Application Form

Form No :
A Government of West Bengal Initiative under the Directorate of Youth Services
Application Form For Education & Training ( 5 th Session )
FOR OFFICE USE ONLY
Registration No. : _ _ _ _ _ _ _ _ _ _ _
Batch : _ _ _ _ _ _ _ _ _ _
Affix your recent
Passport size
photograph here
Course : _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date of Admission : _ _ _ _ _ _ _
Course Code :
USE ONLY BLOCK LETTERS
Name of the Applicant : _____________________________________________________________
Father’s Name : ___________________________________________________________________
Address : ________________________________________________________________________
________________________________________ Post Office : _____________________________
District : _________________________________ Pin Code : ______________________________
Phone Resi . _____________________________ Office __________________________________
Date of Birth : ___ ___ ___ ___ ___ ___ Category:
Attested copy of certificate is mandatory
Educational qualification:
Exam Passed Year Board / University % of Marks obtained
If have any computer exposure, furnish details : __________________________________________
I do hereby declare that the particulars furnished above are true to the best of my knowledge & belief. I declare that I will abide by the rules of the
Krishnanagar Sadar Youth Computer Training Centre, Krishnanagar, Nadia.
Date
Father’s/ Husband’s / Gurdian’s Signature
Place
Applicant’s Signature
- - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Call : 03472-223481 / 9051614118 / 9051614119 Form No :
Krishnanagar
Youth
Computer Training Centre Date : _________________
Name of the Applicant :
____________________________________________________
Course Applied For
____________________________________________________

The Application Form must be submitted in person at :
Krishnanagar
Youth Computer Training Centre
1 st Floor, 33 R. N. Tagore Road,
A. V. School More, Krishnanagar,
Nadia, Pin Code – 741101
Phone : 03472-223481 / 9051614118 / 9051614119
Application Form should enclose the followings:
1. One passport size photograph to be pasted at the maintained area.
2. Attested photocopy of Madhyamik Admit Card or Certificate for age
verification.
3. Attested photocopy of Madhyamik Marksheet / Admit Card for CITA,
CDTP, CFAS, DITA, DFAS, DDTP Course.
4. Attested photocopy of Higher Secondary or equivalent Marksheet or
Higher Secondary Admit Card for ADITA, ADFAS, ADDTP, CCHM,
DCHM, CCST, CCAD, CWD.
5. Attested photocopy of Marksheets for Higher Educational Qualification
( if any ).
6. Attested photocopy of Cast Certificate ( if applicable ).
7. Attach proof copy of Computer knowledge for CCST Course.
Last Date of Form Issue & Submission : ______.
Merit List Publish : _____.
Admission starting from ______ at 10:00 A.M.
Demand Draft should be in favour of “YOUTH COMPUTER TRAINING CENTRE”
Payable at KOLKATA.