The Certificate in Information and Communication Technology (CIT)

Benedict XVI Catholic Institute of Higher Education, Bolawalana
The Certificate in Information and Communication Technology (CIT) - 2019 January Intake

(01) Class Days and Times *

	Weekday Morning Tuesday & Thursday Course ( 8.15 AM - 12.45 PM )
	Weekday Morning Wednesday & Friday Course ( 8.15 AM - 12.45 PM )
	Weekday Afternoon Tuesday & Thursday Course ( 2.00 PM - 5.45 PM )
	Weekday Afternoon Wednesday & Friday Course ( 2.00 PM - 5.45 PM )
	Weekend Morning Saturday & Sunday Course ( 8.15 AM - 12.45 PM )

Before you start filling this form, please have a copy of your Birth Certificate or National Identity Card ready for name verification. You must answer all mandatory questions which are marked with RED colour *

(01) Family Name

Name as in Birth Certificate,
EG1 - Nanayakkarawasam Dona Dilrukshi Wijesekara

Family Name: Nanayakkarawasam Dona
First Names: Dilrukshi

Surname: Wijesekara
EG2 - Gayan Maduranga Fernando

Family Name:

First Names: Gayan Maduranga

Surname: Fernando

EG3 - Warnakulasuriyage Nimesh Indika

Family Name: Warnakulasuriyage

First Names: Nimesh Indika

Surname:
(02) First Names *

Name as in Birth Certificate,
EG1 - Nanayakkarawasam Dona Dilrukshi Wijesekara

Family Name: Nanayakkarawasam Dona
First Names: Dilrukshi

Surname: Wijesekara
EG2 - Gayan Maduranga Fernando

Family Name:

First Names: Gayan Maduranga

Surname: Fernando

EG3 - Warnakulasuriyage Nimesh Indika

Family Name: Warnakulasuriyage

First Names: Nimesh Indika

Surname:
(03) Surname

Name as in Birth Certificate,
EG1 - Nanayakkarawasam Dona Dilrukshi Wijesekara

Family Name: Nanayakkarawasam Dona
First Names: Dilrukshi

Surname: Wijesekara
EG2 - Gayan Maduranga Fernando

Family Name:

First Names: Gayan Maduranga

Surname: Fernando

EG3 - Warnakulasuriyage Nimesh Indika

Family Name: Warnakulasuriyage

First Names: Nimesh Indika

Surname:

Your Full Name

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The name that appears in the above box must be identical with that of your Birth Certificate or National Identity Card. If not please re-visit questions 1, 2 & 3 to make necessary correction. BCI intends to use what appears in the above box for your final Certificate.

If names are identical with those of your Birth Certificate or NIC, tick the box to proceed.

(01) Title *
(02) Gender *
(03) NIC/Passport *

If you are filling this field with your NIC number, please make sure that the NIC number consists of 9 numbers and one alphabetic character
(04) Date of Birth *
(05) Your Telephone Number *

Please note that the telephone number must have minimum of 10 numbers. For an example 0772345678 or 0112123456
(06) Your own Email Address

Please make sure that your email address should have at least one @ sign and one . (dot) sign. For an example Johnp@yahoo.com
(07) Parent/Guardian Tel: *

Please note that the telephone number must have minimum of 10 numbers. For an example 0772345678 or 0112123456
(08) Address *

Help Note Here...
(09) City *

Help Note Here...
(10) School *

(11) Photograph

Attaching your Photograph is optional. However, if you can attach/submit your photograph along with this application it will extremely valuable for the College for the long term record keeping purpose. It may be used for the production of your College ID card.

Your photograph must be similar to your National ID or Passport. See the example for further illustration. PLEASE DO NOT USE CROP PICTURES FROM YOUR PARTY PHOTOGRAPHS.

Drag and fix the picture to the frame.

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Declaration

I declare that the information given on this form is correct to the best of my knowledge and belief. I also declare that I do not have any criminal convictions either in Sri Lanka or overseas. If I am admitted as a student to BCI, I agree to accept and observe the Code of Conduct for BCI Students. I understand that I may be required to provide a record of my fingerprints for course attendance and a photograph of my face as part of my application. I also consent to process the information provided above.

I have read and understood the statements above

Family Name:	Nanayakkarawasam Dona
First Names:	Dilrukshi
Surname:	Wijesekara

Family Name:	Warnakulasuriyage
First Names:	Nimesh Indika
Surname: