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Doeacc Society, Chennai Centre: Short Term Courses Enrollment Form

This document is an enrollment form for short term courses offered by DOEACC Society Chennai Centre. It requests information such as name, address, academic details, computer knowledge, preferred timings and willingness to attend weekend classes. The applicant declares that the information provided is true. The form is to be submitted to the Course Coordinator and requires photocopies of documents to be attached. It will be verified and a decision made on admission. If admitted, fees are to be paid and receipt number endorsed before returning the form to the Course Coordinator.

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Sathish Ragavendran
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26 views1 page

Doeacc Society, Chennai Centre: Short Term Courses Enrollment Form

This document is an enrollment form for short term courses offered by DOEACC Society Chennai Centre. It requests information such as name, address, academic details, computer knowledge, preferred timings and willingness to attend weekend classes. The applicant declares that the information provided is true. The form is to be submitted to the Course Coordinator and requires photocopies of documents to be attached. It will be verified and a decision made on admission. If admitted, fees are to be paid and receipt number endorsed before returning the form to the Course Coordinator.

Uploaded by

Sathish Ragavendran
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DOEACC SOCIETY, CHENNAI CENTRE

[A unit of DOEACC Society under Department of Information Technology,


Ministry ofCommunication & Information Technology, Govt. of India]

First floor, ISTE Complex, 25, opp. to Anna Centenary Library,


Gandhi Mandapam Road, Chennai- 600025.
Ph: 044 - 24421445

Fax: 044 - 24421441

[email protected]

www.doeaccchennai.edu.in

SHORT TERM COURSES ENROLLMENT FORM


To
The Course Co-ordinator,
DOEACC SOCIETY, Chennai Centre.
Sir,
I would like to enroll myself as a candidate for i)Course title: ____________________________________________
ii)Scheduled from:_________________________________________
1. Name (Mr./Ms./Mrs.):____________________________ 2. Father's Name:___________________________________
3. Address
Communication:

Permanent:

Ph:

Ph:

4. Date of Birth:_______________ 5. Sex: Male / Female 6. Whether SC/ST:______ 7. Nationality:_____________


8. Profession:____________________________________ 9. Computer Knowledge, if any:_______________________
10. Academic Details ( Including Dipploma / Certified Courses ):
(i) _________________________________________ (ii)______________________________________________
(iii)_________________________________________ (iv)______________________________________________
11. What are your preferred timings during weekdays ( Monday to friday):
09 am to 01 pm
11 am to 03 pm

02 pm to 6 pm

12. Are you willing to attend course on Saturdays & Sundays (yes/no):___________
I declare that all information furnished above is true to the best of my knowledge & belief
Date :
Place:

Job Responsibilities

Yours faithfully

(signature of the applicant)


NB: Attach photocopies of academic & address proof document
*******************************************************************************************************************************
For office use only
1. Required information provided

2. Documents/Proof attached

Selected for admission: YES / NO

Verified by

3. Eligible for the course / prerequisite met

Fees to be paid:______________________________

Course i/c

Group Leader

Director
--------------------------------------------------------------------------------------------------------------------------------------------------To: ACCOUNTS DOEACC - CHE:
Collect the fee and endorse the receipt number and return the form to the course co-ordinator
Amount Paid:_______________________

Receipt Number:_________________________

Received by:
(Name & Signature with date)
*******************************************************************************************************************************

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