Personal Information

Name*:
Permanent
Address:

Date of Birth:

City:

Pin Code:

State:

Email ID*:

Mobile*:

Educational Information*
Educational Qualification:
Degree Currently Pursuing:
Name of the Institute:
City:

State:

Attachment Checklist

Completed Students Application Form [Formats - JPEG/ PDF/ DOC]

Scanned copy of college/Institution ID card [Formats - JPEG/ PDF only]
SELECTIVE PORTFOLIO (2 Best Projects, Maximum 10MB, A4 Sheets) [Format - PDF]

All applications must be emailed with attachments to: 911@zaxis.info on or before 15th January, 2015. The email
has to be titled: Your Name - Student Application
The results to the same will be announced on 20th January, 2015.
For Queries
Saniya Khan: <911@zaxis.info>
Call: +91(0)0832 - 6514.533
Charles Correa Foundation will evaluate the best portfolios for seats in the conference.

*Mandatory Fields.
Please Read Terms & Conditions Before Registering.

169, st. sebastian chapel road, fontainhas, panaji, goa 403.001

T: 91-832-6514.533

E: 911@zaxis.info