Form No.

CT

Price : Rs.120/Computer Code No. : ______________________

(For official use only)

Lady Shri Ram College for Women

(University of Delhi)
New Delhi-110 024

Diploma Programme in
Conflict Transformation and Peacebuilding ___________
APPLICATION FORM
A. General Information
1.

Name of Applicant (In Block Letters) : _____________________________________________________________________________________

2.

Date of Birth : ________________________________________________________________________________________________________

3.

Male/Female : ________________________________________________________________________________________________________

4.

Postal Address : ______________________________________________________________________________________________________

___________________________________________________________________________________________________________________

5.

Phone : (R) __________________________________________________________ Mobile : ________________________________________

6.

E-mail : _____________________________________________________________________________________________________________

B. Education
Please list in reverse chronological order all education above school level, including training workshops, professional courses et al.
Degree / Professional Qualifications

College / University / Institution

Grade / Division

Year of Study

LADY SHRI RAM COLLEGE FOR WOMEN

Acknowledgement
Diploma Programme in Conflict Transformation and Peacebuilding___________
Form No. CT

Computer Code No. : ______________________

(For official use only)

Date___________________________
Note : This slip must be presented at the time of interview / test.

Signature of the Recipient

C. Professional Experience
Please list in reverse chronological order any positions held.
Designation / Job Title

Employer

Job Description

Dates

D. Please attach to this form:

 A two-page CV;
 Candidates in employment are advised to submit a No Objection Certificate from their employer.
E. Please submit a typed 800 words essay on A4 size paper explaining :
 Your goals for personal and professional development;
 How the Diploma would contribute to your goals;
 What you hope to learn from the Programme;
 Any experiences (personal and / or professional) that have shaped your interest in this field; and
 How you plan to apply learnings from the Diploma in your work.

Signature of the Applicant

Please return completed application form alongwith attested copies of all certificates and degrees to:
Mohammad Israr
Peacebuilding Programme
Lady Shri Ram College for Women
Lajpat Nagar-IV, New Delhi-110024
Phone : 91-11-26434459, 26460400 Mobile: 9999045315
Fax : 91-11-26216951 E-mail: peacebuilding.lsrc@gmail.com