Dr.

MAHALINGAM COLLEGE OF ENGINEERING AND TECHNOLOGY, POLLACHI – 642 003 IIPC 1/4

INDUSTRIAL VISIT / TOUR APPLICATION FORM

Class Details: ………………. Date of Visit:…………….

Total strength of the

Course/Dept. Year/Semester No. of Students visiting
class

Reason for students who are not visiting :

Industry Details:

Name of the Industry Contact person @ Industry Contact number @Industry

Industry address for communication:

Faculty Details:

Accompanying Staff Designation Contact number

Transport Details:

Mode of Transport Name of the Travel and Address

By Bus / Train

Check List:

Dept. IIPC Coordinator Remarks & Signature

S.No. Documents
Verification & Signature of IIPC Coordinator
1. Industry Permission Letter
2. Students Name List Signed
3. Class Cancellation Circular
4. Schedule of visit Signed by
Accompanying Staff, PC/FA,HOD
5. Hostel Permission form
6. Permit copy or Railway Reservation
Details
7. Parent’s declaration form if it is Industrial
Tour
8. Previous Industrial Visit Report
submission
Signature and Name of Class Representatives / IV Co-ordinators with name:
1) Name ……………….……… Signature …………………………….

2) Name ……………….……… Signature …………………………….

HoD
Faculty Advisor Programme Coordinator

Approved / Not Approved

Principal Director (Academic)

Secretary
 IIPC 2/4
Dr. MAHALINGAM COLLEGE OF ENGINEERING AND TECHNOLOGY
POLLACHI – 642 003
CLASS CANCELLATION CIRULAR

Course & Department : __________________________________________

Date of class cancellation : __________________________________________
Purpose :___________________________________________

Sl.No Period Subject Name of the Staff & Designation Signature

SCHEDULE OF VISIT
(May be attached separately if it is Industrial Tour)

Starting Place :______________________ Reaching Place:___________________

Approximate Traveling Distance (in KM) :_________________

Departure time :

Reaching time at company :

Lunch time :

Departure time from company :

Arrival time at college :

Signature & Name of:

Accomp. Staff PC FA Dept. IIPC Coordinator HoD

 IIPC 3/4
Dr. MAHALINGAM COLLEGE OF ENGINEERING AND TECHNOLOGY
POLLACHI – 642 003

HOSTEL PERMISSION FORM

Course & Department : ____________________________ Date: ………………………

Date of permission : ____________________________ Hostel : Boys / Girls
Purpose : ____________________________
Start time : ___________________ Return time: ____________________

Sl.No Roll No. Name Signature

Permitted / Not permitted

PC / FA HOD HOSTEL WARDEN

 IIPC 4/4

Dr. MAHALINGAM COLLEGE OF ENGINEERING AND TECHNOLOGY

POLLACHI – 642 003
INDUSTRY INSTITUTE PARTNERSHIP CELL
INDUSTRIAL VISIT / TOUR REPORT
Date:

Course & Department

Date(s) of Visit

No. of Students visited

Accompanying Staff Members

Name
&
Address of the Company

Feedback
&
Authorized Signatory
from the Company

Technical details about the Company Enclosed / Not enclosed

Comments

Signature of :

Accomp. Staff Dept. IIPC Coordinator PC FA HOD