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 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