Online Registration Form

Apply for Industrial attachment

Polytechnic Name

*

Course Name

*

Full Name

*

Father's Name

*

Mother's Name

*

Present Address

*

Permanent Address

*

Mobile

*

Email

*

Blood Group

*

Date of Birth

*
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Guardian Name

*

Do you have computer/laptop of your own? (Optional)

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Do you have internet connection at your home? (Optional)

*

Recent Photograph(.jpg/png)

Upload CV(PDF)