1. Faculty Development Programme on Outcome Based Management Education | 21 April -5 May, 2015
Sponsored by AICTE, MHRD, Govt. of India | Organised by Dept. of Management, BIT Mesra
Registration Form
Pedagogy for
2. Faculty Development Programme on Outcome Based Management Education | 21 April -5 May, 2015
Sponsored by AICTE, MHRD, Govt. of India | Organised by Dept. of Management, BIT Mesra
Department of Management | Birla Institute of Technology, Mesra, Ranchi, Jharkhand
FDP on Pedagogy for Outcome Based Management Education | Sponsored by AICTE
Duly filled and signed (along with the institute seal) registration forms should be sent to the
Course coordinator either through email (Scanned copy in .pdf format) or at the mailing
address mentioned below on or before 2nd March, 2015:
1. Name of the Participant : ___________________________________________
2. Designation & Affiliation : ___________________________________________
3. Address of the Participant : ___________________________________________
_______________________________________________
4. Contact Phone Numbers : ___________________________________________
5. Email : ___________________________________________
6. Academic Qualification : ___________________________________________
(Highest) _______________________________________________
7. Work experience(in yrs) : ___________________________________________
8. Accomodation Required : Yes/No_____________________________________
9. Bank Draft No. : __________ Date :________ Bank : __________________________
DECLARATION BY THE PARTICIPANT : The information furnished above is true and correct to
the best of my knowledge. I agree to abide by the rules and regulations governing the
programme. If selected, I shall attend the programme for the entire duration.
_________________________
Signature of Participant (with date)
DECLARATION BY THE INSTITUTE : Certified that Mr/Ms/Dr/Prof ______________________
________________________ is an employee of our institute and he/she will be permitted to
attend the course, if selected. It is also certified that our institute is approved by AICTE.
_________________________
Signature of HOD/Registrar
Mailing Address :
Dr. Shradha Shivani,
Professor, Department of Management
Birla Institute of Technology, Mesra
Ranchi – 835215, Jharkhand
Ph – 09431161402 (M) 0651-2275233 (O)
Email – shraddhashivani@bitmesra.ac.in
• REGISTRATION FORM
