STUDENT REGISTRATION – CUM ADMISSION FORM

Admission Form No.

Course Applied For……………………………………………………………

Personal Details of Applicant –Sex: MaleFemale

Name

Address

Mob. No. E mail ID

Father’s NameMother’s Name

Detail of Academic Qualification Attach Attested Copies

Examination / Year Passed / University/Board / % of Marks / Class/Division/Grade
10th
10+2
Graduation
Post Graduation
Others

Details of any other Computer Course attended …………………………………………………..………………………………………………………………………………………………………

Any previous experience of computer skill ? / None at all
A Little
Completed Basic Course
Other (please state)
Why would you like computer training? / General Interest
Keep up with things
Other (please state)
Training Required and level / Absolute Beginners )
Progression - (follow on from beginners level)
Certificated Course
Other (please state)
Times when NOT available for training (Timings 3-5 PM) / Mon / Tues / Wed / Thurs / Fri
eve / eve / eve / eve / eve
Do you have any disability, which would affect you when using a computer? / No
Yes
We have a specially adapted (large size) Keyboard & Mouse
We can increase the size of content on screen for easy reading
We can change colors and fonts for easy reading

DECLARATION FROM THE STUDENT

  1. I declare that all the facts stated above are true to the best of my knowledge and belief and nothing has been concealed therein.
  2. I hereby agree to conform to any rules, acts and laws enforced by Government and this Institute. Further I, hereby undertake that if I disobey any of the rules or regulations of the college, any disciplinary action can be taken against me, even to the extent of expulsion from the Institute.
  3. I know that at any stage of my course, if any, discrepancy is found in my testimonials/documents/eligibility by the Institute or any other authority, the student will be responsible.
  4. I hereby agree to pay the full fee of the Course even if I discontinue at any time during the Course, as I am fully aware that the seat vacated by me will be a loss to the Institute.
  5. I hereby agree to fulfill the 75% attendance condition and to clear the conditional examination to make myself eligible for the final exams as per the Institute rules, failing which my candidature will not be considered for the final Training and OJT.

6.No additional money except mentioned in the Prospectus/notification has been paid by me to the Institute authorities.

Date: ______Place______Signature of the Student______

DECLARATION FROM FATHER/MOTHER/GUARDIAN

  1. The particulars furnished by my son/daughter/ward in his/her form are true to the best of my knowledge and nothing has been concealed therein.
  2. I undertake and bind myself to pay by the due date, on behalf of my son/daughter/ward such fee/fines/ charges etc., which the Institute may levy upon him/her from time to time by due date and in the event of failure to perform this duty, the principal of the Institute may take any action against my son/daughter/ward as he/she may deem fit.
  3. That I being the father/guardian of Mr./Ms. ______agree to take the entire responsibility of his/her good Behavior and that he/she will maintain proper discipline during his/her stay in the Institute.
  4. I agree that I will pay any change/enhancement in Institute fee/dues from time to time.
  5. That the Institute authorities have explained to me about the eligibility criteria & status of the Institute. I am admitting my son/daughter/ward after thorough consideration and to my full satisfaction.

Date:-______Place______Signature of Father/Mother/Guardian______

Mode of Payment / : / Demand Draft /CC / Cash
Detail of Form Fee / : / Amount Rs. 500/
Detail of Course Fee / : / Amount Rs.

DD.No . ______Date ______Bank Name& Branch Address ______

Card Payment Details – Debit Card Credit Card
Card No. :
Card Holder Name :
Issuing Authority :
Validity :

In Case of Cash Payment : Receipt No. ______Date:______

Check List :-

Photo Copies of Certificates

Photo

Address Proof

Id Proof

For Office Use Only

EDN QLN OK Photo Attested

Admitted Registration No.
Signature Centre Head