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 S r is h ti School of A r t D esign and T echnol T T o gy S r is h ti Sch o ol of A r t D esign and T echnol T T o gy S r is h ti School of A r t D esign and T echnol T T o gy S r is h ti Sch o ol of A r t D esign and T echnol T T o gy S r is h ti School of A r t D esign and T echnol T T o gy S r is h ti Sch o ol of A r t D esign and T echnol T T o gy S r is h ti School of A r t D esign and T echnol T T o gy S r is h ti Sch o ol of A r t D esign and T echnol T T o gy S r is h ti School of A r t D esign and T echnol T T o gy S r is h ti Sch o ol of A r t D esign and T echnol T T o gy S r is h ti School of A r t D esign and T echnol T T o gy S r is h ti Sch o ol of A r t D esign and T echnol T T o gy S r is h ti School of A r t D esign and T echnol T T o gy S r is h ti Sch o ol of A r t D esign and T echnol T T o gy Application for Professional Diploma Program 2013-14 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 Gender Permanent Home Address Preferred Mailing Address (If different from above) Father’s Name Office Address Local Guardian’s Name Address Tel No. Mobile Occupation Tel No. Email Mother’s Name Office Address Email Occupation Occupation Tel No. Mobile Email Tel No. Mobile Email Citizenship Indian Other (Please Specify) first DD MM YYYY middle last School of A r t D esign and T echnology T T School of A r t D esign and T echnology T T School of A r t D esign and T echnology T T School of A r t D esign and T echnology T T School of A r t D esign and T echnology T T School of A r t D esign and T echnology T T School of A r t D esign and T echnology T T School of A r t D esign and T echnology T T School of A r t D esign and T echnology T T Office use only APP. DATE APP. NUMBER PASTE A RECENT COLOUR PHOTOGRAPH HERE Srishti School of Art, Design and Technology P 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: [email protected] Website: srishti.ac.in 1
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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
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Application forProfessional Diploma Program
2013-14
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 Gender
Permanent Home Address
Preferred Mailing Address (If different from above)
Father’s Name
Office Address
Local Guardian’s Name
Address
Tel No. Mobile
Occupation Tel No. Email
Mother’s Name
Office Address
Email
Occupation Occupation
Tel No. Mobile
EmailTel No. Mobile
Email
Citizenship Indian Other (Please Specify)
first
DD MM YYYY
middle last
esign echnologySchool of Art Design and TechnologyTechnologyTSchool of Art Design and TechnologyTechnologyTSchool of Art Design and TechnologyTechnologyTSchool of Art Design and TechnologyTechnologyTSchool of Art Design and TechnologyTechnologyTSchool of Art Design and TechnologyTechnologyTSchool of Art Design and TechnologyTechnologyTSchool of Art Design and TechnologyTechnologyTSchool of Art Design and TechnologyTechnologyT
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
List of Secondary Schools / Colleges you have attended. Please start with most recent first
Institution and address 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)
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
2
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)
3
ACADEMIC HONOURS
Briefly list or describe any scholastic distinctions or honours you have won beginning from ninth grade (Std. IX)
INTERESTED AREAS OF STUDY
PREFERENCES FOR PROJECTSYou may tick more then one.
You may tick more then one.
Textiles
Visual Communication
Design for Business Design for Humanity Design as Experimentation
Digital Video Production
Furniture & Interior Product & Interface
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)
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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
Open Reference Form 2013-14
Office use only APP. DATE APP. NUMBER
To the Student
To the Referee
Name
Address
Name of the referee
Tel No.
Address of the referee
RATING (Please Tick)
How many years have you known the applicant?
Occupation
Email
In what context (s) have you known the applicant?
Social adaptability
Emotional adaptability
Leadership
Motivation
Disciplined work habits
Integrity and honesty
Academic ability
Willingness to go beyondthe expected
No basis of judgmentExcellentVery GoodGoodAverageBelow average
first middle last
After you complete the information below, give this form to your referee. Your referee can be any person who has taught you or with whom you have worked for a period of at least 2 years. The reference of a relative is considered invalid. This form should be mailed to the Srishti office with the completed application form.
Thank you for agreeing to provide a referral for the applicant. Please complete this form in its entirety.
Signature Date
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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
Are there any special talents the applicant possesses that would be helpful for us to know, as we evaluate this application? Would you like to share with us any additional comments about the applicant?
Open Reference Form 2012-13
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Signature Date
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
