________________ Pin _______________

Phone _____________________ email __________________________________________________

Nationality:
Whether Belong to SC/ST: Yes / NO
Disability: Yes / No.
Father’s/Guardian’s Name: ___________________________________________________________
Education: [Std. XII Onwards] [Attested copies of Mark sheets/Certificates to be enclosed]
Exam. Passed Board/University Year Passed Specialization % of Marks

1
Software Course (if any) [Attested copies of Mark sheets/Certificates to be enclosed]

Course Institution Duration From To Certificate


[Diploma/Degree]

Work Experience [if applicable]

Organization From To Functional Area Software If Yes.


Experience Duration
(if any)

Demand Draft No. Date Name of the Bank Amount

Any other information relevant to this application:

Declaration:

The information furnished by me is true to the best of my knowledge and belief any statement made in
the application form, if found incorrect on scrutiny, will render the application liable to rejection and
admission, if granted on the basis of the statement, will stand cancelled.

Date of Application:

Place:

____________________
Signature of Applicant
Website: www.jaduniv.edu.in
2

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