Name of the Training Center/ Association:

Address of the Training/Association Center:

Telephone Number: Photo
Email: (2 Copies)
Web Address:

SEIP Trainee Admission Form

SEID :
Course Applied : ________________________________________________________
I. Basic Information
Name : ________________________________________________________

Gender : □ Male□ Female

National ID Number : ________________________________________________________
(Copy of NID to be attached)

BirthRegistrationCertificateNumber:____________________________________________________
(If NID is not available then birth registration certificate to be attached)

Date of Birth (YYYY/MM/DD) : _______________________________________________________

Present Address : _______________________________________________________
________________________________________________________
Permanent Address :________________________________________________________
________________________________________________________
Home District & Upazila : _______________________________________________________
Mobile No: _________________________________________________________________________
E-mail :( If available) : _______________________________________________________
II. Personal Information
Religion : ___________________ Ethnic Group: _____________________
Education Level: Highest Class Completed: ___________Year : ______________

Are You Currently Employed? □Yes □ No

Family’s Monthly Income (BDT) :

Are you physically challenged? □ Yes □No

(* if ‘Yes) □Seeing □Movement □Hearing □Speech others: ________
Family Information

Mother’s Name : ______________________________________________________

Mother’s Education Level
Father’s Name
Father’s Education
Father’s Annual Income
Does your family own home?
Does your family own land?
: ______________________________________________________
: ______________________________________________________
: ______________________________________________________
: ______________________________________________________
: □ Yes □ No
: □ Yes □ No

Number of brothers and sisters : ______________________________________________________

IV. Declaration:

1) I certify that I correctly provide my information and qualifications in the student admission form.
2) I express my willingness to render my services to the related industrial sector after completion of the
training program.

Signature of Trainee Date