31st July, 2018 ADMISSION FORM REGISTRATION …

1 Submission of completed Application form : 31st December, 2018 Course Commencing from 1st January, 2019 ADMISSION form for ISTD Diploma 80th Batch REGISTRATION NO. APPLICATION NO. Administrative Officer, Diploma Programme Indian Society for Training & Development Training House B-23 Qutab Institutional Area, New Mehrauli Road New Delhi 110 016 Phones: 011-41688772, 26867710, 26857157 (M) 9971300653 Email: Website: CENTRE 1. Full Name: : .. 2. Father s/Mother s/Husband s Name: .. 3. Date of Birth: .. (DAY) (MONTH) (YEAR) 4. Address for Correspondence (in Block Letters): .. Town/City: ..State: .. Telephone: (Office) .. Mobile: ..Email: .. 5. Academic & Professional Qualification: (start with highest degree) University/Institution Degree/Diploma Duration Year of Passing A.

2 B. C. D. (Self-attested Copies of University Degree/Professional Qualification must be enclosed) 6. Present Occupation: a. b. Name & Address of Employer .. Date: (Signature of Applicant) Affix here a stamp size Photograph and attach one more copy which will be affixed to your identity card, issued by the Diploma Office, will be required for appearing at the examination. /2/ 7. a) Enclosures: 1. 4. 2. 5. 3. 6. b) I also enclose herewith : i) Rs. 500/- towards Prospectus Fee. ii) Rs. 1000/- towards REGISTRATION Fee iii) ,000/- towards full Course fee/ ,500/- towards First Instalment of Course Fee.

3 In case of Armed Forces Officials ,000/- towards full Course ,800/- towards First Installment of Course Fee. iv) Rs. 40,500/- towards full Course Fee for ISTD Permanent Institutional Members in one lumpsum ,500/- towards full Course fee/ ,000/- towards First Instalment of Course Fee for SC/ST Candidates . v) Demand Draft ..for The Draft should be in favour of ISTD (Diploma Programme) payable at New Delhi or through NEFT. vi) If you are eligible, you can make a single draft for the total amount 8. I certify that the above particulars are correct to the best of my knowledge. Date: .. (Signature of Applicant) FOR OFFICE USE ONLY Status; Training Experience Certificate/Ed.

4 Certificate (s) required ADMIT/ NOT ELIGIBLE Diploma Programme Office How did you come to know about ISTD Diploma Programme / through a News Paper / Brochure / Website / ISTD Member /Chapter /Collegue /Diploma Student / Any other.