Srishti professional diploma-form-2013

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

Office use only APP. DATE APP. NUMBER

PERSONAL INFORMATION
Name
first middle last

Date of Birth Place of Birth Gender
DD MM YYYY

Citizenship Indian Other (Please Specify)

Permanent Home Address

Tel No. Mobile Email

Preferred Mailing Address (If different from above)

Father’s Name Mother’s Name

Occupation Occupation

Office Address Office Address

Tel No. Mobile Tel No. Mobile

Email Email

Local Guardian’s Name

Address

Occupation Tel No. Email

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: admissions@srishti.ac.in Website: srishti.ac.in

1

EDUCATION BACKGROUND

List of Secondary Schools / Colleges you have attended. Please start with most recent first
Date (From-To) Institution and address Marks/Grade (%) Board of Exam
in Exam Passed State/ 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 Salary / Income

Extracurricular, Personal and Volunteer Activities
Activity Approximate time spent Position held or Honours earned

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)

PREFERENCES FOR PROJECTS
You may tick more then one.

Design for Business Design for Humanity Design as Experimentation

INTERESTED AREAS OF STUDY
You may tick more then one.

Furniture & Interior Textiles Product & Interface

Visual Communication Digital Video Production Animation & Visual Effects

I HEARD ABOUT SRISHTI FROM
Friends or Relatives Print Ad Internet Search
(specify publication) (specify search engine)

School Counsellor Internet Ad Other (specify)
(specify source)

APPLICATION FEE
DD enclosed

DOCUMENTS AND OTHER REQUIREMENTS
Please submit the following with this form:
1. A Demand Draft favouring "Srishti" for Rs.2500/- (non-refundable processing fee),
payable at Bangalore, with your name clearly written on the reverse
2. Open reference forms fully completed and signed by the referee (two references required)
3. Copies of your most recent mark sheets / transcripts
4. A copy of Birth Certificate
5. Details of Visa (if you are not of Indian origin)
6. Two recent colour passport size photos
7. Personal statement (as mentioned earlier)
Please note that material submitted will not be returned under any circumstances.

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

Signature Date
4

Open Reference Form 2013-14

Office use only APP. DATE APP. NUMBER

To the Student
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.
Name
first middle last

Address

To the Referee
Thank you for agreeing to provide a referral for the applicant. Please complete this form in its entirety.

Name of the referee Occupation
How many years have you known the applicant?

In what context (s) have you known the applicant?

Address of the referee

Tel No. Email

RATING (Please Tick) Below average Average Good Very Good Excellent No basis of judgment

Social adaptability
Emotional adaptability
Leadership
Motivation
Disciplined work habits
Integrity and honesty
Academic ability
Willingness to go beyond
the expected

Signature Date


...2

-2-

Open Reference Form 2012-13

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?

Signature Date


Srishti professional diploma-form-2013

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