JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Teachers' Registration Form
Please fill the following form as you will be adjudged to be honoured on Pritabha Samman Samaroh-2019.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Personal Information
Teacher's Name
*
Your answer
Father's Name
*
Your answer
Address
*
Your answer
Contact No./Whatsapp No.
*
(Mandatory for Sending Event Information)
Your answer
Email ID
*
(Mandatory for Sending Event Information)
Your answer
Academic Qualification
*
Your answer
Professional Qualification
Your answer
Experience
*
Your answer
School Details
Name of the School
*
Your answer
Name of the Board
*
Choose
CBSE
BSEH
ICSE
Name of the Subject taught in 12th Class
*
Your answer
Pass Percentage the Board Result taught by the Teacher
*
Your answer
Total Number of the students taught by the teacher (in the 12th examination)
*
Your answer
Number of the students got 90% and above marks (Taught by the teacher)
*
Your answer
Awards and Achievements
Awards and Contributions
Your answer
Pedagogic Achievements
Your answer
Preferred Venue for Samman Samaroh
*
Choose
PIET Campus
I hereby confirm that all the information submitted above are true to my knowledge.
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Panipat Institute of Engineering & Technology.
Report Abuse
Forms
