PROFORMA FORM :PARTNERING INSTITUTION / CENTER

Date:
1. Name of the Institution :

Address of the Institution :

District :

State :

Phone No. :

Fax No. :

E-mail ID :

2. Nature of Management : Society Trust Any other (Specify)

(Check whether a copy of Trust

deed/Society Registration
document is attached) Yes/ No
3. Mandates of the Institution :

4. Any other collaborative experience :

(Govt./University/Private/NGO- Last 3 years)

5. MoU with University :

6. Courses offered : i.
ii.
iii.
7. Students Enrolled :

8. Fees paid to the University :

9. Infrastructural Facilities of the Institution : Owned Rented

(Photos Enclosed)
a. Size of the Building (in sq. ft)
(Copy of the blue print should be attached :

b. No. of rooms available : Office Room: Class Room:

c. Laboratory Facilities Available :

 i. Computer Lab
1. No. of Computer System Available
with Version (List should be furnished) :

2. Internet Facility : Yes NO

3. Backup Facility (UPS) : Yes NO

ii. Infrastructure facilities : Enclosed details related to programmes

d) Library
1. No of Text Books :
2. No. of Reference Books :
3. No. of Journals / Magazines :
4. No. of General Knowledge /
Personality Development / Other Books :
iii. Expenditure in infrastructure facilities : Details enclosed

10.i) Teaching Staff

a. (List with Name, Qualification &
Experience is to be attached) :
Proforma - 4

Other Courses - Infrastructure facilities

b. Nature of Employment of Teaching Staff :  Regular  Part time

c. No. of Administrative Staff along with

Names and Qualification (List to be furnished) :

11.Enclosure :
i. Trust or Society deed

ii. Blue print of the building

iii. List of equipments available I

iv. List of books and journals available in the Library

v. Last three years of auditor report :

vi. Any other item enclosed please specify :

12.Credentials / Remarks information Remarks (please specify) :

Date :

Place: Signature of the Applicant