For Office Use Only
SRI LANKA INSTIT UTE OF INFORMATION
TECHNOLOGY
Level 16, BoC Merchant Tower, No.28, St.
Michael’s Road, Colombo 03.
Tel: + 94 112 301904, Fax: + 94 112 301906,
E-mail: cybersecurity@sliit.lk, URL: www.sliit.lk
APPLICATION FOR ADMISSION TO
GRADUATE DIPLOMA IN CYBER SECURITY/MSC IN IT (SPECIALIZATION IN CYBER
SECURITY) 2014/2015
Complete all pages in BLOCK CAPITALS and tick boxes as appropriate.
Application Processing Fee:
Bank receipt for Rs.750/= paid at the Bank of Ceylon at ………….……….. (branch) * / Sampath Bank
at ………….……….. (branch) * is attached to this application. (* Strike off which ever inapplicable) The
fee should be paid
at any branch of the Bank of Ceylon in favour of Sri Lanka Institute of Information
Technology to the Current Account No. 0001630552 at Bank of Ceylon
OR at any branch of Sampath Bank in favour of Sri Lanka Institute of Information
Technology to the Current Account No. 003990000033 at Sampath Bank.
1.
Name with initials
Full Name
2.
4.
Present Mailing Address
3.
Office Address
………………………………………………………..………
………………………………………………………..……
………………………………………………………..………
………………………………………………………..……
………………………………………………………..………
………………………………………………………..……
Telephone : …………………………...…………
Fax : …….…………………………………..……
E-mail : …….…………………………….………
Telephone : …………………………...………
Date of Birth
Fax : …….…………………………………..…
E-mail : …….…………………………….……
6. NIC No.
5.
F
Gender
M
7.
Academic Qualifications
Year of
Institution / University
Qualification
Award
Attended, Country
(Eg. BSc.)
Main Speciality/Field
Class/GPA
Page 1
8.
Professional Qualifications
Qualification
Awarding Institute
Date of Award
9.
Specialization
(if any)
Employment History (Please give details of employment and/or professional experience
[current first])
From
(M/Y)
To
(M/Y)
Position held
Name and Address of Employer
Page 2
10.
Your Expectations from Programme (Please use this space to give a brief outline of your
expectations from the Programme. This is optional.)
11.
Fees
Who will be responsible for the payment of your fees?
Myself
Other
If other than yourself please give name and address of funding Institution/Organization.
Address
………………………………………………..…………………………………………………………
………………………………………………..…………………………………………………………
………………………………………………..…………………………………………………………
Telephone : ……………………………………...………… Fax
: ……………….…………………………………..……
E-mail : ……………….…………………………….………
12.
References (Please name two referees here)
Referee 1
Referee 2
Name : …………….…………………………
Name : ………………….…………………………
Position : .……………………………………
Position : …….……………………………………
Address : …………….………………………
Address : ………………….………………………
…………………………………………………
……………………………………………....……..
…………………………………………………
………………………………………………………
…………………………………………………
………………………………………………………
Telephone No : ……………….…………….
Telephone No : .…………………….…………….
Fax No : …………………………..…………
Fax No : ………………………………..…………
E-mail address : ……………………………
E-mail address : …………………………………
Page 3
13.
Please check that your application is complete and that you have enclosed all the relevant
documents.
Copies of Birth and Educational certificates
Certificates of Professional memberships
Curriculum Vitae
One Passport Size Photograph
14.
15.
How did you find out about this programme?
Declaration :
I certify that, to the best of my knowledge and belief, the information provided above is true and
correct.
Signature :
Date:
Page 4
16.
When completed please return this application to:
Head/Department of Information Technology
Sri Lanka Institute of Information Technology,
Level 16, BoC Merchant Tower,
No. 28, St. Michael’s Road, Colombo
03.
Sri Lanka.
Or
Head/Department of Information Technology
Sri Lanka Institute of Information Technology,
New Kandy Road
Malabe
Sri Lanka.
Page 5