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Unformatted text preview: INDIAN INSTITUE OF TECHNOLOGY BOMBAY INDIAN INSTITUE OF TECHNOLOGY BOMBAY Dear Student, You will soon become an alumnus/alumna of IIT Bombay. We would like to remain in touch with you as you follow your career. Please fill in this form to help us update our database. Thank you, Dean, Alumni & International Relations ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­ IIT BOMBAY ALUMNI INFORMATION FORM A) PERSONAL INFORMATION Dr./Mr./Ms. ____________________ ___________________ ___________________________ (First Name) (Middle Name) (Last Name) Nickname at IITB (if any): _______________________________ Date of Birth: _______________ Email ID (not IITB) : _________________________________________________________________ Do you wish to keep your email ID private? Yes / No URL: ______________________________________________________________________________ Hostel: ______________ Room: __________________ Mailing address: ____________________________________________________________________ ___________________________________________________________________________________ City: _______________________ Pincode: ____________ State: _____________________________ Country: ____________________ Phone No (mobile and landline).: _________________________ B) ACADEMIC INFORMATION IITB Degree: _______________ Department: ____________________________________________ Roll No.: _________________ Year of Joining: ______________ Year of Graduation: __________ Other Degrees from IITB (if any): ______________________________________________________ Area of specialisation: ________________________________________________________________ Thesis/ Project guide: 1) Prof. _________________________________________________ 2) Prof. _________________________________________________ Page 1 of 2 Page Awards / Scholarships received while at IITB: Awards / Scholarships received while at IITB: ___________________________________________________________________________________ ___________________________________________________________________________________ C) FUTURE PLANS: What are your plans immediately after graduation? [ ] I am joining ________________________________________________________________Ltd., at _____________________ (city) as ______________________________________________. [ ] I am joining ___________________________________________________________University, at _____________________ (city) for ______________________________________________. [ ] I plan to set up my own business. [ ] Other, specify _________________________________________________________________. It may happen that we are unable to reach you with the information you have provided above.. Please also provide the email addresses and telephone numbers of a few close friends or relatives through whom we may be able to contact you. 1. Email:_______________________________________ Tel:_________________________________ 2. Email:_______________________________________ Tel:_________________________________ 3. Email:_______________________________________ Tel:_________________________________ 4. Email:_______________________________________ Tel:_________________________________ We thank you for the information provided and please stay in touch with your Alma Mater. Whenever you change your address and email ID, please inform us, as well as at [email protected] We wish you the best in all your endeavors!. Page 2 of 2 Page ...
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This note was uploaded on 09/30/2011 for the course GENRAL 101 taught by Professor Aa during the Spring '11 term at IIT Bombay.

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