PISER

PROYASH INSTITUTE OF SPECIAL EDUCATION & RESEARCH

PATRONIZED BY BANGLADESH ARMY

(AFFILIATED WITH BANGLADESH UNIVERSITY OF PROFESSIONALS)

APPLICATION FORM

01 Personal Details

Applicant Name (In Block Letters) *

Name (In Bangla) *

Session *

Email *

Application for the Program *

Gender *

Mobile (WhatsApp) *

Date of Birth *

Blood Group *

Nationality *

NID / Passport / Birth Registration No. *

02 Family Information

Father's Name *

Mother's Name *

Father's Occupation *

Mother's Occupation *

Father's Phone *

Mother's Phone *

03 Local Guardian Information

Local Guardian's Name *

Local Guardian's Occupation *

Local Guardian's Phone *

04 Address Information

Present Address

Care Of *

Village / Road / House *

Post Office *

Postal Code *

Thana *

District *

Permanent Address

Care Of *

Village / Road / House *

Post Office *

Postal Code *

Thana *

District *

05 Photograph & Signature

Applicant Photograph * JPG or PNG, maximum 2 MB. Please upload a recent passport-size photograph.

Applicant Signature * JPG or PNG, maximum 2 MB. Recommended size: 300 × 80 pixels.

06 Academic Qualifications

Examination	Name of Institute	Group / Area	Passing Year	Board	Roll No.	GPA / Result
SSC/Equivalent *
HSC/Equivalent
BSc (Hons)
MSc
M.Phil
PhD

07 Additional Information

Co-Curricular Activity (If Any)

Do You Have Any Disability Requiring Special Assistance? *

If Yes, Describe Briefly

08 Financial Guarantor Information

Guarantor's Name *

Occupation *

Phone *

Relationship *

Admission Fee Applicable admission fee for selected program

* Required fields

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PROYASH INSTITUTE OF SPECIAL EDUCATION AND RESEARCH (PISER)

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