Application No : ...............

(For Office Use Only)

Application Form for seeking Permission for Additional Trades/Units in Existing ITIs
(APPLICATION SHOULD BE FILLED IN CAPITAL LETTERS)
Section – A : Details of Institute

1. Name of ITI : ............................................................................................................

2. Village : ............................................................................................................
3. Block : ............................................................................................................
4. Tehsil : ............................................................................................................
5. District : ............................................................................................................
6. Pin Code : ............................................................................................................
7. MIS Code : ............................................................................................................
8. SCVT Code : ............................................................................................................

9. Complete Postal Address with Pin Code :

.............................................................................................................................................
.............................................................................................................................................

10. Location Details : (GPS Coordinates of Centre of Institute from Google Map)
Latitude of ITI : ..................................................................................................
Longitude of ITI : ..................................................................................................

11. Contact Person Details :

Name : ..................................................................................................
Designation : ..................................................................................................
Mobile Number : ..................................................................................................
Email ID : ..................................................................................................

12. Name of Organization Running ITI :

.......................................................................................................................................
.......................................................................................................................................

13. Status of Grading of ITI : Grading of ITI is Done (Yes/No) : ....................................

If Yes Current Rating of ITI : .......................................................................................
Section – B : Details of Training

1. Details of previously affiliated Trades

Units in Units in Units in Date of Affiliation Order
SN Trade Shift-I Shift-II Shift-III Affiliation Number
1 2 3 4 5 6 7

2. Additional Trades/Units for which Institute is seeking Affiliation

Units in Units in Units in Total Session from which New
SN Trade Shift-I Shift-II Shift-III Units Trades/Unit will start
1 2 3 4 5 6 7

3. Trade wise Details of Training for Past Three Academic Sessions

No of No of No of
Trainees Trainees Trainees
SN Trade Session Admitted Passed Employed Remarks
1 2 3 4 5 6 7

4. Consolidated Details of Training for Past Three Academic Sessions

Total
Admission Total Admitted Total Passed Total Employed
SN Session Capacity Trainees Trainees Trainees Remarks
1 2 3 4 5 6 7

Date :
Signature of Applicant
Name/Designation & Seal of Applicant
For Office Use Only :
Checked By : ..............................................................................................................................................
Status (Approved/Rejected) : .....................................................................................................................
Reason for Rejection : ................................................................................................................................
.....................................................................................................................................................................

Name/Designation/Signature & Seal