Tata-Dhan Academy

T. Malaipatti, Thenkarai PO, Mullipallam SO, Sholavandan (Via), Vadipatti Taluk, Madurai 625 207

Application for Development Executive Education Programme (DEEP): 2011-2012

Instructions

  • Please read carefully before filling the application form.
  • Incomplete application will not be considered.
  • Write the name and location of the nearest telegraph office without fail.
  • Don't leave any box / column blank. Write NA if `Not Applicable'.
  • Last date for the receipt of filled in application is May 7, 2011.
 

Name:

Mailing Address

Pincode:

Telephone No. with STD code:

Email:

Mobile No:

Nearest Telegraph Office:

Permanent Address ( Same as mailing address)

Pincode:

Telephone No. with STD code:

Email:

Mobile No:

Nearest Telegraph Office:

1. Date of Birth

- -

Age: (As on 6th July, 2011)

Marital Status:

Are you a first graduate from your family?

2. Registration Fee

Send a demand draft of Rs.500/- in favour of "Tata-Dhan Academy", payable at Madurai.

2. Education
Qualification Name of the Institution and Location Month & Year Marks/OGPA Obtained Percentage of Marks
From To
Secondary School (10th)

(mm-yyyy)

(mm-yyyy)

%
Higher Secondary School (10-12)

(mm-yyyy)

(mm-yyyy)

%

Bachelor's Degree in

(mm-yyyy)

(mm-yyyy)

%

Master's Degree in

(if applicable)

(mm-yyyy) (mm-yyyy) %

3. Work Experience (if applicable - fill in only as many rows as required)
Date Employer's Name & Location Job Title Nature of Job
From To

(mm-yyyy)

(mm-yyyy)

(mm-yyyy)

(mm-yyyy)

(mm-yyyy)

(mm-yyyy)

(mm-yyyy)

(mm-yyyy)

(mm-yyyy)

(mm-yyyy)


4. Previous programme attended (if any)
Programme Institute Period

5. Please describe your specific duties and responsibilities in your current position.

6. Describe your expectations from this course (What do you expect to gain from this course?)
7. Languages Known 8. Advertisment: How did you come to know about this programme?
(Check at least one box)

Speak

Read

Write

Friends

Website

Others

NGOs

9. Declaration

I hereby confirm to the best of my knowledge, the information I have provided in this application is complete and true.


Send Demand Draft for Rs. 500/- in favour of "Tata-Dhan Academy", payable at Madurai alongwith 2 self attested passport size photograph and a nomination form from the organisation in the following format.

Nomination by the Organisation

We hereby, nominate Mr. /Ms. _________________________________________________ to attend the

“Development Executive Education Programme (DEEP)”, being conducted by Tata-Dhan Academy, Madurai, starting

from 16th July 2011.

Signature