Training Request Form
Name
*
First Name
Last Name
Select your disability type
*
Vision Impairment
Deaf/Hearing Impairment
Physical Disability
Other
Phone Number
*
-
Area Code
Phone Number
Whatsapp Number
E-mail
What is your highest education qualification?
*
Below 10th Grade
10th
12th
Diploma
Graduate
Post Graduate
What is the subject in which you hold a diploma/degree
Do you have previous work experience?
*
Yes
No
If yes, how many years of experience do you have?
Do you have internet access at home?
Yes
No
Can you travel to another city for training?
Yes
No
Your date of birth
-
Month
-
Day
Year
Date Picker Icon
Your highest graduation
10th/SSC
12th/HSC
Below 10th
Diploma
Doctoral
Graduate
ITI
Post Doctoral
Post Graduate
Submit
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