FOR OFFICE USE:

IAESTE IndiaMIT
Application for Internship
Name College Branch : Rahul Giri : Manipal Institute of Technology : Computer Science and Engineering Phone : 9876542210

Ref No:_____________ Recd By:____________

Registration. No : 080905123 Email id : sample@anydomain.com

PLEASE SPECIFY YOUR PREFERENCE FOR APPLICATION

1st Preference
Offer No: Country: TR/09/0012/04 Turkey Desired Period Of Internship From 01-Jun-2010 To 31-Jul-2010

2nd Preference
Offer No: Country: E-5045 Spain Desired Period Of Internship From 15-Jun-2010 To 28-Jul-2010

3rd Preference
Offer No: Country: D/09/112 Germany Desired Period Of Internship From 22-May-2010 To 15-Jul-2010

I Rahul Agarwal here by declare that I shall abide by the rules and regulations of IAESTE IndiaMIT, and will respect and accept the decision made by IAESTE IndiaMIT regarding my application. I declare that all information provided in my application and supporting documents is true to the best of my knowledge, and in the event of providing wrong information I would accept any decision taken by the IAESTE IndiaMIT. Date: 23-Jan-2010 Place: Manipal Signature

Please submit this form along with hardcopies of your Fact Sheet with Offer Number mentioned on it for every offer you are applying and one copy of your university transcripts and supporting documents at IAESTE IndiaMIT Office, 104 Center of Excellence, 1st floor, Academic Block 4, MIT, Manipal between 5 PM and 7 PM, on or before the last date for application. Students outside Manipal should send their applications through email at application@iaeste.in Kindly email your application related queries to application@iaeste.in