Bangladesh Association of Construction Industry (BACI)

Mirpur Agricultural Workshop and Training School (MAWTS)

1/C-1/A, Pallabi, Mirpur12, Dhaka1216, Bangladesh.
Telephone: +88-02-9002544, 9002493
Fax: +88-02-9031107
email: dirmawts@caritasmc.org
website: www.mawts.org

Photo
(2
Copies)

SEIP Trainee Admission Form

Course Applied
I.

: ________________________________________________________

Basic Information

Name

: ______________________________________________________

Gender

National ID Number

:_______________________________________________________

Male Female

(Copy of NID to be attached)

BirthRegistrationCertificateNumber:_______________________________________________________
(If NID is not available then birth registration certificate to be attached)

Date of Birth (YYYY/MM/DD)

:_______________________________________________________

Present Address

:_______________________________________________________
_______________________________________________________

Permanent Address

:_______________________________________________________
_______________________________________________________

Home District & Upazila

: _______________________________________________________

Mobile No:_______________________________________________________
E-mail :( If available)

II.

:_______________________________________________________

Personal Information

Religion

: ___________________

Education Level:

Highest Class Completed: ___________Year

Are You Currently Employed?

Yes No

Familys Monthly Income (BDT)

Ethnic Group: _____________________

: ____________

Are you physically challenged?

(* if Yes)

Yes No

Seeing Movement Hearing

Speech

others: ________

Family Information
Mothers Education Level
Fathers Education

: ______________________________________________________
: ______________________________________________________

Fathers Annual Income

: ______________________________________________________

Mobile Number of Father/Brother/: ______________________________________________________

Sister/Friend
Does your family own home?

: Yes

No

Does your family own land?

: Yes

No

Number of brothers and sisters : ______________________________________________________

IV. Declaration:
1) I certify that I correctly provide my information and qualifications in the student admission form.
2) I express my willingness to render my services to the related industrial sector after completion of the
training program.

Signature of Trainee

Date