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Pledge a Dream Program Application
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Email
*
Your email
Date of application
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MM
/
DD
/
YYYY
IIT Roorkee enrollment number
*
Your answer
First name
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Your answer
Last name
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Your answer
Phone (eg: +91xxxyyyzzzz)
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Your answer
Current enrollment program (eg: B. Tech)
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Your answer
Current field of study (eg: Biotech Eng)
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Your answer
Current year of degree program (eg: 4th year)
Your answer
IIT Roorkee faculty reference (Name, Department, Email, Phone)
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Your answer
Activity description for which funds are requested (eg: Research Internship for 12 weeks)
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Your answer
Activity start date
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MM
/
DD
/
YYYY
Activity end date
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MM
/
DD
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YYYY
Location of Activity (eg: University, Department or Conference)
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Your answer
Activity guide/ contact (eg: Prof ABC in Dept of Biotech, Univ of XYZ, city, country, phone, and email)
*
Your answer
Link of supporting documents (e.g.internship offer/ conference acceptance/ other) - share with
admin@iitrhf.org
*
Your answer
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