APPLICATION

FORM

No. PAC/

Paste your recent

passport sized
photograph
here

PICASSO ANIMATION COLLEGE

E-mail: info@picasso.co.in Website: www.picasso.co.in

ACADEMIC RECORDS
(Do not enclose any Certificates)
Examination
Level

Qualification

Major
Subjects

Medium of
Instruction

Board/
University

Marks (%)/
Grade

Year of
Passing

Senior
Secondary
School (10+2)

Graduation

Others

Please read the instructions carefully before filling up the form.

Please retain a photocopy of the application form with you.
Write in CAPITAL LETTERS (USE BLACK INK only)
Send the form, duly filled in, along with a
Demand Draft/Bankers Cheque/ Pay Order for Rs. 500/-

Programs
Applied
For

B.Sc. (MM)
M.Sc. (MM)
STAR-AFM
Other Programs

PERSONAL DETAILS
Name : Mr./Ms .................................................................................................................................................................................................................................
Date of Birth (Specify Date/Month/Year) ..........................................................................................................................................................................
Correspondence Address : ........................................................................................................................................................................................................
................................................................................................................................................................................................................................................................
City....................................................................................... State .................................................................................. Pin-code .........................................
Phone (STD code No.)................................................................................................................................................. Mobile ...............................................
E-mail ..................................................................................................................................................................................................................................................
Permanent Address : ...................................................................................................................................................................................................................
................................................................................................................................................................................................................................................................
City ....................................................................................... State ............................................................................... Pin-code ...........................................
Phone (STD code No.) ..................................................................................................... Mobile .........................................................................................
Fathers/ Guardians Name .......................................................................................................................................................................................................
Profession of Guardian ................................................................................. Annual Household Income ..................................................................

DECLARATION
I hereby declare that I satisfy the eligibility requirements of the Programme as stated in
the Prospectus of the Picasso Animation College and have furnished correct information.
I also declare that I have read all the rules and regulations governing admission and fee
payable and agree to abide by the same, if selected. I also understand that the decision of
the Admission Committee regarding my selection will be final and binding on me.
I have enclosed DD No.
............................................................................................................................................................................................
Dated ................................................................... for Rs. .......................................................................................
on Bank ........................................................................................................................................................................

PICASSO ANIMATION COLLEGE

E-mail: info@picasso.co.in Website: www.picasso.co.in

Signature of Applicant