Application Form for the Cisco Certified Network Associate (CCNA) training at the Consultancy, Training and Testing Center (CTTC) of the University of Asmara
Please submit this form with all supporting documents to the CTTC before April 12, 2004. I. Personal Information
Full Name: Sex: Female Male Place of Birth:
Date of Birth: Nationality: Email Address: Telephone – Residence: Current Mailing Address:
Telephone – Office:
II.
Educational Background
A. College Graduate: BSc BA Certificate Diploma Other (please specify in the blank space)
B. Current University Student:
C. University Incomplete:
Withdrawal
Dismissal
D. High School or Technical School Graduate:
List all High Schools, Colleges or Universities you have attended or now attending. Institution Entering Date Leaving Date Major Subject (If any) Minor Subject (If any)
Please continue on the back page …
III.
Relevant Computer Training
Please state relevant computer trainings you have achieved a certificate. The minimum time spent to receive the certificate should be one month. Certificate Achieved in Training Center/ Institute Date (From – To)
NB – In the column “Certificate Achieved in” write only the following: Office Application (for MS Windows, MS office, and other Office Applications) Programming (for C, C++, Visual Basic, Java or others) Maintenance Networking Others (if the training you took is not listed above and it is an IT related)
IV.
Employment
Please state jobs you have worked for more than six months only. Employer or Organization Position Held Nature of Work Date (From – To)
V.
Payment Commitment
I can pay myself: I will look for a sponsor: My Employer will pay:
I certify that the information contained in this application form and the supporting documents are complete and accurate, and I understand that submission of inaccurate information may be sufficient to cause for denial of admission.
Signature: Date: