First Name

Last Name

Preferred Pronoun

Age

Email

Cell Number

City

Address

Educational Qualifications

Profession

Briefly describe your Creative Arts Experience

Have you studied Psychology? Have you studied Psychology? Yes No

Have you experienced Counselling / Therapy? Have you experienced Counselling / Therapy? Yes No

Are you a practising Counsellor / Therapist? Are you a practising Counsellor / Therapist? Yes No

Any Mental Health issues (past / present)? Any Mental Health issues (past / present)? Yes No

Please give details of the illness & medication received. In case there has been a past history of mental illness &/or medication, please indicate the same

Are you Neurodivergent? Are you Neurodivergent? Yes No

Diagnosis Diagnosis Self Diagnosed Diagnosed by a Professional

Reason for doing the course?

Any physical, mental or emotional reason that can be a challenge for you to complete the course?

How did you hear about the course?

Reservation Reservation We at SMArT are committed to making our institution more diverse and inclusive. We encourage individuals from SC, ST, and OBC categories, across religions, and individuals who identify as LGBTQIA+ or non-binary genders, to apply. Check this box if you would like to avail reservation.

Select your Reservation Category Select your Reservation Category SC, ST, OBC, DBA (Dalit-Bahujan-Adivasi) LGBTQIA+

Are you Seeking Scholarship? Are you Seeking Scholarship? Yes (Please read the process here https://smartmove.co.in/scholarships/) No

Declaration Declaration I declare that the information provided above is accurate and true to my knowledge. I understand that in case there are discrepancies found, SMArT reserves the right to terminate my application during the interview and assessment stage or post-admission, during the course of the program. I also understand and acknowledge that the fees are non-refundable, non-transferable and cannot be rolled over to the next year.