APPLICATION FORM

FOR SUMMER/WINTER INTERNSHIP PROGRAMME IN CSIR-IMMT

1. Name of the applicant:

2. Date of birth: Paste a self-
3. E-mail address: attested passport
size photograph
4. Mobile number:
5. Name & address of the institute:

6. Certificate from head of the institute/ training & placement officer for permission to
carry out the work in CSIR-IMMT attached? (Yes / No):
7. Area in which the proposed work to be carried out:
8. Duration of internship:
9. Educational qualification:
a) Secondary Education:
Name of Percentage Institute from University/
Year Subject/ Branch
Exam. of Marks which passed Board

b) Higher Secondary Education/Diploma in Engineering:

Name of Percentage Institute from University/
Year Subject/ Branch
Exam. of Marks which passed Board

c) Graduation Degree (B.Tech. / Int. M.Sc. / Int. M.Tech.):

Percentage
Name of Institute from University/
Year of Marks/ Subject/ Branch
Exam. which passed Board
CGPA*

*Self-certified hard copy of mark sheet is given up to which semester/year:

d) Master Degree (M.Sc. / MCA / M.S. / M.Tech.):

Percentage
Name of Institute from University/
Year of Marks/ Subject/ Branch
Exam. which passed Board
CGPA**

**Self-certified hard copy of mark sheet is given up to which semester/year:

HRD Cell, CSIR-IMMT Page 1 of 2

 NOTE:

• Eligibility criteria:
o Graduation degree students who have completed their 5th semester/ 3rd year
course can only apply. Accordingly they have to submit the copy of mark sheet.
o Any master degree student can apply.
• Application format may be printed in a single A4 size paper printed on both sides.
• Fill up the relevant information only.
• The duly filled application must be sent to "Convenor- HRD Cell, CSIR-IMMT,
P.O.: RRL Campus, Acharya Vihar, Bhubaneswar-751013”.
• The application containing envelope must be superscribed with “Application for
Internship” & “Name of Discipline/Branch”.
• Keep a stamp size photo with you which will be required for the issue of ID card
at the time of joining in our institute.
• Mandatory Requirements:
o Attach the following documents:
ü Original approval/forwarding letter from head of the parent institute/
training & placement officer.
ü Self-certified photocopy of ID card issued by your parent institution.
th
ü Self-certified photocopy of mark sheets from 10 onwards.
th
ü Self-certified photocopy of pass certificates from 10 onwards.

o Application will be rejected under following conditions:

ü Incomplete application.
ü Non submission of relevant documents.
ü Application without signature.

Signature of the Applicant

HRD Cell, CSIR-IMMT Page 2 of 2