Entry Form

Note: Please provide at least a contact address (Address, Email, Phone, FAX, etc.).
Do not forget to notify any change in address, phone, etc.
If you wish to keep something private, leave that field blank.
Please leave all irrelevant fields blank.

Name:        
                 < Firstname > < Middlename > < Lastname >

REC, Rourkela Information:

Graduation:     
Format YYYY (eg: 1983) 
Branch:         
                Select your Branch here
                Appl. Electr. and Instr. Engg.
                Ceramics Engineering
                Chemical Engineering
                Civil Engineering
                Computer Science & Engineering
                Electrical Engineering
                Mechanical Engineering
                Metallurgical Engineering
                Mining Engineering
                Master in Computer Application
                Master's in Physics
                Master's in Chemistry
                Master's in Mathematics
                Faculty / Research Fellow
                Other: Please Specify ===>
                
                
(Please indicate if the degree was not undergraduate)
 BS      MS      PhD

Nickname:       
 (If any. People might not remember you without it) 

Education After REC:

Use if required or leave it blank: 
Major:            
University:      

Major:          
University:     

Current Info:

 
Occupation: 
                
(Specify Job Position & Company; specialization & program if in Univ.)
Work Address:
                
Work Phone:     
FAX # :         
Email Address:  
HomePage URL:   

Personal Info:

Residential Address:    
                
Residence Ph:    

Spouse's Name:  
Children:       

Additional Information: 
                

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Comments/Suggestions:
                 

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