Application Form for Registration
Electronics & ICT Academy, IIT Roorkee
* Required
Email address
*
Note
Draft will be made in the name of "DEAN SRIC IIT ROORKEE"
Course Name
*
Electric Vehicle
AI and Machine Learning
5G Communications
Note
Select anyone which is nearby your location
Nodal Center
*
C-DAC Noida
NIT Jalandhar
IIT Roorkee
Name of the Applicant
*
Gender
*
Male
Female
Others
Required
Father's Name
*
Category
Gen
OBC
SC
ST
Date of Birth (MM/DD/YYYY)
*
MM
/
DD
/
YYYY
Name & Address of the Organization/Institute
Organization/Institute/College Name
*
Address
*
City
*
District
*
State/UT
*
Qualification
*
Choose
P.hD
M.Tech/M.E.
B.Tech/B.E.
MCA
Other
Branch
*
Electronics & Communication
Computer Science
Information Technology
Electrical Engineering
Other:
Required
Designation
*
Professor
Associate Professor
Assistant Professor
Research Scholar (Phd.)
Research Scholar (M.Tech)
Student
Other:
Required
Mobile Number
*
Do You Need Accommodation
*
Yes
No
Required
Amount
*
Demand Draft Number
*
Payment Date
*
MM
/
DD
/
YYYY
Name of The Bank
*
Applicant Photograph
*
Add file
Required
Scan copy of payment receipt
*
Add file
Required
Note
1. The Demand Draft with application form must reach to the following address: Mr. Prateek Sharma, EICT Academy, ECE Department, IIT Roorkee, Uttarakhand 247667.
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Additional Terms
Forms
