Applicant InformationName in Full (as per NIC)(Required) First name Last Name Title (Mr / Ms / Rev / Dr):(Required)Name with Initials:(Required)NIC Number:(Required)Date of Birth(Required) MM slash DD slash YYYY Gender(Required)SelectMaleFemaleContact Number(Required)Whatsapp Number(Required)for future communicationsEmail Address(Required) Enter Email Confirm Email Postal Address(Required) Street Address City Highest Educational Qualification(Required) G.C.E Ordinary Level G.C.E Advanced Level Other Other QualificationCurrent Status:Please indicate your current status Just completed the G.C.E. A/L University Student Teacher Other FieldCourse Selection & Medium of Instruction – Phase INote: The application fee is LKR 500.00 per course, and the total amount should be paid accordingly.Course Selection:(Required)Please select the Phase I course(s) you wish to apply for: CCC21: Smart Devices and Internet of Things CCC22: Python Essentials for Problem Solvers CCC24: Responsive Web Development CCC26: Mobile App Development Medium of Instruction – First Preference:(Required)Please indicate your first preference for the medium of instruction: Tamil Medium Batch English Medium Batch Medium of Instruction – Second Preference:(Required)Please indicate your second preference for the medium of instruction: Tamil Medium Batch English Medium Batch No Second Preference Application Fee PaymentsNumber of Courses:(Required)1234Total Application Fee Paid:(Required) (LKR. 500.00 × number of courses):Payment Date:(Required) MM slash DD slash YYYY Proof of Payment(Required)Upload a copy of your bank slip in PDF, JPEG, JPG, or PNG format.Max. file size: 5 MB.Declaration of the Candidate(Required)I declare that all information provided is true and correct, and I understand that any false information may result in cancellation of my application or registration. I agree to the above declaration.——————————— Signature of Applicant Δ
