Next Batch commencing from: January 2010 Last Date for Submission of completed Application Form: 3o Nov 2009

ADMISSION FORM REGISTRATION NO. Programme Officer, Diploma Programme Indian Society for Training & Development Training House B-41 Qutab Institutional Area, New Mehrauli Road New Delhi 110 016 Phones: 011-26867710, 26857157 Fax: 011-26867607 Email: istd@nic.in / istdtrg@airtelmail.in Website: istddiploma.org 1. 2. 3. 4. APPLICATION NO.

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.

Full Name: Shri/Smt./Kumari: .. (Surname) (First Name) (Middle Name) Fathers/Mothers/Husbands Name: .. Date of Birth: ..
(DAY) (MONTH) (YEAR)

Address for Correspondence (in Block Letters): ..

.. ...... Town/City: ..State: Pin. Telephone: (Office) ...Residence..... Mobile: ..Email: .. 5. A. B. C. D. (Attested Copies of University Degree/Professional Qualification must be enclosed) 6. Present Occupation: a. b. Designation..... Name & Address of Employer Organisation...... Date: (Signature of Applicant) Academic & Professional Qualification: (start with highest degree) University/Institution Degree/Diploma Duration Year of Passing

/2/ Details of Experience: In case of Graduate Degree or its equivalent, and have a minimum two years work experience in Training/Human Resource Development function, attested by Department head must be attached separately or given here: Organisation Post held Training Functions Experience Years Months

NAME: DESIGNATION: Attested by Department Head : SIGNATURE AND SEAL 8. a) Enclosures: 1. 2. 3.

b) I also enclose herewith :

4. 5. 6.

i) ii) iii)

Rs. 300/- towards Prospectus Fee. Rs. 500/- towards Registration Fee Rs.25,000/- towards full Course fee/ Rs.12,700/- towards First Instalment of Course Fee. In case of Armed Forces Officials and SC/ST candidates Rs.20,000/- towards full Course fee/Rs.10,200/- towards First Instalment of Course Fee. Demand Draft No.dated ..for Rs. The Draft should be in favour of ISTD (Diploma Programme) payable at New Delhi If you are eligible, you can make a single draft for the total amount

iv)
v)

9.

I certify that the above particulars are correct to the best of my knowledge.

Date: FOR OFFICE USE ONLY

(Signature of Applicant)

Status; Training Experience Certificate/Ed. Certificate (s) required ADMIT/ NOT ELIGIBLE

Director (T & D) ISTD

Programme Officer Diploma Programme