Application Form For :
Admission Type : MITID
Graduate Diploma Program
Affix a recent passport size photograph here
Disciplines :
GDP
A. Personal Particulars
1. Name : Date of Birth : Place of Birth : Height (in cms.) : Permanent address : Pin Code : 302002 Mr.
krishana kumar sharma
Age : Nationality : Weight(kgs) :
27-Jul-1992 jaipur 180
19Yrs 6Months indian 82
64j/2 kailash puri colony, amer road, jaipur rajasthan
Phone : 8058650035 E-mail : rahul.gladiator.sharma@gmail .com
2. Parents/Guardians Name :
mr Jagdish prasad sharma
Relationship with applicant : father
Profession of the parent/guardian : artist
Annual Income :
200000
Address for correspondance :64j/2 kailashpuri colony,amber road jaipur Pin Code : Phone : 9413043009 E-mail : jprasadsharma@gmail.com
3. Address for correspondance on admission matters :
64j/2 kailash puri colony, amer road, jaipur jaipur rajasthan E-mail :
Pin Code :
302002
Phone :
B. Health Information
Blood Group : Any major illness? Specify details : Physically challenged or not :
Rajbaug, Next to Hadapsar, Loni-Kalbhor, Pune-412201, INDIA
admissions@mitid.edu.in
www.mitid.edu.in
Page 1 of 4
C. Education Information
Exam Name
senior secondary
Prev. School Name
Adarsh vidhya mandir
Division
2nd
Major Subject
science/maths
Year Of Passing
2009
Year Gap
Please specify the last examination appeared/cleared in the current year. Please specify if there has been any discontinuety in your educational career. Indicate type of activity undertaken during this time.
D. Work Experience
After completion of final examination(either school or college/Institute), if you were engaged in any field of your interest, Professional activity or job, Please specify the details of your work during this period.
Company Name Experience(In Months)
E. Hobbies / Interest
Interest sketching interest in watching animation movies me and my friends have maked a short animatioin movies Achievement
F. Language
Please state Indian language known: Language
Hindi ENGLISH
Write
Known Fluently Resonably Well
Read
Known Fluently Known Fluently
Speak
Known Fluently Resonably Well
Rajbaug, Next to Hadapsar, Loni-Kalbhor, Pune-412201, INDIA
admissions@mitid.edu.in
www.mitid.edu.in
Page 2 of 4
(Note: To be filled in your own handwritting)
G. Skill Competence
Please specify skills in which you have achieved competence and indicate if you have achieved any recognition in them :
H. Aptitude
1. Describe the type of design profession that you know.Also describe briefly kind of work they are supposed to do :
2. Explain how others percieve you as a person. :
3. Write briefly on: a. Movie/drama/performance you have seen or book you have read recently. b.Your own place of residence in city/town/village
Rajbaug, Next to Hadapsar, Loni-Kalbhor, Pune-412201, INDIA
admissions@mitid.edu.in
www.mitid.edu.in
Page 3 of 4
(Note: To be filled in your own handwritting)
I. References
Names and addresses of two references (whom you know well at task level or learning level and who know you as well)
1.
2.
Tel No. Date : Place :
Tel No.
Signature of the applicant
Check List (before sending form):
a) Students should send hard copy of entire form (4 pages) partially filled online & partially filled in own
handwriting. b) Demand Draft of Rs. 2000/- in favour of MAEER Punes MIT Institute of Design, payable at pune should be attached in front of the form with name of the student written on the back side of the Demand Draft.
C) Passport size color photograph should be pasted on space provided in the form.
The complete set should be send by speed post (preferably) or courier to the following address To Admission Cell MAEERs MIT Institute of Design Next to Hadapsar, Rajbaug, Loni-Kalbhor, Pune Solapur Highway Pune 412201 INDIA Tel:+91-20-30693666 / 696 Fax: 020-30693601
Rajbaug, Next to Hadapsar, Loni-Kalbhor, Pune-412201, INDIA
admissions@mitid.edu.in
www.mitid.edu.in
Page 4 of 4
