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AN ISO 9001:2015 CERTIFIED


A NATIONAL IT TRAINING & DEVELOPMENT ORGANISATION
Since: 2007 APPLICATION FORM
CENTER NAME -

PERSONAL DETAILS Date of Birth


Title : Mr Mrs Miss Other
DD/ MM/YYYY/ - ATTACH PHOTO

FULL NAME : Gender


Male
FATHER’S NAME :
Female
MOTHER’S NAME: Others

CONTACT DETAILS

E-mail Id Guardians Number Student Number

PRESENT ADDRESS PERMANENT ADDRESS

SELECTED COURSE

 DCA  DTP  PHOTOSHOP  JAVA


 MS OFFICE  AKRUTI  C & C++  .NET
 PGDCA  QUICK TYPING  TALLY  Others

DOCUMENTS NEEDED FOR ADDMISSION

1. Passport Size Photo 2


2. Compulsory Id Proof Any (Photo Copy)
3. Certificate Photo Copy

DECLARATION
I hereby declare that the information provided by me is subjected to verification by NICET. I hereby acknowledge that i
have read the prospectus and understood the rules and regulation, fee structure & syllabus specified by NICET and agree
to abide by the same time to time with modification if any.
Place: Signature:

Date: Name:
REGD OFFICE: PLOT NO: 7, GROUND FLOOR, UNIT-2, ASHOK NAGAR, NEAR RAJMAHAL SQUARE
BHUBANESWAR-9, ODISHA, PIN - 751009

Contact: 0674-2530169, 09337146651, 08908008906, 9437146651


E-mail: nicetodisha@gmail.com Web: www.nicetindia.in

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