DESIGN CLINIC REGISTRATION FORM FOR
Design Students
APPLICATION FOR DESIGN CLINIC SCHEME FUNDING ASSISTANCE
(To ensure the easy and correct processing of your application, please ensure that the application form is filled up completely and neatly. Where information is not available or applicable, please indicate accordingly. Please enclose all supporting documents as
requested in the form).
1.   GENERAL
a.Name of Student (please mention initials as Mr.,Ms.,Mrs. etc.
*
b.Contact information
*
Address
*
District
*
State
*
Phone No
Fax
E-Mail
*
Website
2.OTHER DETAILS
Courses conducted for
*
 UG (Under graduation)
 PG (Post graduation)
Specialization
*
Expected Date of Completion
*
Previous Work Experience (If Any) Organization
*
Total years
*
Write in Brief
3.INSTITUTION'S DETAILS
Contact Person (please mention initials as Mr.,Ms.,Mrs. etc.
*
Address
*
District
*
State
*
PIN Code
*
E-Mail
*
Phone No
Mobile
Fax
Website
4.INSTITUTE'S CERTIFICATE OF STUDENT BONA FIDE
We certify that above mentioned information
about the student is as per institutional record.

We certify that Mr/Miss/Ms.
*
is a bona fide student of our institution
Name
*
Designation
*
5.Attach a file (e.g. Visiting Card, Portfolio...)
(Maximum size of the zipped folder attachment should not be larger than 10mb)
 
SUBMIT