Training Registration Form – Health Training Center, Dhankuta

📋 Training Information

Training Name *

Role in Training *

Participant Trainer Co-Trainer Coordinator

Training Site *

Province

District

Starting Date *

Ending Date *

Fiscal Year *

👤 Personal Information

Name (in Block Letters) *

नेपालीमा नाम (Name in Nepali)

Sex *

Male Female Other

Date of Birth (BS) *

Format: 2050/05/15

Sex – Other (Specify)

🏠 Permanent Address

Province *

District *

Rural / Municipality *

Ward No. *

Contact No. *

Email

👥 Caste

If Other, Specify

🩺 Cadre

Medical Nursing Paramedics Other

If Other, Specify

Qualification *

💼 Sponsored By

Sponsor Type *

Sponsor Details (Name / Specify)

🏢 Working Place

Working Organization (Office) *

District

Province

Rural / Municipality *

Office Contact No.

Designation *

Level

PIS No.

Citizenship No. & Issued District

Council Reg. No.

By submitting this form, you confirm that the information provided is accurate. Your record will be reviewed by Health Office, Sankhuwasabha before being archived.