Application Form for Non-Degree Program

Department Name
Name of the Program
Application Number

From

To

Field of Training
Registration Number

Course work
Research work
Internship

Mode of Training
(Please tick ())

Please attach
recent colour
photograph here

Number of Credit Hours

To be allotted by PIEAS

Financial Support (Please tick ())

Departmental Support/HEC
[Only for serving Govt./Semi Govt. employees

Self-Financed
Personal Information about the Applicant
Full Name
Fathers Name
Please provide the NADRA computerized NIC number

Date of Birth
Permanent Address
Correspondence Address

Telephone (with City Code)

Mobile

Detail of Educational Qualification

Certificate/Degree Name of the Institute /
Dept. where studied or
still studying
a
b
c
d
e
f
g

CNIC

Email

Name of the Board /

University

Year of Subject/ Div./Grade/ Marks % Position

(in Board /
Passing Group
CGPA

University if
any)

Matric / O-Level
FSc / A-Level
BSc / BSc (Hons.)
BE / BSc (Engg)
MSc / BS (4 years)
MBBS
MS / MPhil
Title of the final degree

Title of your final degree.

e.g. MSc (Physics) / MBBS / BE (Electrical) / BE (Mechanical) etc

Deposited (by please tick ())

Cash

Cheque

Amount

Date

Draft

Supervisor: ___________________________
Head of the Department

Receipt No.

: ________________

Registrar, PIEAS : ______________________________

Applicant's Signature: ____________________

Date: ____________________