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VA Visitor Registration & Feedback Form
Your registration and feedback will help us to serve better.
Thank you.
Best Regards,
Vigyan Ashram Team
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* Indicates required question
Full Name
*
Your answer
Gender
*
Male
Female
Contact no. (Preferabally WhatsApp)
*
Your answer
Profession
*
Choose
Farmer
Student
Entrepreneur
Director
Teacher / professor
Reporter
Service
CSR representative
Other
संस्थेचे / शाळा / महाविद्यालयाचे नाव (Name of the organization / school / college)
Your answer
Type of the organization
Choose
School
College
Company
Press
NGO
SHG
FPO
Other
Address- Area /village
Your answer
Taluka / Block
Your answer
District
Your answer
State
Your answer
Email ID
Your answer
Have you visited Vigyan Ashram before?
*
Yes
No
Name of the VA staff conducted tour / provided an information
*
Your answer
Purpose of visit or inquiry
*
DBRT admission
DIC admission
Short term course admission
FAB Lab admission
Require entrepreneurship support
Want to start IBT program in school
Want to start DIY lab
Want to organize educational tour for our school/college
Soil testing
Food testing in laboratory
Want to buy VA product / technology
Need a service
Fabric lab
Want to adopt VA product / technology / program under CSR program
Other
Required
Inquirry belongs to department
*
DBRT
DIC
FAB bab
EDC
IBT
DIY lab
Soil testing lab
Food testing lab
Fabric lab
Accounts
Other:
Required
How would you rate your experience with our service during your visit?
*
Very Satisfied
Satisfied
Partly Satisfied
Dissatisfied
Your remark / feedback
Your answer
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