Navdanya Delhi A-60 Hauz Khas, New Delhi – 110 016 Tel: 91-11-26561868, 26968077, 26853772, Fax: 91-11-27962093

Navdanya Dehradun 105, Rajpur Road, Dehradun – 248 001, Uttarakhand, INDIA
Tel: +91 – 135 – 2743175 Telefax: +91 – 135 – 2749931
earthuniversity@navdanya.net

NAVDANYA’S BIJA VIDYAPEETH (EARTH UNIVERSITY)

BIJAK APPLICATION
Prior to filing out this form, please read the Visitor’s Guide (link to updated guide)

Please limit all answers to 200 words or less

*First Name Answer Below

*Surname Answer Below

*Date of Birth (DD /MM /YYYY) Answer Below

*Gender Answer below

*Mailing Address Answer below

*Permanent Address Answer Below

*Email Address Answer below

*Telephone (Include country code) Answer below

*Please describe any medical conditions or special needs that may be an issue for you.
(Limited mobility, food allergies, or anything else you need to mention) Answer below

*Name and contact information of person to be contacted in case of emergency.

Include relationship to you. Answer below

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Occupation Answer below

Organization affiliation, if any? Answer below

*Please list your proposed arrival and departure dates. Answer below

*Give a brief overview of your educational and/or professional background. Answer below

*Why have you chosen to join us at Bija Vidyapeeth? Answer below

* Please list your preference for accommodation (dorms are available for those staying
more than 2 months, double & single rooms with shared bath for those staying less
than two months. Both are subject to availability. Accommodation is only for Dehradun
& no accommodation provisions by the Delhi office. Please visit the website or go
through the Visitor’s Guide for more information). Answer below

*What do you hope to achieve during your time here? Answer below

*Describe your learning/working style. Are you comfortable working independently with
minimal supervision? Answer below

*If any, describe the requirements from your educational institution regarding
internships (if any). Answer below

*Are you coming to Navdanya on a scholarship or grant? If so will you require any
special needs from Navdanya regarding research or anything else? Answer below

Hobbies, interests, anything else you would like to share? Answer below

*Where did you learn about the opportunity to come to Bija Vidyapeeth? Answer below
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*Have you been affiliated with Navdanya in the past? Answer below

Thank you for your interest in joining us at Bija Vidyapeeth. Please return the
completed form in .doc or pdf format to: EARTHUNIVERSITY@NAVDANYA.NET
If you are interested in the Delhi office please return the completed form to:
NAVDANYA@GMAIL.COM

*By typing my name below, I verify the above and acknowledge I have read the
"Visitor’s Guide," and will agree to the Navdanya farm community living guidelines.
X DATE:

*REQUIRED FIELDS