WEB Committee- 2011 Nomination From

INSTRUCTIONS:
This form must be completed by any current student wishing to be considered for a position on
Web Branding Team.

Name : ___________________________________________

Address: ___________________________________________ Photograph

(Paste Self Attested

___________________________________________
Passport Size Recent
Photo)
___________________________________________
Telephone:
Home: _____________________ Cell:_________________

E-Mail Address: __________________________________________

Mention Any Previous Related Experience in school/college (if any):

_______________________________________________________

________________________________________________________

Nominated by: Self/Mentor

(Strikeout whichever not applicable. Provide name of the mentor and get it cross-signed in case
of recommendation)

Student Undertaking For Nomination:

I verify that I am a full-time student during the academic year as defined by the accredited
university, and that I will be a student as of _______/_________/________.

I verify that I am fully aware that this is ___ hours a week activity and it shall not affect my
academics in any manner whatsoever. I have gone through skills laid out and possess all/most of
them to carry out the key activities detailed in the web committee handbook.

I am fully aware that this internship is voluntary and if selected, is applicable for a term of
__________, from ____________ to _________________.

Student’s Name & Signature with Date:

(In the space provided) Signature /Date
Student Name
______________________

Please provide a personal statement of the reasons why you wish to serve on the Student
Committee at the back of this form

Version 1.3, 24 December 2010