INNOVATION CENTRE MIT, Manipal PROPOSAL SUBMISSION FORM FOR INNOVATION CHALLENGE (25 October, 2016) Title of the Project Name of the Inventor Is the Inventor (Please Tick)

Student

Faculty

Institution If Faculty : Designation & Department If Student: Roll No, Year/Sem Branch/ Specialization (Specify appropriately) If student specify the Mentor(Faculty) details Contact Details Email Id

Team Members

Mobile

1. 2. 3. 4.

Product/ Process (Is it an idea/prototype/ product) Brief description of the Product/prototype (if required add extra sheet)

Resources Required: 1. Space 2. Table 3. Chairs 4. Notice Board Please Note: 1.Requirements like Web camera, laptop & Charger have to be brought by the participants 2.Proposal submission form should be mandatorily signed by the Mentor

Signature of Mentor

Proposal submission form.pdf

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