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 : *
c.  Occupation: Employed / Self -Employed / Entrepreneur :                 *
     
 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 New Delhi/Jhansi [wherever training has been held] 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