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APPLICATION FORM FOR AFFILATION
Institute Location
City / Town / Village
District
State
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Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujrat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Madhya Pradesh (MP)
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Institute Information
Name of the Institute
Year of Establishment
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1917
1918
1919
1920
1921
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1923
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1926
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2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
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2018
2019
2020
2021
2022
2023
Status of The Institution
Trust
Regd. Society
Partnership Firm
Proprietorship Firm
Pvt. Ltd.
Others
Post Office
Police Station
Pin Code
Postal Address of the Institute
Phone No.
Phone No.
Email Address
Information About Centre Head
Full Name
Designing / Position
District
Postal Address
State
Select State
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujrat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Madhya Pradesh (MP)
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Post Office
Posice Station
Pin Code
Mobile No.
Email Address
Date of Birth
Nationality
Religion
Gender
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Male
Female
Marital Status
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Married
Unmarried
Educational Qualification
Professional Experience
Available Infrastructure Facility of the Centre
Office Room
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1
2
3
Theory Room
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1
2
3
Practical Room
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1
2
3
Staff Room
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1
2
3
Library
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1
2
3
Reception
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1
2
3
Toilet
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1
2
3
Waiting Room
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1
2
3
Any Other
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1
2
3
Faculty Information of the Centre
Full Name
Qualification
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Class VIII
Madhyamik
H.S.
Graduate
Post Graduate
Others
Teaching Experience
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Status Full time / Part time
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Full Time
Part Time
Full Name
Qualification
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Class VIII
Madhyamik
H.S.
Graduate
Post Graduate
Others
Teaching Experience
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Status Full time / Part time
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Full Time
Part Time
Details of Available Facilities of the Centre
No. of Computer
No. of Reference Books
Licensed Software
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Yes
No
No. of Journal
No. of CD's
No. of Projector / LED
Internet Facility with Speed
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Yes
No
Inverter / Generator Facility
Select Inverter / Generator Facility
Yes
No
Drinking Water Facility
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Yes
No
DECLARATION
I hereby certify that the context stated above are correct and true to my knowledge and belief and hereby confirm that our Organization / Society / Trust is free from any legal / official disputes whatsover.I accept that any facts stated above. I found incorrect will automatically result in cancellation for nominations associate.However I will have no right whatsover to fight / challenge legally against the judgment in any court of law. All disputes are subject to Ranaghat Jurisdiction only.
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