applicationg_form - tec.pdf
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Association of National Technology – Sri Lanka. Application for the association memberships.
www.nct-tech.edu.lk
80/3, Malwatta Rd, Hokandara South,Hokandara. T/P: 0773613399 Email: [email protected]
Membership No: _ _ _ _ / _ _ / _ _ _ _ (only for office use)
Applicant’s NIC No: …………………………………….
1. Required associate membership: (a) Student Membership (STM) : ( ) (b) Employee Membership (EMM) : ( ) (c) Honorable Membership (Hon.M) : ( )
2. Applicant’s relevant Engineering field.
(a) Civil Engineering – CE ( ) (b) Electrical & Electronic Engineering – EE ( ) (C) Mechanical Engineering – ME ( ) (d) Quantity Surveying – QS ( )
3. Personal details:
3.1 Name in full:………………………………………………………………………………………………………………………….
3.2 Name with initials: ………………………………………………………………………………………………………………….
3.3 Date of birth: Date……….. Month: …………… Year: ………………………………
3.4 Postal Address: …………………………………………………………………………………
3.5 Contact No: Home …………………………… Mobile: ……………………………………..
3.6 Email address: …………………………………
4. Technical / Vocational education background.
Institute Course of study Duration From To 1. 2. 3. 4. 5. 4.1 Index Number of NCT final certificate (for employee members): ...…………………......................... 4.2 Technical College /COT and student’s ID number (for student members): …...................................... 5. History of applicant’s careers.
Employer Position held From To 1. 2. 3. 4. 5.
6. Special training programs obtained in relevant technical / vocational field. Yes ( ) No ( )
If yes: ………………………………………………………………………………………………………
7. Educational back ground.
7.1 School attended
(a)
(b)
(c)
(d)
(e)
7.2 Attended to G.C.E Ordinary Level ( )
7.3 Did you attend to G.C.E Advanced Level Yes ( ), No ( )
If yes 7.3 (a) Bio Science ( )
7.3 (b) Mathematics ( )
7.3 (c) Commerce ( )
7.3 (d) Arts ( )
8. Special activities of applicant: Teaching, Presentation skill, Singing, Dancing, sports, web designing, IT skill, Photographing & etc. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
9. Are you a blood donor? Yes ( ), No ( )
9.1 If yes, your blood group: …………………………..
Note: As a charity service, association plan to help patients who need blood for urgent surgeries and other medical treatments.
Do you like to save valuable lifes, please join us as a blood donor.
Do you like to register as a blood donor on our data base? ……………………………………
10. Declaration: I wish agree to get the membership of Association of National Technology – Sri Lanka as a Student Member/Employee Member/ Honorable Membership from the date of ……………………………….. (Payment date for the membership). All my details are true and correct. And I shall assist to develop & lead the association to higher level and agree to terms & conditions of ANT SL. Date: ………………………………… Signature: …………………...