Apply For Study Center

Personal Details

Name of the Institute / Centre

Postal Address with Pin Code

Mobile

Land line

Fax No

Email-Id

Website

PAN No

Name of the Registered Society / Trust with Complete Address

Documents of registration

Name of President / Chairman/ Trustee/ Proprietor of the Society Trust / Centre

Applying for

State

Name of The District applied for

Personal Details

Qualification

Board / University

Year Of Passing

Reference Details

Nominated Coordinator / Representative

Nominee Details

Details of Premises

No. of Rooms

Total Area(Sq. Ft.)

Seating Capacity

Faculty 1

Name

Designation

Qualification

Teaching Experience (in years)

Subjects Taught By Him / Her

Faculty 2

Name

Designation

Qualification

Teaching Experience (in years)

Subjects Taught By Him / Her

Faculty 3

Name

Designation

Qualification

Teaching Experience (in years)

Subjects Taught By Him / Her

Faculty 4

Name

Designation

Qualification

Teaching Experience (in years)

Subjects Taught By Him / Her

Faculty 5

Name

Designation

Qualification

Teaching Experience (in years)

Subjects Taught By Him / Her

Other Details

Type of Internet Facility

Whether the land & building are owned by the Center

If your centre is also associated with any other Institution . (Give Details)

Nearest Airport

Distance from Railway Station

Distance from Bus Stop

Driving License / Voter Id Card / Passport

PAN Card

Signature

Photo

Photograph of Computer practical Room

Signed Declaration Printed on your Letter Head

Benefits