EmailMe Form - DATA SHEET

Name of the Nominee *
First Last
Address for communication *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Mobile *
### - ### - ####
Email *
Degree (obtained from RMK) *
Academic Background *

First Class with Distinction First Class Second Class Third Class

SSLC

HSC/Intermediate

UG

PG
GRE/TOEFL/CAT/GMAT SCORE
Percentage obtained(EX:88.00)

SSLC

HSC/Intermediate

UG

PG
Year of Passing (EX:2000)

SSLC

HSC/Intermediate

UG

PG
Work Experience

Years

Months
Contributions
Papers Published (National/International/Journal)
Projects Undertaken
Innovations
Social Activities
Achievements
Awards
Prizes Won
Scholarships
Sponsorships
Files should be less than 100kb
Your Latest Passport size Photo (Jpeg Format, File should be less than 50KB) *
Appropriate Certificates (Academic/Achievement)
Professional experience Certificate
Contributions that merit this award (1 page)
Any other relevant information (Testimonials)
Brief CV of the alumnus
Proposed by *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Mobile *
### - ### - ####
Email
If proposer is an alumnus, please give details:
Batch / Discipline / Year:
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Years
Months

	First Class with Distinction	First Class	Second Class	Third Class
SSLC
HSC/Intermediate
UG
PG