Application for Student Membership

Personal Information

Title *

Forename(s) *

Surname *

How it should appear on the Certificate *

Home Address *

Telephone

Mobile *

Current Educational Programme

Current Educational Provider

Date joined to follow the current course of study

ICT Education - Diplomas/Degrees or Equivalents/Training obtained including the current programme.

School/University/Institution	Name of the Course/Programme	From	To	Results/Dates of qualification/Status	Action

School/University/Institution *

Name of the Course/Programme *

From *

To *

Results/Dates of qualification/Status *

Details of Referee
A member of the Institute/University should recommend the Application for Student Membership.

Full Name *

Designation *

Contact No *

Email Address *

Account Information

Username *

Password *

Confirm Password *

I certify to adhere to the Code of Ethics and Code of Conduct.

I certify that the information contained in this application is true to the best of my knowledge, and acknowledge the fact that if any information given is found to be false it would result in the termination of my membership of the society.

275/75, Colombo 7, Sri Lanka
Prof. Stanley Wijesundara Mawatha

(+94) 114 713 290
(+94) 112 592 762

[email protected]
[email protected]

Application for Student Membership

NITC