Smrti Academy - Student Application Form

Women and Girls Inspiring STEM Excellence (WISE) Student Application Form

We thank you for starting your journey with WISE. All fields in this form are compulsory. If some are not applicable, please do type in as Not Applicable.
Instructions for filling in the Application Form

All Fields are compulsory. If it is not applicable, please fill as "Not Applicable"

Step 1: Fill in the details
- Enter all relevant details carefully. Once data is submitted can not be changed. So please take a look before final submission.
- Provide a color photo in jpg/jpeg/png format
- Print the application form before pressing the Submit Button. You can sign the hard copy of the application form and submit it.
- This application is for women and girls. For girls, please complete pages 2-5. For professional women, please complete page 2 and skip down to page 6 until the end.
Step 2: Confirmation of Submission
- Press the Submit Button
- After successfull submission of application form, you will get a confirmation message on screen.

School Information
Name of School*
Contact Name*
Date Attended From

DayMonthYear
Date
Date Attended To

DayMonthYear
Date
Parent Information

(If you are 18 years or older you do not need to have a Parent completed this section)
Marital Status*
School Communication should go to*
Father's Name*
Father's Occupation
Father's Education Level*
Father's Office Number
Father's Mobile Number*
Father's Email ID*
Father's Address*

Street Address

Street Address Line 2

CityState / Province

Zip Code
Mother's Name*
Mother's Occupation
Mother's Education Level*
Mother's Office Number
Mother's Mobile Number*
Mother's Email ID*
Mother's Address (If different from Father's Address)

Street Address

Street Address Line 2

CityState / Province

Zip Code

Professional Information
Title
Can you provide details on what you need help with?
Acceptance of Terms & Conditions and Declaration
1. This application has been comlete after having read and understood all the rules of the program.
2. We declare that the information furnishe in this application is true to the best of my knowledge and belief.
3. I will observe the rules relating to WISE.
4. By pressing the Submit Button, I confirm the above declaration and accept the terms and conditions.
Signature*

Clear
Date

DayMonthYear
Date
Please ensure the following before pressing the submit button