Internship Project Course Code: 4350704

Sem-5 Internship/Project Registration Form

Note: Students needs to submit this registration form after finalize the details of 6 Weeks of Internship

Sem-5 Internship/Project Registration Details

Student Enrollment Number

Student Full Name

Student Contact Details Mobile Number:

Email Address:

Internship Duration [Date]

Code and Name of the 624 – Government Polytechnic, Himatnagar

Institute
Mentor Details Full Name:
(Industry/Company)
Industry/Company Resource Person Designation:
Mobile No:
Email Address:
Industry Details Full Name:
Address with Pincode:

Email:

Phone:
Website [If any]:
Mentor Details (Institute) Name:
Institute/College Resource Person
Designation:

Mobile No:

Email Address:
Mode of Internship Internship in industry (Offline Mode)
[Tick the Appropriate one only]
Internship in industry (Online Mode)
Project [Offline in Institute]
Technology/
Programming Languages
Brief of Tasks [Modules]
/Project Title
Nature of Work
[Tick the Appropriates & Write if  Web Design
any other from given list]  Application Development (Website)
 Application Development (Desktop Application)
 Mobile App (Android/iOS)
 Networking/Security
 Data Analysis and Visualization
Other:

Student Signature Signature with stamp/seal

[Industry/Company Mentor/Guide]

Note: In case of internship at college, consider college as company and college guide/mentor as company guide