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Form 1 - J (Jugaad Innovators)
Form 1 - P (Professional Innovators)
FORM 2 - Student Innovators
FORM 3 - Institution Empanelment
FORM 4 - Mentor Registration
FORM 5 - Start-ups
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FORM 3
For registration of Institution’s Empanelment with CiiA-4 Innovations Exhibition, Competition & Awards.
Institution
Affiliated to
Address
City
State
Pincode
WhatsApp / Mobile
Email
Branches or franchises of the Institution
Select
Yes
No
Operating an Incubation centre
Select
Yes
No
If yes, how many start-ups are active
Facilities provided at Incubation centre
Is there any Workshop, Lab or R & D infrastructure to develop prototype/ working models?
Select
Yes
No
If yes Please provide information
If no, would the Institution like to develop infrastructure to promote R & D? What support does it need?
Are students likely to enrol for the CiiA contest & participate in the CiiA-4 exhibition? Tentative Numbers
Select
Tentative Numbers
Exhibits
Do you provide mentors for the students to guide and help in completing working models / prototypes?
Select
Yes
No
If yes, please provide names
Head of the Institution
Title
Select
Dr.
Prof.
Mr.
Ms.
Mrs.
Name
Gender
Select
Male
Female
Others
Designation
Select
Principal
Director
Other
Mobile
Email
Head of the Innovation Cell
Title
Select
Dr.
Prof.
Mr.
Ms.
Mrs.
Name
Gender
Select
Male
Female
Others
Designation
Select
Principal
Director
Other
Mobile
Email
The Institution is ready to accept CiiA Empanelled
Select
Yes
Not at present
Reason
I confirm that all the information provided above is true and correct.
Referred by:
Contact Number
Email
Submit
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