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Admission Form

Azeem Educorp Computer Institute

Near Mahadeva Talab, Main Road, New changorabhata Raipur (C.G.) - 492013

Phone: 96303-11118, 93436-42488 | Email: azeem.educorp@gmail.com

ADMISSION FORM

Please fill in BLOCK CAPITAL LETTERS

This form requests a significant amount of personal information. It is required so that we can decide on your suitability for the course you are applying for. The information you provide will be treated in confidence and will only be seen by staff who require it to process your admission.

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Course Title

Session / Batch Period

PERSONAL DETAILS

Title

Gender

Date of Birth

First Name

Last Name

Father's /Husband Name

Mother's Name

Qualification Details :

#	Qualification	School / College	Board / University	Passing Year	% of Marks

Documents to be attached:

5^th Marksheet
10^th Marksheet
Address Proof: Aadhar / Voter ID / Driving Licence (any one)

Do you want a hard copy of the study material?

Yes

Declaration (please tick that you have read & understand the following)

I cetisfied that the information submitted by me in support of this application is true to the best of my knowledge and belief. I understand that in the event of any information being found false of incorrect, my admission is liable to be rejected/Cancelled at any stage of the program.
I have read and understood all provision of admission and agree to by them. I also affirm that I fulfill the eligibility requirement for the course applied.
In the event of submission of eligibility document from the unrecognized Board/university, fraudulen incorrect or untrue information or suppression or distortion of any fact, like educational qualification marks, etc. I understand that my admission is liable for cancellation.
I undertake to abode by the disciplinary rules and regulation of the institute.
I will be attendingmy PCP in fortnight or Sunday made.
I am aware that examinations will be conducted in Azeem Educorp Computer Institute, Near Mahadeva Talab, Main Road, New changorabhata Raipur, Chhattisgarh.

Date Place Branch

Signature of Candidate