Application form for Degree Courses through The NIIT Academy
 
  All Fields marked * are compulsary
  PERSONAL DETAILS
 
 
  NIIT Registration No*:            
  Name*:      
    (First Name) (Middle Name) (Last Name)      
  Postal Address*:        
    (Address Line1) (Address Line2)      
  City*:   Zip/Pin Code*:    
  Country*:   Phone/Mobile*:      
  E-Mail-Id*:            
   
 
  ACADEMIC DETAILS
   
  Performance at NIIT
   
 
Country*:
  Curriculum*:
 
Centre*:
  Course*:
 
   
 
Quarter/Semester  Marks(% or GPA)   Quarter/Semester Marks(% or GPA)
   
   
   
   
   
 
   
  Select the Degree course you would like to enroll for:
 
 
   
 
PUSRC                                                                                                                                            PUJRC
 
Status:
Name of Certificate Obtained:
Aggregate % or Grade:
Status:
Name of Certificate Obtained:
Aggregate % or Grade:
 
University/Degree Preference List
Please mark the top three preference of yours for the Degree/University you would like to enroll for
Sl. NoUniversityCountryDegree NameDegree DurationDegree Exemption
1 *La Trobe University AustraliaBachelor of Information Technology3 Years2 Years
Preference 1 : University Course
Preference 2 : University
Course
Preference 3 : University
Course
 
 
Bachelors Degree Performance
Duration:   Name of Degree:
Name of University:   Aggregate % or Grade:
University/Degree Preference List
Please mark the preference of yours for the Degree/University you would like to enroll for
 Preference 1 : University Course
 Preference 2 :  University
Course
   
  EMPLOYMENT STATUS
 
 
 
   
 
Position Held:   Name of the Organisation:
City:   Country: