Manipal Dot Net Pvt Ltd.

Student Name*

Course Name*

Branch Name*

College/University*

Present Address*

Permanent Address*

E-MAIL ID*

Phone Number

Mobile Number*

What is your typing speed (in words per minute)?*

Are you capable of performing soldering tasks?*

Yes No

Do you smoke?*

Yes No

Have you indulged in software piracy?*

Yes No

Do you consume alcohol?*

Yes No

Please provide details of your academic details *

Please give details of a faculty member willing to recommend you and personally vouch for your behavior*

Faculty Name:

Faculty Phone:

Faculty Email:

How many hours/week will you be at MDN during the semester (excluding sessionals/final)?*

How many hours/week will you be at MDN during the break (excluding 2 weeks off to visit family)?*

Where do you plan to do your final semester Practice School?*

MDN

Other

If Other, give details:

CGPA Marks:

1st Semester:

2nd Semester:

3rd Semester:

4th Semester:

5th Semester:

6th Semester:

7th Semester:

Technical Projects Done:

What:*

Where:*

From:*

To:*

Awards:

Extra Curricular Activities:

Other Training:

Do you intend to attend any other club, training, etc. during your internship at MDN?

Yes

No

If yes, give details

Are you planning on doing an internship at MDN through IAESTE?

Yes

No

Are you planning on doing an internship abroad?

Yes

No

Earliest available date:*

Application for Internship at MDN

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