Affiliated by Government of the People’s Republic of
Bangladesh
(Seal)
National Youth Training Academy (NYTA)
A Project of Nyta Social Foundation (NSF), Govt. Reg. No-
3212
Founded- 1992 AD
Maniknagar Campus- 6, Maniknagar Bishwa Road, Dhaka
Tikatuli Campus- 2, Hatkhola Road, Tikatuli, Dhaka
Mobile- 01726-542991, 01726-542992, 01726-542993
Phone- 9563173, Web: nytabd.com, E-mail- nyta1992@yahoo.com
Serial no- 11887
Admission Form
Name of the Course- Dcovy
1.
Name of Applicant (In Bengali) (In English)-
Fazle Rabbi Tusher
2.
Name of Father/ Husband/ Guardian (In Bengali)
(In English)- Nurul Hadi Haque
3.
Name of Mother (In Bengali) (In English)-Ferdous
Ara
4.
Present Address (Phone and Mobile No)- 21/6,
Gopibagh, Arai Lane, Dhaka- 1203
5.
Permanent Address: Village- Umpaddi Lasai,
Police Station- Kabir Hat, District- Noakhali
6.
Educational Qualification- H.S.C (2017)
7.
Date of Birth (As Per Certificate)- 22 August,
1999 AD
8.
Nationality- Bangladeshi
9.
Description if any previous experience or
training is received-
10.
Blood Group- O Positive
11.
Information as above mentioned and based on the
given information I am applying for the admission in this institute. I will be
obligued to follow all of the rules of this institute.
Signature and date of the guardian
Sd/ Illegible
Date- 21/07/2018 AD
Signature and date of the applicant
Filled up by office
Courser fee- 6000/-, Name of the course-
Dcovy, Course duration- 6 months
1st installments- 3500/-,
Receipt no- 12398, 2nd installments- ..............., Receipt no-
.......................
ID no- 11883, Date of admission- 21/07/2018
AD, Date to start to the course-
Batch no- Days_ Saturday/ Sunday/ Monday/
Tuesday/ Thursday, Time-
Sd/ Illegible
Register
Sd/ Illegible
Accountant
........................ Director