AHTC - APPLICATION FORM Anti Human Trafficking Club

AHTC -  APPLICATION FORM

Anti Human Trafficking Club

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                                                                                                                             Date: __________________

1.    Name of the college/Institution:                    _____________________________________________

                                                                                              _____________________________________________

2.    Address:                                                                    _____________________________________________

                                                                                              _____________________________________________

                                                                                              _____________________________________________

3.    Email Id:                                                                     _____________________________________________

                    

4.    Contact No:                                                              _____________________________________________                             

5.    Name of the two Mentors (Faculty)

With contact details                Mentor - 1       _____________________________________________

                                                                                              _____________________________________________

                                                                      Mentor -2          _____________________________________________

                                                                                              _____________________________________________                                                                                                                                                                                                                  ­

6.    Name and contact number of the AHTC Student Members:-            

I.   Co-ordinator                 _______________________________________________________________

II.  Deputy Co-ordinator  _______________________________________________________________

III. Deputy Co-ordinator ________________________________________________________________

  IV. Deputy Co-ordinator________________________________________________________________

  V.    Members                    ________________________________________________________________

  VI.   Members                                   ________________________________________________________________

  VII.  Members                   ________________________________________________________________

  VIII. Members                   ________________________________________________________________

  IX.   Members                    ________________________________________________________________

  X.    Members                    ________________________________________________________________

I hereby express my willingness to start AHTC in our college /institution with the support of ICWO.

Name:-                 __________________________                           Designation:-___________________________

Signature:-          _________________________                             Seal:-

Please send the filled in application to the following address. Thank you very much for your valuable time.

          The Secretary - Indian Community Welfare Organisation – I.C.W.O.

AP-216, 18^th Main Road, ‘I’ Block, 6^th Street, Vallalar Colony, Anna Nagar West,

Chennai-600040. Phone: 044-26184392, Email: fieldmaster2000@gmail.com