Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology Srishti School of Art Design and Technology

Application forProfessional Diploma Program

2012-13

Please type or print in black ink. Mail the completed application forms with the completed reference form to the Srishti Admissions Office

PERSONAL INFORMATION

Name

Date of Birth Place of Birth

Permanent Home Address

Preferred Mailing Address (If different from above)

Father’s Name

Office Address

Local Guardian’s Name

Address

Citizenship Indian Other (Please Specify)

Tel No. Mobile

Occupation Tel No. Email

Mother’s Name

Office Address

Email

Occupation Occupation

Tel No. Mobile

EmailTel No. Mobile

Email

first

DD MM YYYY

middle last

Office use only APP. DATE APP. NUMBER

PASTE A RECENT COLOURPHOTOGRAPH HERE

Srishti School of Art, Design and TechnologyP O Box No. 6430, Opp. Wheel and Axle Plant, Off Doddaballapur Road, Yelahanka New Town, Bangalore 560106, Karnataka

Tel: 080 40447000 / 40446964 / 65 / 66 Telefax: 28560950 Email: admissions@srishti.ac.in Website: srishti.ac.in

EDUCATION BACKGROUND

List of Secondary Schools / Colleges you have attended. Please start with most recent first

Date Institution and Location Marks/Grade (%)in Exam Passed

Board of ExamState/ ISC/ CBSE/IB/ ‘A’ Level/ Others

Employment History (if any). Please start with most recent first

Date (From-To) Name of Organisation & Address Job Description & Position

Extracurricular, Personal and Volunteer Activities

Activity Approximate time spent Position held or Honours earned

Salary / Income

PERSONAL STATEMENT:

Please write a personal statement outlining your interests, motivations and skills that you feel are relevant for your application

(in no more than 500 words)

ACADEMIC HONOURS

Briefly list or describe any scholastic distinctions or honours you have won beginning from ninth grade (Std. IX)

DESIRED MAJOR

DIPLOMA PROGRAM INPlease indicate the desired program path.

Please indicate the desired major.

Textile & Surface Design

Visual Communication

Design for Business Design for Humanity Design as Experimentation

Digital Video Production

Furniture & Interiors Design Product & Interface Design

I HEARD ABOUT SRISHTI FROM

Animation & Visual Effects

Other (specify)

Friends or Relatives Print Ad(specify publication)

School Counsellor

Internet Search (specify search engine)

Internet Ad(specify source)

APPLICATION FEE

SIGNATURE

DOCUMENTS AND OTHER REQUIREMENTS Please submit the following with this form:

DD enclosed

I certify that all the information in my application is factually true, and honestly presented.The personal statement is my own work.

Signature Date

Please note that material submitted will not be returned under any circumstances.

1. A Demand Draft favouring "Srishti" for Rs.2500/- (non-refundable processing fee), payable at Bangalore, with your name clearly written on the reverse2. Open reference forms fully completed and signed by the referee (two references required)3. Copies of your most recent mark sheets / transcripts4. A copy of Birth Certificate5. Details of Visa (if you are not of Indian origin)6. Two recent colour passport size photos7. Personal statement (as mentioned earlier)