Acharya Institute of Technology

Dept. of ………………………………………………

NOMINATION FORM FOR BEST OUT–GOING STUDENT FOR THE BATCH 2016-2020

NAME : USN:
Address for communication with e-mail and contact
number

Aggregate marks & percentage (from 1st sem. to 7th

Sem.)

Participation in co – curricular activities

( Paper presentation, attending workshops, Industrial
visits, internships, training program, etc.,)

Participation in extra – curricular activities :

(Sports, Cultural)

Participation in departmental activities:

Participation in societal activities

(NCC NSS, CULB, etc.,)

Career focus

Membership of professional bodies

Any other details you wish to state

Date: Signature of Student

*Note: Attach the supporting documents for your claim in sequence of the check list,
 Check list of the documents to be attached with nomination form
Note : Tick √ only those boxes for which documents are submitted.
Keep documents in the order of check list.
1) VTU Results

Sem 1 Sem 2 Sem 3 Sem 4 Sem 5 Sem 6 Sem 7 Agg.

CGPA
□ □ □ □ □ □ □
2) Technical Activities
(a) Paper Presentation /Symposium □
(b) Technical Competitions Participation □ Prizes □
(c) Internships Participation □ Prizes □
(d) MOOC/NPTEL/Swayam etc Certificate □
3) Career Focus
(a) Placement □
(b) GATE/GRE/GMAT Qualifying Result □
(c) CAT/SAT/Prelims of UPSC/KPSC Result □
(d) Entrepreneurship Trainings/Project Report □
4) Extracurricular Activities
Sports : (i) Acharya Player □
(ii) University Player □
(iii)State /District Representative/Selection □
Cultural : (i) Acharya/University □
(ii) Open Performance □
Societal Connect:
(i) Through Acharya /CNSS/NCC/ Blood Donation □
(ii) Open Participation (Orphanage/Old Age Homes/ □
Voluntary Services)
Literary Skills:
(i) Publications (Books/Articles/Poems/Paintings/Oratory) □
5) Leadership Qualities
(i) Departmental coordinator □
(ii) Institutional coordinator □
(iii) Any other Coordinator □