DOEACC SOCIETY, GORAKHPUR CENTRE

(An Autonomous Body of Department of Information Technology, Ministry of
Communication and Information Technology, Govt. of India)

WOMEN EMPOWERMENT PROGRAMME IN IECT AREA

Student Registration Form
Name of Course:
Training Location:
Name: (As given in Board Certificate)
Father's Name:
Mother's Name:
Nationality:
Category: (General/OBC/SC/ST)
Religion:
Address for Correspondence:
Permanent Address:
Mobile Number:
Email-id:
Date of Birth:
Educational Qualification:
Exam passed
Name of Board/Institute
Passing of Year
% of Marks obtained
Class/Division

Highschool:

(HSC)

Intermediate:

(SSC)
Graduation:
Post Graduation: