TARA Livelihood Academy
Development Alternatives
111/9 - Z, Kishangarh, Vasant Kunj,
New Delhi - 110070
Ph(dir) : 011-26132718
Fax :91(11) 2613-0817
email : tla@devalt.org
NOMINATION FORM
1.
Programme
a. Title :
*
b. Dates-From :
*
to
*
(
DD/MM/YYYY
)
c. Venue :
*
2. Participant
a. Name :
*
b. Age :
*
Sex :
Male
Female
*
c. Occupation: Employed / Self -Employed / Entrepreneur :
Employed
Self-Employed
Enterpreneur
*
3. Employed
a. Designation :
*
b. Area of responsibility :
*
c. Name and designation of the executive /functionary to whom you report :
*
4. Self -Employed/ Entrepreneur
a. Nature of Self -Employment/ Entrepreneurship:
*
b. Experience (Years/Months):
*
5. Qualification
6. Experience in the area of the above training programme
7. Previous participation in training programme organised by DA
Title
Dates
8. What are your expectations from the pprogramme
*
Date :
*
(DD/MM/YYYY)
Signature :
*
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** Nominating Authority:
a. Name:
*
b. Designation :
*
c. Name and Address of the organization:
*
Pin :
*
Phone:
*
Mobile :
*
Fax :
*
Email :
*
We enclose Demand Draft No. :
*
Dated :
*
of Rs.
*
(In words
*
)
as registration fee, in favour of TARA Livelihood Academy, payable at Jhansi We would ensure fullest utilization
for the enhanced capacity (through the above training) of our nominated staff and agree to fully cooperate with
training organizers in monitoring its effective utilization.
Date:
*
Signature and seal of the nominating authority
** Not applicable for self-employed/entrepreneurs.
**
All star
field marked with red (
*
) are Compulsory