RS-CIT Admission Form

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Application Form for Admission to

Rajasthan State Certificate in Information Technology (RS-CIT)
Please fin the frm using BLACK ik and wit In BLOCK ters.

"Name of he applicant as i should appear onthe RS-CIT Coffee as appears on SSC Content

Nome Father stHusband Name!
Date orsinhs II CT CTs)
Gender: Male) Female] Mother Tongue: Marta Status: Marie / Single

Quaieation | ]
‘Adress for Comespondence
(ars
iy Tem Vago Tats
[Dan Sato PITT
Permanent Address (Please enter oy is rat same as above)
fares
Gay own Trage
[tet En ¡NA
Telephone No. Resercs) |] om]
Tas Ts ar LE Lt
Email

alegar College Student / School Student] Post Graduate Student [] /Gow Employes L] /Protssonal LJ
Business Person [Housewife] /Senor Citizen [] / Oines (spect)

‘re you Physical Chalenged ?__Yes/No. (les please atlch oriicte ghing sia o desabii)

‘Your choice of RS-CT course Batch, Medium and Mode (eae rad rempart nstucio 1 RS. Sen ble ing in hose des)

Medium of instruction erst] Hina

RS CI Bat ]

a ver

Mode of study {Please refer to able overeat: Regular | art, [] Sox

Pease so attached herewith the ue copy of my PAN Card Voters Card / Drng License! Passport / Government ID Gard / College or
‘Schoo! 1D Car a poo! of my int. | Rereby solemnly arm that my name, photograph and signature on is appicatn form match wih
the copy ofthe pre of my ¡demi stached herein by me, | undertake 1 carry NS proa In person atthe time appearing or RS.CIT
‘examination (Applcant should eountersgn the copy ofthe prof finit attached har by hm / or)

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