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PROYASH INSTITUTE OF SPECIAL EDUCATION AND RESEARCH (PISER)
An Army Institute Under Bangladesh University of Professionals (BUP)
PISER
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PISER
(PROYASH INSTITUTE OF SPECIAL EDUCATION & RESEARCH)
PATRONIZED BY BANGLADESH ARMY
(AFFILIATED WITH BANGLADESH UNIVERSITY OF PROFESSIONALS)
APPLICATION FORM
Personal Details
Applicant Name (In Block Letters):
Name (In Bangla):
Application for the Program:
Please select the program
BACHELOR OF SCIENCE IN AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY (BSCASLP)
BACHELOR OF EDUCATION (HONOURS) IN SPECIAL & INCLUSIVE EDUCATION (BED -HONS)
MASTER OF SCIENCE IN AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY (MSCASLP)
MASTER OF SPECIAL EDUCATION (MSED)
POST GRADUATE DIPLOMA IN SPEECH LANGUAGE THERAPY & AUDIOLOGY (PGDSLT)
CERTIFICATE ON DISABILITY MANAGEMENT & EDUCATION (CDMED)
CERTIFICATE ON DISABILITY MANAGEMENT & EDUCATION EXECUTIVE (CDMEDE)
POST GRADUATE BACHELOR OF SPECIAL EDUCATION (BSED)
Audiology Technician Course
Email:
Gender:
Please select Gender
Male
Female
Mobile:
Date Of Birth:
Blood Group:
Please select Blood Group
A+
A-
B+
B-
O+
O-
AB+
AB-
Nationality:
NID/Passport/Birth Reg No:
Father's Name:
Mother's Name:
Father's Occupation:
Mother's Occupation:
Father's Phone:
Mother's Phone:
Local Guardian's Name:
Local Guardian's Occupation:
Local Guardian's Phone:
Photo:
Address
Present Address
Permanent Address
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
Co-Curricular Activity(If Any):
Do You Have any Disability requiring special assistance?
Please select
Yes
No
If Yes, Describe Briefly below:
Financial Guarantors Information:
Guarantors Name:
Occupation:
Phone:
Relationship:
* Before submit please pay with Nagad at 01813378218
NAGAD TrxID:
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