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PGDGC Application Form - Winter Intake 2023

This document is an application form for admission to the Post Graduate Diploma in Guidance and Counselling program offered in the winter intake of 2023. The application requests personal details, academic records, employment details, payment details, and a declaration. Applicants are advised to retain a copy of the completed form and submit the scanned copy along with required documents to the program coordinator by email or in person.

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47 views2 pages

PGDGC Application Form - Winter Intake 2023

This document is an application form for admission to the Post Graduate Diploma in Guidance and Counselling program offered in the winter intake of 2023. The application requests personal details, academic records, employment details, payment details, and a declaration. Applicants are advised to retain a copy of the completed form and submit the scanned copy along with required documents to the program coordinator by email or in person.

Uploaded by

aneeshdash06
Copyright
© © All Rights Reserved
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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For office use

Form No.:

Post Graduate Diploma in Guidance and Counselling (PGDGC)–Online Mode


Application for Admission – Winter Intake 2023
DO NOT STAPLE
1. PERSONAL DETAILS (Use Capitals) (as it appears in Official Records)
Affix your latest
Name: Mr./Ms./Dr.
passport size
Middle Name self attested photograph

Last Name

Father's/Husband’s Name:
Mr./Ms./Dr.

Residential Address:
(Use Capitals)

Pin Code:

Nearest Landmark (Near/Adj./Opp./Behind):


(to facilitate easy delivery of study material)

Tel.(Res.): Mob.:
(STD code) (Number)

Date of Birth: D D M M Y Y Y Y Nationality: Gender:


(Specify Date/Month/Year) Indian Male Others
Email: Others Female

2. ACADEMIC RECORD
Examination Subjects/ Board/ Medium of %age / Year of
Level Course University Instruction Grade /CGPA Passing

Sr. Secondary

Bachelor's Degree

Master's Degree

Professional

Others
3. EDUCATIONAL INSTITUTION YOU ARE CURRENTLY ATTENDING (If applicable)
Name of Institution University/ Subjects/ Likely date of completion
Awarding Body Course of the Program/course

4. CURRENT EMPLOYMENT DETAILS


Designation:
Name of the School:
Name of the Principal:
School Address:
State: Pin:
Telephone: E-mail: Website:
Experience with Current Employer: Total Experience:
5. REMITTANCE DETAILS (for RTGS/NEFT/Money Transfer)
Account Holder: ICTRC Bank: State Bank of India
Account Number: 67100993075 Branch : Mayur Vihar (Phase II), New Delhi, India
IFSC Code: SBIN0007881 Swift Code: SBININBB818

6. PAYMENT DETAILS
Date of Fee Transfer: Amount:
Ref. No./Transaction ID: Bank :
DECLARATION
I hereby declare that I have read and understood the conditions of eligibility for the program for which I seek
admission. I fulfill the minimum eligibility criteria and I have provided necessary information in this regard. In the
event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the
Institute at any time and I shall not be entitled to refund of any fee paid by me to the Institute.

Place:
Date: Signature of the Candidate
Checklist
1. Attested copies of certificates of educational/professional qualifications
2. Attested copy of experience certificate in the case of non-employed teachers
3. Deputation letter in the case of Government deputed candidates
4. Passport size colored photographs

The candidates are advised to retain a photocopy of the completed Application Form for their records.

The scanned copy of duly filled in application form along with testimonials should be sent to [email protected]

The Program Co-ordinator (DLP)


ICTRC Regional Office
6A, Block A, Phase II, Near MTNL Telephone Exchange
Mayur Vihar, Delhi - 110091 India
Phone: 011-43035840, 43048382; Mobile: 9971226076, 9821166307
E-mail: [email protected]; Website: www.ictrc.org

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