INDIAN INSTITUTE OF PROFESSIONAL TRAINING
,
LUCKNOW
APPLICATION FORM FOR ADMISSION
(Please fill clearly in block letters and mark tick in appropriate box)
Home
Personal Detail:
1 (a). Programme Applied for:
Category
2. Course:
SubCat
3. Name:
4. Father's Name:
5. Date of Birth:
6. Gender:
Male
Female
7. Marital Status:
M.
UM.
9. State if:
NRI
Foreign Student
8. Nationality:
10. Present Mailing Address :
City:
District:
State:
E-mail address:
Pin Code:
Telephone:
11. Permanent Home Address:
City:
District:
State:
Pin Code:
Telephone:
Upload photo
12. Give Applicable Educational Data as per Course Eligibility :
Sr.No
.
Examination Passed
Year of Passing
Board/Institute/University
% of Marks
1.
2.
3.
4.
5.
13. (a) Whether Employed :
Yes
No
(b) If Employed give Name of Employer
(c) Working Experience (attach seprate sheet if required) :
Sr.No
.
Name of Organisation
From
To
Post Held
Remarks
1.
2.
14. Payment Details :
Cash
Draft/ChequeMoney
Money Fund Transfer
Lumpsum
Instalment:
Scheme I
Scheme II
Name of Bank
DD /Cheque/Cash/Money Transfer I.D. No.
Date of Issue/Deposit
Amount
15. Have you enclosed :
a)
Registration Fee
Yes
No
b)
Postal Charges
Yes
No
c)
Examination Fee
Yes
No
16. Option for Examination:
a)
At examination Centre Lucknow
b)
Assignment Based Examination (Postal)
c)
On Line Examination
17. You came to know about this course through:
(a) News Paper
(b) IIPT Student
(c)Internet
(d)Any other means
18. Enclose Self Attested copies of following Requared documents:
High School Certificate(10) :
Intermediate Certificate(10+2):
Graduation Certificate :
Exprience Certificate if required:
Fee Concession Certificate :
Employment cerificate :
Diploma Certificate :
Other :
Instructions
Completed application form should be submitted to The Director,
IIPT, first floor, Nidhi Complex, Sec-2, Vikas Nagar, Lucknow-226022,
. On The application form mention the details of the required fee (crossed
Demand Draft drawn in favour of Indian Institute of Professional Training
payable at Lucknow or Counter foil of Electronic Fund Transfer Receipt).
Declaration
I have carefully read the Academic and Administrative Rules and Regulations of IIPT for Correspondence Programmes as given in the information brochure and agree to abide by the same. I hereby declare that if I am enrolled in the programme applied, I agree to pay balance of fee instalments on specified dates. I further declare that the information provided by me in the application is true to the best of my knowledge and belief. A list of enclosures is attached with this application form.
Date
Place