Application Form Welcome Please use this form to apply for admission in the courses at Wish2Learn. Please note that: Submission of the Application Form does not guarantee admission. The form must be filled truthfully and as completely as possible. Mandatory form-fields are indicated in BOLD You will require an image of your Proof of ID, Proof of Address, Passport-type Photo. The images must be in JPG format and less that 1 MB in size with dimensions of at-least 1000 pixels in the shorter edge. You may use a free online service like http://jpeg-optimizer.com/ to resize and compress your images. After submitting the form, you will receive an automatic acknowledgement via email. Your Application Form will be manually verified and admission granted depending on eligibility and availability of seat. Course: ---Course for Front-line Workers on COVID-19COVID-19 पर स्वास्थ्यकर्मियों (ANM / ASHA / AWW) के लिए पाठ्यक्रमCourse for Hospital Staff on COVID-19COVID-19 पर अस्पताल के कर्मचारियों के लिए पाठ्यक्रमCourse for Nurses and Medical Officers on COVID-19COVID-19 पर नर्स एवं चिकित्सा अधिकारियों के लिए पाठ्यक्रमCourse for Lab Technicians on COVID-19COVID-19 पर प्रयोगशाला कर्मचारियों के लिए पाठ्यक्रमCourse for Doctors in COVID-19 Hospitals Basic Information Title: ---Mr.Mrs.Ms.Dr.Gender: ---MaleFemaleOthers First Name: Middle Name: Last Name: Birth Year: Birth Month: Birth Day: Contact Information Flat / House No.: Building Name: Plot No. / Society: Lane / Street: Colony / Locality: Area: City / Town / Village: Landmark / Directions: State: Country: PIN Code: Mobile Phone: Alternate Phone: Email ID: Documentary Proof ID Proof: Address Proof: Profile Photo: ID & Address Proof must be a Central / State Government generated document. Profile photo must be of passport type. Acceptable file-type is JPG / JPEG with a maximum size of 1 MB with minimum 1000 pixels width on the shorter side. Educational Information Course Type: ---10th Class12th ClassDegreeMastersDoctorateDiplomaPG DiplomaCertificateCourse Name: University / Institute: Year: Course Type: ---10th Class12th ClassDegreeMastersDoctorateDiplomaPG DiplomaCertificateCourse Name: University / Institute: Year: Course Type: ---10th Class12th ClassDegreeMastersDoctorateDiplomaPG DiplomaCertificateCourse Name: University / Institute: Year: Employment Information Organisation: Designation: Job Role: Experience: Organisation: Designation: Job Role: Experience: Organisation: Designation: Job Role: Experience: Payment Information Sponsorship: ---FreeSelf SponsoredOrganisation SponsoredFee Schedule: ---Full PaymentInstallment PaymentOthersPayment Mode: ---Online TransferDemand DraftCheque DepositOthers Visitor Survey How did you discover us: ---E-Mail CampaignElectronic Media Ad / FeatureOnline SearchPrint Media Ad / ArticleSMS CampaignSocial MediaWord of MouthOthersFeedback / Query about site: Refer us to your friends: Terms & Conditions I agree that I have read and understood the Copyright Policy, Disclaimer, Privacy Policy, Refund Policy, and Terms of Service Policy available on this website and unconditionally accept them as binding on me. I understand that Fee once paid will not be refunded under any circumstances. I understand that switching from one course to another course after admission is not allowed. I agree that I have to finish my course within the stipulated course duration and obtain passing grades. I agree that if I don't successfully finish my course within the stipulated duration, I may have to retake the course by paying admission fee once again. I further declare under Penalty of Perjury that the above information provided by me is true and correct in all aspects. I hereby indemnify the organizers of the Courses and their partners, associates, employees against damages of any nature caused due to erroneous or falsified data submitted by me. Form Revision: 201216a