SRI LANKA TELECOM TRAINING CENTRE - WELISARA
Application Form
BEng Honours in Electrical and Electronic Engineering Degree
Below sections are to be filled by the Student.
Please select the course you wish to enrol.
☐	Electrical and Electronic Engineering
☐	Electronics and Communication Engineering
PERSONAL DETAILS
Please use BLOCK CAPITALS.
Title	☐	Mr.	☐	Ms.	☐	Other
Name with Initials
Name indicated by Initials
Gender	☐	Male	☐	Female	Date of Birth (YYYY/MM/DD)
☐	NIC No.	☐	Passport No.
☐	Driving Licence No.
Address
Email
Telephone	Mobile
Home
ENTRY QUALIFICATIONS
A-Level Examination Results	☐	Local A-Levels	☐	London A-Levels	Year
Stream
Subject	Result	Subject	Result
English Language	☐	Local A-Levels	☐	London A-Levels	Year
☐	Local O-Levels	☐	London O-Levels	Result
Please attach copies of related Academic Certificates.
DECLARATION OF APPLICANT
☐	Please check this box to confirm that you agree with the following statements.
“I confirm that the information given on this form is true, complete and accurate and no information requested or other material information has been omitted. I agree to abide by the rules and regulations of Sri Lanka Telecom Training Centre.”
Date	Signature
MARKETING SURVEY
Please select the media source(s) through which you get to know about this course. In completing this section, you are helping us to monitor the effectiveness of the marketing media.
☐	Newspaper	☐	Facebook	☐	SMS	☐	Friend	☐	Other
☐	TV	☐	E-Flyers	☐	Radio	☐	SLT Employee
Below section is for OFFICE USE ONLY.
ADMISSION
Applicant No.	Year
UCAS code(s)	Programme code
Pathway	Entry Level
Entry Qualifications
A-Level Examination Results	☐	Qualified	☐	Not-qualified
Certificates	☐	Attached	☐	Not-attached
English Language Proficiency	☐	Qualified	☐	Not-qualified
Certificates	☐	Attached	☐	Not-attached
Academic Decision
☐	Unconditional	☐	Conditional	☐	Reject
Conditions/Reason for reject
Date	Signature
Frank