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Campus ambassador info form
1. Photo
Campus Ambassador
Reg.no……………………Name of University: …………………………………………………………………………......
Creative Professional Development Associate (CPDA)
House-1/C, Main Road, Nobodoy Housing, Mohammadpur, Dhaka-1217, Bangladesh.
Web: www.cpdabd.com, Email: info@cpdabd.com,
Personal Information
Semester:……………………………………… Department…………………………. Year…………………
1. Name : …………………………………………………………..…………………………………………….….
2. Father’s Name:……………………… ………………………………………………………………..………
3. Mother’s Name:…………………………………………………………………………………………..…
4. Date of Birth:………………… ………............... 5. Age:.............................................................
6. Marital Status:………………………………………..... 7. Religion:………………………………………
8. Permanent Address:……………… ……………………………………………..…..Dist..…………….….
9. Mailing Address :………………………..…………………………………….…………………….............
………………………………......................................................…………………………………….……….…
10. E-mail:………………................................... 11.Facebook ID…………………………………………….
12. Mobile:……………………..…...….……...…..13 Alternative Mobile ………………….…………….…
14. Professional Course (if any):…………………………………….…………….…………………..
15. Organizing activities (if any):…………………………………….………………..………………..
………………………………………………………………………………………………………………..
16. Extra curriculum (if any) :…………………………………….…………………………..……..
………………………………………………………………………………………………………………..
Above information is true. I will not do any task or work which will disharmony or disfavor for this
Institute.
………………………………
Signature Date:……………….
