Application for Internship
1. Name of Student:
2. Father’s Name:
3. Name of the Course:
B.A/ [Link]./ BBA/ BCA/ B.A. Single Major ( ______________) B. Sc. (LS/PS/CS)
4. Semester:
5. Current Session:
6. College Roll No:
7. University Roll No:
8. Mobile No:
9. Email Id:
10. Address:
11. Period of Internship: From _______________ to ___________________
12. Internship Preferences
S. No. Area of Interest Preferred Organisation/ Linkage with the Course
Expert
Signature of the Student
Full Name & Signature of the Internship Full Name & Signature of Internship In-charge
College Mentor
Designation Designation
GOVT. PG COLLEGE FOR WOMEN, SIRSA
PERFORMA FOR MENTOR/SUPERVISOR FOR INTERNSHIP
Sr. No. Particular Mention/Submit
Information
1 PRN
2 University Roll No.
3 College Roll No.
4 ABC ID
5 Name of the Applicant
6 Father's Name
7 Mother's Name
8 Aadhar No.
9 College Internship Mentor Name and Designation
10 Area of Internship (Chosen by Student)
11 Internship Linkage with the Course (Major/Minor/SEC etc.)
12 Internship IPO Mentor Name, Designation
13 Internship Providing Organisation's Name and Address
14 MOU, if any (Yes/No)
15 Industry's Name and Affiliation
16 Date of HEI's application for Internship
17 Date of offer of IPO's for Internship
18 Date of Joining the Internship
19 Mode of Internship (Physical/Online)
20 Location of Working Place (Laboratory/Industry/Office)
21 Title of the Project of Internship
22 Duration of the Project for Internship
23 Date of Commencement of Internship
24 Date of Completion of Internship
25 Attendance of the Student
26 No. & Date of Internship Certificate issued by IPO
Date of submission of Internship certificate along with
27
Internship Report/Research Internship Report in HEI
Signature of College Internship Mentor
Govt. PG College For Women, Sirsa
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Govt. College for Women (GCW) Sirsa
Opp. Bal Bhawan, Barnala Road, Sirsa-125055 (Hr)
Ph. No. 01666-225776, 225777 College Code: SRS003 E-mail: gcwsirsa@[Link]
Web Site: - [Link] Affiliated to UGC under 2(f)
Memo No: Date:
To
_________________________________
_________________________________
_________________________________
Subject: Recommendation and request for NEP-2020-mandatory internship of 120
hours.
Dear Sir/Madam,
This is to recommend Mr./Ms. ____________ ____________ a bona fide student of
B.A. /[Link]. / B. Com / BBA / BA. Single Major (_______________), Semester_____
University Roll No. _____________, for an internship at your organization from _________
to _____________.
The student has expressed keen interest in undertaking the internship with your
organization. As per NEP 2020, an internship of at least 120 hours is mandatory for
undergraduate students. In accordance with the university internship guidelines, we request you
to:
1. Issue a Letter of Confirmation / Consent in the prescribed format (Annexure-I), duly
signed by an authorized official.
2. Assign a competent mentor from your organization who will guide the student,
provide necessary training, and monitor her/his day-to-day work.
3. Ensure maintenance of a daily work diary in the prescribed format (Annexure-II)
4. Maintain daily attendance in the prescribed format (Annexure III). The total
internship duration shall be at least 120 hours.
5. Issue letter of completion in the prescribed format (Annexure IV).
With warm regards
Mentor/Internship In-charge (Sig.)
Name and Designation
Annexure I
Consent of Internship Providing Organisation (IPO) Mentor
I ___________________having designation __________________at _____________
__________________________(Name of the IPO) hereby extend my consent to allow
___________________________(Name of the Student) of Govt. PG College for Women,
Sirsa, University Roll No. _______ ______________ to do the internship at this organization/
with me during the period from _____________to ____________.
Mr./Ms./Mrs. __________________________ or myself will act as an Internship Mentor.
Signature Seal of the Organization
Name: _________________
Designation_____________________
Address
Email
Contact No.
Annexure II
Internship Daily Diary
Name of the Internship providing Organisation/ Individual____________________________
Name of the Intern ___________________
University Roll No. __________________________
Class & Semester ___________________________
Internship Period: From __________________to _______________
Date Working Time No. Task Signature Signature of Remarks
Hours Assigned of Intern Mentor (of If any
From To Worked & organisation)
Performed
Signature of Mentor
(Assigned by Internship Providing Organisation / Individual)
Name of Mentor
Seal of the Certifying Organization/ Individual
Annexure III
Attendance Sheet
Name of the Internship providing Organisation/ Individual____________________________
Name of the Intern ___________________
University Roll No. __________________________
Class & Semester _________________
Internship Period From______________ to ________________
S. Date Time of Arrival Signature Time of Departure Signature of No. of
No. of the the Intern Hours
Intern
Total No. of Days Total no. of Hours
Signature of Mentor
(Assigned by Internship Providing Organisation / Individual)
Name of Mentor
Seal of the Certifying Organization/ Individual
Annexure IV
Internship Completion Certificate
It is certified that Mr./Ms./Mrs. ________________ D/o___________________________
Class ____________________Semester _________University Roll No._____________ of
Govt. PG College for Women, Sirsa carried out his/her internship of
________________hours from ____________to _____________ from this organisation /
individual.
She/he displayed keen interest in learning and worked with regularity and punctuality,
showing regard for dignity of labour, team participation and mutual cooperation. While
working, she/he fulfilled all the objectives of the internship.
I wish her/him a bright future ahead.
Signature of Mentor
(Assigned by Internship Providing Organisation / Individual)
Name of Mentor
Designation
Address
Contact No.
Email
Seal of the Certifying Organization/ Individual
Govt. PG College for Women, Sirsa
INTERNSHIP REPORT
ON
TITLE OF THE REPORT
(IN CAPITAL LETTERS)
Submitted in partial fulfilment of the requirements for undergraduate course
Course ____________
Session-____________
SUBMITTED BY
NAME
COLLEGE ROLL NO.
UNIVERSITY ROLL NO.
NAME OF THE COURSE
PLACE OF INTERNSHIP
SUBMITTED TO
DEPRTMENT OF _________________
GOVT. PG COLLEGE FOR WOMEN, SIRSA
DATE OF SUBMISSION
____________________
CERTIFICATE
Certified that this Internship report is based on my learning experience during
internship done by me under the guidance of Internship Mentor Mr./Mrs./Dr.
________________ at _____________________________________
(name of organization/ place) from ____________to ______________
submitted as a part of the Internship Course of Undergraduate Programme
________________ of Govt. PG College for Women, Sirsa affiliated to Chaudhary
Devi Lal University, Sirsa
Signature of the Student Signature of the Internship Mentor of the
IPO
Name of the Student Name of the Internship Mentor
Date Date
Place Place
Seal of the Organisation/ Individual
Countersigned by
Signature of the Internship College Mentor Signature of the Internship In-charge
Name of College Internship Mentor Name of the Internship In-charge
Designation Designation
Date Date
Place Place
Acknowledgments
There are many persons who may have helped the student during Internship. It is customary
to acknowledge and thank them for their help.
TABLE OF CONTENTS
1. Organization Overview- Describe the internship site (e.g. Location, working etc.)
2. Internship Description / Key Roles and Responsibilities
3. Objectives of Internship
4. Details of Activities/Work done during Internship
5. Skills Acquired /Learning outcomes
6. Conclusion/Summary
7. Attachments
➢ Mandatory Supporting documents
• Internship Work Diary
• Internship Attendance
• Internship completion certificate
➢ Any other e.g. photographs, charts, tables etc. (Optional)