Registration Form Course Coordinators fromAcademy . Prof. Ratnajit Bhattacharjee Name of Applicant (first, last):…………………. .………………………………………................. Affix passport Principal Investigator, E&ICT Academy, IIT Guwahati. Fathers Name:……………………………........... size An Initiative of Ministry of Electronics & ………………………………………………….. photograph . Dr. Gaurav Trivedi Mothers Name:…………………………………. Co-Principal Investigator, Information Technology (MeitY), Date of Birth (DD/MM/YY):…………................................................ E&ICT Academy, IIT Guwahati. Government of India Gender:……………………………………………………………….. Organizers from NERIST Category(General/SC/ST):…………………..……………………….. Electronics & ICT Academy Patron Designation:………………………………………………………….. IIT Guwahati, Assam Highest Qualification:………………………………………………... Prof. H.S.Yadav Name and Address of the Institute/ Organization:…………………… Director, NERIST. ……............................……………………………………………….. Coordinators A One-week Faculty Development Programme City/town:……………………………………………………………. Dr. (Mrs) Joyatri Bora District / State:..............................................Pin.:................................. Behavioral Remodelling and Research Assistant Professor, Dept. of ECE, Methodology Email:……………………………………………………………….... Mobile number: +91-9436042998/+91-8414843484 Landline Number (with STD code):…………………………………. Email id:
[email protected],
[email protected] (01 - 05 April, 2019) Mobile Number:………………………………………….................... Dr. (Mrs.) Bijoylaxmi Sarmah Do you need accommodation? (Yes/No):…………………………….