Registration Form - Cybershiksha Program 
Read the eligibility criteria carefully. Apply only if you qualify all the factors. There is no money charged anywhere in this training at any stage. Do not pay any money if they claim to be from Cybershiksha.
Email *
Candidate Name  *
Mention Full Name
Email ID *
All communications regarding the program will be sent only to this email ID. 
Contact number *
Alternate contact number
Qualification *
Are you a B.Tech/B.E/MCA holder? Pls specify
Branch  *
College Name *
Degree - Year of passing *
Date of birth *
MM
/
DD
/
YYYY
Communication address *
Mention complete address with Pincode number.
Name of the village/town/city that you are currently staying? *
District *
State *
Is your family income less than 7 lacs/annum (INR)?
*
Are you ok to provide the supporting document the family income clause:
*
Are you willing to sincerely complete the online/hybrid training for 4 months and carry out all the assignments/hands on sessions provide to you virtually?
*
Are you working anywhere presently?
*
Do you have an own laptop/desktop(camera enabled) with minimum 3g connectivity to participate in the virtual/hybrid training?
*
Declaration: The information provided above is true and correct to the best of my knowledge.
AND
I completely understand that any wrong information provided will lead to immediate termination of my candidature from the Cybershiksha program.
*
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Indian Institute of Information Technology Dharwad.