Punjab Engineering College

(Deemed to Be University)

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Student Name Father’s Name

Chirag Srivastava Avinash Chandra Srivastava

Name of the Branch Student ID UG/PG

Aerospace Engineering 20101025 UG

Home Address Temporary Address (if different):

104 A/177 Rambagh, P.road, Kanpur, U.P

Telephone Number: Mobile Number

7007675195

E-mail:

chiragsrivastava234@gmail.com

Activity for which Award Has been Activity No.: Activity Name:
Applied

All Rounder

Type of Award Applied For (Say YES/NO) Institute COE COA

Colour

Has any disciplinary action been taken against you? Please mention if yes.

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No. Name of Group Position / Officership/Activity Duration Marks
(Club / Society /
Other)

UG/PG: 1st Year

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No. Name of Group Position / Officership/Activity Duration Marks
(Club / Society /
Other)

UG/PG: 2nd Year

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No. Name of Group Position / Officership/Activity Duration Marks
(Club / Society / Other)

UG: 3rd Year

Total Marks

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No. Name of Group Position / Duration Marks
(Club / Society / Other) Officership/Activity

UG 4th Year

Total Marks

Name of the Verifying Officer

Signature of the Verifying Officer

Final Recommendation

SID: Student name:

The Award is Recommended for: ☐Institute Colour

☐ Certificate of Excellence
☐Certificate of Apreciation

Name of Recommending Officer

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Designation of Recommending
Officer
Signature of Recommending
Officer

*In the case when Chief Advisor position doesn't exist, O/I will be the
recommending officer.

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 Form B
Extra-Curricular Activities Awards
Recommendation for Institute colour/Certificate of Excellence/Certificate of
Appreciation (To be filled by O/I)

Category in which Institute Colouris recommended Marks

Student Affair Council

Career Development &Guidance Cell (UG and PG)

Hostels

Cultural Clubs

Technical Societies

PECfest

Sports

NSS

NCC

All Rounder

Passing Out PG

Organizational Activities

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 Recommendation for the Award in the order of Merit
S.N Name of Father's SID Bran Year-wise Marks
o. student Name   ch I II III IV Total
       
                 

                 

                 

                 

                 

                 

                 

                 

                 

                 

                 

Name of Recommending O/I Designation of recommending O/

Signature of Recommending O/I

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Date:

Notes:

1) Forms incomplete in any respect will not be accepted.

2) Signed Hard copy of form is to be sent separately

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