DESIGN CLINIC REGISTRATION FORM FOR
MSME Association/ Govt Organization
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.Applying as
*
 Government Organization
 MSME Cluster Association
b.Registered name of Group/Cluster/Representative Forum
c.Registered as (please tick)
*
 Trust
 Association
 Government Institution
 Service Company
 Other (please specify)
d.Affiliation/Recognition by (If Applicable)
Govt. Body
Industry Body
International Group
Institutional Body
Establised Since
e.Total Number of Member Units
*
 Less Than 10
 10 to 50
 50 to 100
 100 and more
f.Total Number of Associations
*
 Less Than 10
 10 to 50
 50 to 100
 100 and more
2.CONTACT INFORMATION
Contact Person (please mention initials as Mr.,Ms.,Mrs. etc.
*
Address
*
District
*
State
*
PIN Code
*
E-Mail
*
Phone No
Mobile
Fax
Website
3.INFORMATION ABOUT THE ASSOCIATION
a.Industry Type (Textile, Automobile, Pharmaceuticas, etc.)
*
b.Represents to which Industry Type
*
 Manufacturing
 Processing
 Service
 IT
 Trading
 Craft
 Other (please specify)
4.DESIGN CLINIC INFORMATION
a.
Has the MSME been granted any financial support from Design Clinic before? If yes, please list all project references and amount of funding involved. Please also list other Design Clinic applications of the MSME pending approval.*
b.
Has the Association of MSMEs been granted any financial support from Design Clinic in the name of another MSME? If yes, please list all project references.*
c.
Please provide any other supporting information (if any).
5.Please mention the activities you would be interested to take up for DC
 Design Sensitizing Workshop -
1 Day workshop/seminar
 Need Assessment Survey and Design Clinic -
3-4 Days workshop/seminar
 Design Projects -
Scheduled project
6.Attach a file (e.g. Visiting Card, Portfolio...)
(Maximum size of the zipped folder attachment should not be larger than 10mb)
 
SUBMIT