Dr. T. Thyagarajan: Phone: 044 - 2220 0599 / 2235 8989 Professor & Director

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CENTRE FOR UNIVERSITY – INDUSTRY COLLABORATION

ANNA UNIVERSITY, CHENNAI – 600 025


Phone: 044 - 2220 0599 / 2235 8989
E-mail: [email protected] / [email protected]
Dr. T. Thyagarajan
Professor & Director
Ref: CUIC/TRAINING Date:
To
…………………………………………………………
…………………………………………………………
…………………………………………………………
APPLICATION FOR INPLANT TRAINING

Name of the student (Capital Letters) : ………..……………………………………Roll No :…..….…………….……

Degree: …………… Branch: …………………………………………………………………Semester: ……………..

Student’s Address for communication: …………………………………………………………………………………...

…………………………………………………………………………………………………………………………………

E-mail ID: …………………………………………Contact No:……………………………………………………………

Proposed duration of training : From………………………………. To………………………………….

Signature of Student Signature of the Class Advisor Signature of HOD with Seal

Dear Sir / Madam,

I am forwarding the above student’s application for your kind consideration to undergo Practical Inplant
training in your esteemed organization please.

DIRECTOR – CUIC

…………………………………………………………………………………………………………………………………………
APPLICATION FOR INPLANT TRAINING
(To be retained by CUIC Office)

Name of the student (Capital Letters) : ………..……………………………………Roll No :…..….…………….……

Degree: …………… Branch: …………………………………………………………………Semester: ……………..

E-mail ID: …………………………………………Contact No:……………………………………………………………

Student’s Address for communication: …………………………………………………………………………………...

…………………………………………………………………………………………………………………………………

Name and Address of the Company: …………………………………………………………………………………...

…………………………………………………………………………………………………………………………………

Proposed duration of training : From………………………………. To………………………………….


Signature of Student Signature of the Class Advisor Signature of HOD with Seal Director, CUIC with Seal

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