FDMPOM -03   Modular Programme  - Application Form  
Kindly fill the application form. You will receive an intimation mail if you are selected for the FDMPOM. The selection list will be available in our website (www.nitttrc.ac.in).
Email *
Course Code and Title *
Salutation *
Name of Participant *
 Date of Birth *
Gender *
Category *
Are you belonging to EWS (Economically Weaker Section) *
Person with disability(PWD) *
Department *
 Designation *
Have you attended any online FDPOM conducted by NITTTR, Chennai (Academic Year 2020-2021)? *
 If so, please select how many programmes you have attended? *
Name of the Institution *
Type of Institution *
 Institution category *
Institution  Address *
City *
Pincode *
State *
Contact Phone / Mobile *
Years of Experience -Teaching *
Years of Experience - Research *
Years of Experience - Industry *
Will you be able to submit deputation order or permission / authorization letter from your organisation ? (Kindly obtain deputation order or permission/ authorization letter from concerned authorities (i.e. Principal/Head of the Department/ Immediate reporting officer) *
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