(A WINGS OF DICE,BBSR)
ONLINE APPLICATION FORM
(Teacher Training & Distance)

Timer: 10m 0s

ନୋଟ:- ଏ ଅନଲାଇନ ଆପ୍ଲିକେସନ ଫର୍ମ ର ଟାଇମ୍ ୧୦ ମି, ଯଦି ଟାଇମ୍ ଭିତରେ ସବ୍ ମିଟ ନ କରିବେ, ଫର୍ମ ଅଟୋମେଟିକଲି ସବ୍ ମୀଟ ହେଇଯିବ।ଆଉ କିଛି କଲ:- ୯୬୯୨୨୩୪୧୪୪

(FILL ONLY CAPITAL LETTER)

Personal Details

Center ID:

DATE OF APPLICATION :

NAME:

DATE OF BIRTH :

AGE (in year & month) :

GENDER :

Male Female

Father Name:

Mother Name:

Program                                            ~Select~. ONLINE ACADEMIC DISTANCE EDUCATION (CERT/DIPL/UG/PG) Advance Diploma in NTT (ADNTT) - 2 Years Diploma In Nursery Teachers Training (DNTT) - 1 Year Diploma In Primary Teachers Training (DPTT) - 1 Year Diploma In Montessori Teachers Training (DMTT) - 1 Year Diploma In Early Childhood Care Education (DECE) - 1 Year Diploma In Computer Teacher Training (DCTT) - 1 Year Certificate In Early Childhood Care Education (CECCE) - 4 Months Certificate in Nursery Teacher Training (CNTT) - 6 Months Certificate in Primary Teacher Training (CPTT) - 6 Months Certificate in Montessori Teacher Training (CMTT) - 6 Months OTET Entrance Coaching Online Certificate in Pre School & Day Care Facilitator (CPDF) - 6 Months Post Graduate Diploma in Early Childhood Care Facilitator (PGDECF) - 1 Year

Specialization:

SPOUSE NAME(If Married):

CORRESPONDENCE ADDRESS

VILLAGE/WARD/HOUSE NO:

BLOCK:

DISTRICT/CITY:

STATE:

PIN NO:

PHONE NO:

MOBILE NO:

E-MAIL:

PERMANENT ADDRESS

   Same as Correspondence Address

VILLAGE/WARD/HOUSE NO:

BLOCK:

DISTRICT/CITY:

STATE:

PIN NO:

PHONE NO:

MOBILE NO:

E-MAIL:

ACADEMIC BACKGROUND

Examination

Year of Passing

School/College

Board

Stream

Percentage

X

XII

Graduation

Post Graduation

Other Info/Achievements :

Work Experience

Do you have any work experience? :

Yes No

How much Experience? :

Year(s) Month(s)

Organisation

From

To

Total Months of Exp

Designation

Last Salary

Declaration

I have gone through the Institute information bulletin & admission guidelines brochure to the various programmes offered at Institute.I have clearly understood the eligibility criteria for the programme offered & agree to abide by norms for the same. I declare that all the information given & statements made in this application are true to the best of my knowledge. I agree that if any information is found incorrect in my application & subsequent admission will automatically be cancelled and no money will be refunded. I am also aware that the Institute may reject my application without assigning any reason.