Annexure II – Institutional Nomination Form
Purpose: To ensure proper endorsement and verification from the institution.
Name of Institution
Address
1. Team Name
2. Theme Selected
-- Select theme --
User Centric Interventions
Tech-Driven Safety
Infrastructure & Environment
Evaluation & Enforcement
3. Members (max 4) — name, email, mobile, stream, year
Year:
Team Leader
Year:
Team Leader
Year:
Team Leader
Year:
Team Leader
Team Leader Email Verification
OTP will be sent to the selected Team Leader's email. Team Leader email and mobile are mandatory.
6. Faculty Mentor Name
Faculty Mentor Email & Mobile
Signature of Dean/Principal
Institution Seal
Date
Note: Upload (only pdf format) the filled and duly signed copy of this annexure in the registration portal
