Student Application Form

Course Details
Course Name * Certificate Program in Web Designing
Venue * Kalinga Institute Of Social Sciences (KISS)
State * Odisha
Personal Details
Student Name *
Father's Name *
Mother's Name *
Date Of Birth *
Gender *
Martial Status *
Community *
Other Community
Caste *
Physically Challenged *
Contact Details
Email-id  *
Mobile Number  *
Address for Communication
Address 1 *
Address 2 *
City *
District *
State *
Pin Code *
School Educational Details
ClassGroup Year of PassingMarks (%) Name and Location of the Institution 
SSLC *
HSC *
College Educational Details of UG / PG
Name & Location of the InstitutionDegreeMonth & Year of CompletionTotal Marks (%) / CGPA 
UG
PG
Others
Image Verification
Verification Code
Enter the Above Verification Code *
Declaration
I declare that all the above details are true to the best of my knowledge. I intend to attend the scheduled training classes and would participate in all the events conducted as part of the Training program.