enquiry form of NIIT Foundation

1. ENQUIRY FORM
Personal Details
Name: ___________/___________/___________ DOB: ___/___/___ Category: ______ (SC/ST/Gen)
Contact Address: ______________________________________________________, Gen (M/F): _______
Contact No.: ________________, Email ID: __________________________, Mother Tongue:_______
What brought you to NIIT Foundation ______________________________________________
Qualification:
Academic: ________; Board RollNo ________; Professional(If any): __________
Course Interested:
Career Course Non Career Course
CourseName: ___________________________________________________________
Placement:
Interested in doing a JOB: Yes No If ‘Yes ‘1) willing to work in shifts: Yes No ,
Waiting to relocate: Yes No ; Previous work experience: Yes No , If yes specify:
_______________________________
Family Details
Father’s Name: _______________Occupation: ___________ Mother’s Name: ____________
Total family member: ________ Total earning member: ___________ Total monthly income:
________________
Declaration: I hereby declare that all information given above by me are true and correct to
the best of my knowledge and belief.
(Student’s Signature)
OFFICE USE ONLY
Course offered: ______________________________________________ Fee: _____________________ Timing:
__________________________
Screening Details:
Applicable Not applicable applicable, Marks Date of Test ________,Screening cleared, Yes No
Admission details
Adm. Taken, Yes No If Yes, Date: ______________ StudentID: _______________ Batch ID:
________________
Comment 1): ________________________________________________________________________________________________
Comment 2): ________________________________________________________________________________________________
(Centre Head’s Signature)
Reg.No:
Date: ________________