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INDIAN INSTITUTE OF CRAFTS AND DESIGN

(An undertaking of Government of Rajasthan & presntly Managed by Ambuja Educational Institute)

J - 8, Jhalana Institutional Area, Jaipur 302 004 India


Tele +91 141 270 2519/0494/01203/1504 Fax : +91 141 270 0160
email: admissions@iicd.ac.in www.iicd.ac.in

Application form for Admissions 2011-12


For choice of program (Please

tick one)


4 Years Under Graduate Diploma
2.5 Years Post Graduate

Program in Craft Design
Diploma Program in


Fired Material Application
Furniture and Interior Products

Terracotta, Ceramics

Hard Material Application


Wood, Metal, Stone

Soft Material Application


Fiber, Fabric, Paper, Leather

2.5 Years Post Graduate


Program in Craft Management
and Entrepreneurship

Home Textiles
Floor coverings & furnishings

Instructions:
Please fill in BLOCK LETTERS in English or fgUnh with Black Ink/Ball Pen only.

The application form would be filled in your own handwriting.

Space for photograph

The Aptitude test centre is Jaipur, Rajasthan.

DO NOT PIN/STAPLE

Last date for receiving completed application form is 20th May, 2011 at the above address.
The Application should be sent to Admissions Officer at the above address.
Enclose Mark sheet of the final examination.

the photograph
Paste the recent photograph
inside the box only
PHOTO NOT TO BE ATTESTED

Use separate sheets if required.


Refer prospectus for details on selection procedure.

Candidate

ID:

(Above ID to be filled by office only)


A. Personal Particulars:
1. Name

(First Name)

(Middle Name)

(Last Name)

2. Date of Birth
(dd/mm/yy)

Age
(as on 1st January 2011)

3. Place of Birth

(Country)

(City)

(State)

4. Nationality
5. Marital Status
6. Category

Unmarried

SC

*7. Domicile residence of Rajasthan

Gender (M/F)

Married
ST

OBC
Yes

General
No

(If SC/ST or OBC please attach relevant certificate)

(Please attach relevant document/certificate)

8.

Do you belong to a traditional or practicing craft family?

Yes

No

If yes, please specify the craft area.


9. Are your parents associated with any NGO, Craft sector or Social/Rural Development activity ? Please specify.

_____________________________________________________________________________________________________________
IICD gives preference to candidates from practicing craft families.

10. Blood Group_______________________________________Allergies (if any) _______________________________________________


11. Any physical impairment of permanent nature, or any chronic illness?
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
12. Mailing Address

13. Permanent Address

_______________________________________________________

_________________________________________________________

______________________________________________________

_________________________________________________________

______________________________________________________

_________________________________________________________

______________________________________________________

_________________________________________________________

Telephone No. ________________________________________

Telephone No. ___________________________________________

Mobile No. ___________________________________________

Mobile No. ______________________________________________

Fax No. ______________________________________________

Fax No. _________________________________________________

Email ID______________________________________________

Email ID ________________________________________________

Alternate Email ID _____________________________________

(Please mention all the email IDs clearly

14. Fathers Name, Profession & Address

15. Mothers Name, Profession & address

____________________________________________________

________________________________________________________

____________________________________________________

________________________________________________________

____________________________________________________

________________________________________________________

____________________________________________________

________________________________________________________

Telephone No. ______________________________________

Telephone No. __________________________________________

Mobile No. _________________________________________

Mobile No. _____________________________________________

Fax No. ____________________________________________

Fax No. ________________________________________________

Email ID____________________________________________

Email ID _______________________________________________

16. Family Income per annum ________________________________________________________________________________________


B. Educational Qualifications
1. Please start with the most recent first.
Programs/Board Duration

Major Name of the

Subjects

Board/School/College/University

Grade/Class/Division

2. Work experience (if any). List the most recent work experience first.
Year

Employer/Project/Assignment Position held

Emoluments

3. State knowledge of Indian & Foreign Language (either fluently, reasonably, with difficulty)
Language Speak

Read

Write

Hindi

_____________________

_____________________

_____________________

English

_____________________

_____________________

_____________________

................

_____________________

_____________________

_____________________

................

_____________________

_____________________

_____________________

Declaration:
I declare that all the information provided herein is true and correct.
Signature of Candidate ___________________________________ Signature of Parent/Guardian________________________________
Place _________________________________________________ Date_____________________________________________________

Indian Institute of Crafts and Design, Jaipur



Entrance Test Admit Card

Candidate Id:

Space for photograph

Name: ___________________________________________________________________

DO NOT PIN/STAPLE

Program: _________________________________________________________________

the photograph
Paste the recent photograph
inside the box only

Parents /Guardians/Name: _________________________________________________


Mailing Address: __________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

(Candidates Signature)

PHOTO NOT TO BE ATTESTED

(Admissions Officer)

INDIAN INSTITUTE OF CRAFTS AND DESIGN


FOR OFFICE USE ONLY

Name
Mode of issue of Application

Application No.

Date of reciept of completed Application


Mode of payment and Details
Acceptance of the form

YES

NO

INDIAN INSTITUTE OF CRAFTS AND DESIGN


(An undertaking of Government of Rajasthan & presntly Managed by Ambuja Educational Institute)

J - 8, Jhalana Institutional Area, Jaipur 302 004 India


Tele +91 141 270 2519/0494/01203/1504 Fax : +91 141 270 0160
email: admissions@iicd.ac.in www.iicd.ac.in
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