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* 1. Student’s Name

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* 2. Gender (required for handling hostel accommodation)

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* 3. Your Educational Status

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* 4. Contact Phone number

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* 5. Name of our college

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* 6. Contact E-mail address

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* 7. Please provide your IEEE Membership number (write "NA" if not applicable).

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* 8. The fee structure for the summer internship is as follows. Select the one that is applicable to you.

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* 9. How do you rate your project skills?

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* 10. Have you carried out projects on microcontrollers?

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* 11. Will you be able to participate in the summer internship program in total (July 15-July 25)? 

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* 12. There will be an opportunity to showcase successful projects developed at the internship program at IEEE CONECCT-2019 in Bangalore. Will you be able to attend this program if selected? (Registration for CONECCT-2019 will be provided free of cost.)

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* 13. Are you a resident of Bangalore?

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* 14. If you are not a resident of Bangalore, would you need hostel accommodation at DSU?

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* 15. Expected Date of arrival in Bangalore (enter 15-Apr-2019 if you are resident)

Date / Time

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* 16. Expected date of departure from Bangalore (enter 28-Apr-2019 if you are a resident of Bangalore)

Date / Time

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* 17. Hostel facility will be available on a twin-sharing basis at DSU for outstation students. The hostel accommodation will be on a shareable basis (Rs 250/student/day) and must be paid directly to DSU. The rooms will have bedding, pillow, attached bath. Blankets may be brought by the student. Blanket and bedspread may be brought by the student. Breakfast, dinner, and tea for the participants will be sponsored by DSU.  When staying in the hostel, you must abide by the rules and regulations set by DSU.  For any questions about hostel accommodation, please reach out to : pushpa.mala-ece@dsu.edu.in with the subject line “Summer Internship Hostel Accommodation: <Your Name>”.

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* 18. If you have opted for hostel accommodation and wish to share the room with a friend who is also attending the program, please provide his/her name.  (Leave it blank if you have not opted for hostel accommodation or if you do not have any preference.)

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* 19. Read the payment instructions provided at: http://ieee-cas-bangalore.org/activities/2019/nirmiti2019.html#registration
Fill in the details of your payment.  The payment must be completed before May 15 to avail early-bird rates.

Your form will be ignored if these details are not provided.

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* 20. Please note the following. (i) The seats in the program are limited to 40. (ii) The students who wish to enroll in the program must complete their registration no later than June 25. There is a discount for IEEE members and for early registrants. (iii) In case the program is cancelled due to some unforeseen reason, the amount will be returned to the participants in full. (iv) In case the participant cancels the registration, a refund of 20% of the fee will be made.  (v) A participant who is unable to attend for unforeseen reasons will be able to transfer his/her registration to a friend.

Click below to state that you have understood these terms.

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