Internship Program Application Form
1. Personal Information
Full Name: _______________________________________________________
Student ID/Roll Number: ____________________________________________
PU Registration Number: ____________________________________________
National ID No. (if available)/ Citizenship No.____________________________
Date of Birth: _________________________________________
Contact Number(s): _______________________________________
Email id: ________________________________________
Permanent Address: _____________________________________
2. Academic Information
• Program: _________________________________
• Year/Semester: _______________________________________
• CGPA (up to 6th semester): ____________________________________
• Total credit hours passed up to 6th semester: _________________
• Number of subjects passed up to 6th semester: _______________
3. Internship Preferences
• Preferred Internship Area(s):
1. _________________________________
2. _________________________________
3. _________________________________
• Preferred Location (if applicable): ______________________
• Availability Period: From ______________ To ______________
4. Previous Experience (if any)
• Have you undertaken any prior internships? (Yes/No): ______
• If yes, provide details:
o Organization: _________________________________
o Role: ________________________________________
o Duration: _____________________________________
o Key Responsibilities: ___________________________
5. Skills and Certifications
(List any relevant technical skills, certifications, or software proficiency)
6. Emergency Contact
• Name: _____________________________________________
• Relationship: ________________________________________
• Contact Number: _____________________________________
• Email: ______________________________________________
Self-Declaration
I, [………Full Name……….], hereby declare that the information provided in this form is true and accurate to
the best of my knowledge. I understand that any false or misleading information may result in the rejection of
my application or disqualification from the internship program. I also commit to:
1. Adhering to the rules and regulations of the School of Engineering and the host organization during the
internship.
2. Maintaining professionalism and confidentiality throughout the program.
3. Completing the internship within the stipulated time and submitting all required reports and
evaluations.
Signature: _________________________
Date: _________________________
For Office Use Only
• Application Received On: _________________________
• Reviewed by: ____________________________________
• Remarks: ________________________________________