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Email Requisition and Internet Access Form (Teaching/Non Teaching)
The hardcopy of the form needs to forwarded by Registrar for Internet access and creation of new email id for niperrbl.ac.in domain
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Name
Your answer
Last Name
*
Your answer
Staff Type
*
Faculty
Non Teaching Staff
Scientist
Employment Type
*
Regular
Contract/Outsource
Designation
*
Your answer
Department
*
Choose
Department of Medicinal Chemistry
Department of Pharmaceutics
Department of Pharmacology and Toxicology
Department of Regulatory Toxicology
Department of Biotechnology
Administration
Establishment
Finance Section
Store and Purchase Section
CIF
Academic Section
Library
Computer Section
Animal House
Any other Department(if not listed above)
Your answer
Employee ID (if not allotted mark as NA)
*
Your answer
Alternate Email (Existing Personal working Email id)
*
Your answer
Mobile Number
*
Your answer
Declaration
*
I hereby declare that the information furnished above is true and I shall abide by the Email Management Policy, NIPER Raebareli. I agree that NIPER Raebareli will not be held responsible in any form if the email is misused for any purpose.
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A copy of your responses will be emailed to the address you provided.
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