INSTITUTE OF DISASTER MANAGEMENT (IDM)
KHULNA UNIVERSITY OF ENGINEERING & TECHNOLOGY KHULNA-9203, BANGLADESH
APPLICATION FOR ADMISSION TO PROFESSIONAL DIPLOMA IN DISASTER MANAGEMENT
Semester:
(Type or use capital letters throughout. Check or delete where necessary)
Name in full : ...
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E-mail: ... Cell phone: ...
Father’s name Mother’s name Mailing address
Permanent address : ...
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Nationality : ... Religion: ...
: .../.../...
Date of birth
(Day) (Month) (Year)
Sex : ... Marital status: ...
: ...
Present Affiliation
ACADEMIC RECORDS (High School and Above)
Examination Passed or Degree Awarded
Division Rank in Class or Class (if any)
Year Board/Institute/University CGPA Marks (%)
SSC or Equivalent HSC or Equivalent BSc / Graduation
(Attach the photocopy of all the certificates and transcripts/mark sheets with this application) PRACTICAL EXPERIENCE:
From To
Designation Organization Brief Description of the Job (Month/Year) (Month/Year)
Name two referees, at least one from whom should have taught you in the institution last attended or present Employer.
1. Name: ... 2. Name: ...
Address:...
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Address: ...
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DECLERATION (Applicant Must Complete):
I hereby declare that to best of my knowledge the information given above is correct and complete. I recognize that it is my responsibility to provide all necessary documentary evidence of my qualifications and studies and hereby authorize KUET to obtain further information where necessary. I agree to present the original copies of my academic results and transcripts for verification by KUET, when required. Students found to have false statements or to have presented false evidence of any kind with their application render themselves liable for immediate dismissal from the IDM of KUET.
Date Signature of the applicant
