APPLICATION FOR ACADEMIC CENTRE श णणक क द र क लरए आव दन

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Elinor Carr
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1 APPLICATION FOR ACADEMIC CENTRE श णणक क द र क लरए आव दन ORGANIZATION PROFILE स गठन प र प इर 1. Name of the Organization: स स थ क न भ 2. Year of Establishment: स थ ऩन वषष (Please Attach Proof) 3. Type of Organization: Trust Society स गठन क प रक य स स थ (Tick Most Appropriate) 4. Full Postal Address: ड क ऩत District: ज र State: य ज म Country: Pin Code: 5. Official Communication: आधधक रयक स च य Phone No: न Tele Fax: (Country Code) (STD/Local Code) (Country Code) (STD/Local Code) Mobile No: भ फ इर न फय Fill the Following and Enclosed Proper Proof: 6. Premises Details: Owned Rented ककय ए ऩय

2 8. Total Carpet Area of Organization (Sq. Ft): (Sq.Ft) 9. Total Site Area of Organization (Sq. Ft): (Sq. Ft) 10. Internet Connectivity: Leased Line Broadband Dial-up Speed ब र डफ ड ड मर अऩ 11. Details of Computers (Dedicated Earmarked for Training and Research Purpose) ( औ ) Type Processor Ram HDD Network(Y/N) Internet(Y/N) प र स सय एच Server Computer Client Computer 12. Infrastructure Details: Generator LCD Player Fax Photocopier नय टय प क स प ट क पऩमय S.No स न Other Infrastructure for Training प रलश ण क लरए अन म फ ननम द ढ च Units Area (Sq. Ft) (Sq.Ft) Seating Capacity 1. Class Rooms 2. Library (Total Books: ) ( : ) 3. Reading Room /Conference Room/Audio Visual Room / / 4. Administrative Area 5. Trainer Room 6. Service Area-Toilets etc. स व त र श च रम आदद 7. Other: अन म

3 13. Details of Courses that you are Interested to offer through GMVSS: आ GMVSS Sr.No स न Proposed Course प रस त पवत ऩ ठ मक रभ Expected No. Of Admission उम भ द प रव श Sr.No स न Proposed Course प रस त पवत ऩ ठ मक रभ Expected No. Of Admission उम भ द प रव श क क स ख म स ख म (Use Separate Sheet, If Necessary) (, आ ) 14. Teachers and other Staff Teaching Department Details: औ Enclosed separate List of all other Staff Members in following Format: Name Father s Name Date of Birth Sex Academic Qualification Professional Qualification Experience(Teaching & Non-Teaching Both) Level Of Association(Full Time/ Part Time/ Visiting Faculty) Key Skills DIRECTOR PROFILE 1. Name: 2. Designation: Latest Color Photograph In Passport Size Of The Proposed Principal/ Director ऩद 3. Sex: Male Female लर ग 4. Qualification: : 5. Experience: अन बव: 6. Photo ID Proof: आ Driving License Passport Voter ID PAN Card ऩ सऩ टष व टय आईड (Kindly enclose the copy)

4 DECLARATION We certify that the particulars furnished above or in the preceding pages are true to our knowledge and express out willingness for an inspection to assess the infrastructural facilities, qualified staff etc. We declare that the Organization will abide by all the rules and directions of GRAMEEN MUKT VIDHYALAYI SHIKSHA SANSTHAN (GMVSS) given from time to time. In case of any information furnished by us is found wrong or incomplete in any regard, we shall be the responsible for any decision taken by GMVSS. I hereby confirm that I will regularly visit/login website namely and any information relevant will be received by me from above-said website. Further, I will never claim any information officially or unofficially in hard copy and . Therefore, only I will be responsible for all types of consequences, if I don t visit/login the said website. आ, आ ऊ औ (GMVSS) -, GMVSS / औ ऊ, औ आ आ /, I have carefully read and understood all the guidelines, specifications and other information published by the GMVSS on the Website In case of any disputes or for any unforeseen issue(s) or issues not covered in the guidelines, specifications and other information published by the GMVSS, the decision of the GMVSS shall be final and binding on me and all other concerned. I agree that the GMVSS reserves the right to withdraw any location or any Discipline/Programme or its nomenclature at any time without assigning any reason and to make modifications in any information published anywhere whenever deemed necessary. औ औ, औ GMVSS झ आ, औ GMVSS, GMVSS औ झ औ GMVSS / औ आ झ In the event of any disputes between the parties, which are not covered at the arbitration clause, the courts of Uttarakhand shall have exclusive jurisdiction.,, DATE: ददन क Specimen Signature of the Proposed Principal/Director Seal & Signature of the Head of the Organization /

5 FOR AC USE ONLY Allotment Fee of Rs. /- (Non-Refundable and Non-Adjustable) in favour of GRAMEEN MUKT VIDHYALAYI SHIKSHA SANSTHAN payable at Delhi आव टन श ल क र../- (ग य व ऩस औय ग य सभ म ज म) GRAMEEN MUKT VIDHYALAYI SHIKSHA SANSTHAN क ऩ भ "ददल र " भ द म Demand Draft No. Date ददन क Bank Issuing Branch य कयन व र श ख Kindly allot me the following selected Programmes: झ : 1) High School Examination 2) Intermediate Examination ह ई स क र ऩय इ टयभ डडएट ऩय PHOTOS TO BE PASTED: Space for Affixing WIDE RANGE PHOTOGRAPH SHOWING THE LOCALITY OF THE ORGANISATION जगह ज ग UNDERTAKING The above pasted photographs are belonging to our Organization. I also undertake that if I fail to pay renewal fee for Academic Centre then GRAMEEN MUKT VIDHYALAYI SHIKSHA SANSTHAN (GMVSS) have the right to transfer all our enrolled Students to any other Academic Centre or treat them as Direct Students to complete their course.

6 I understand and agree that fees paid by me with the application form or on account of processing fee, for conduct of Inspection, for grant of approval of my application or any other fee or charges, as prescribed for Study Center once paid, will be non-refundable. Withdrawal of my proposal or rejection by the GMVSS at any stages for reason whatsoever shall not entitle me to claim any amount or compensation from the GMVSS. झ औ आ,, आ, GMVSS GMVSS आ झ Signature of the Proposed Principal/Director Seal & Signature of the Head / Kindly Submit AC form at: GRAMEEN MUKT VIDHYALAYI SHIKSHA SANSTHAN (GMVSS) Office: 1/11955, Ground Floor, Muskan Building, Keshav Chowk, Punchsheel Garden, Naveen Shahdara, Delhi Website: ID: info@gmvss.ac.in] INFORMATION OF ORGANIZATION स गठन क नक य Name of the Organization Type of Organization स गठन क प रक य Registered Address Date of Registration.. Registration Number ऩ कयण स ख म.. PAN Card No ऩ न क डष.. Proposed Office Address प रस त पवत ऑकपस क ऩत

7 List of Office Bearers ऩद धधक रयम क स च President/Chairman / च मयभ न Mobile No भ फ इर न फय Authorized Person Phone No. With STD Code.. Address - Fax DOCUMENTS TO BE ATTACHED ज ह An Application For Requesting Academic Center श णणक क द र अन य ध कयन क लरए एक आव दन Organization Registration Certificate Copy स गठन ऩ कयण प रभ ण ऩत र क प रनतलरपऩ Organization PAN Copy स गठन ऩ न क ऩ Organization Head PAN Copy स गठन ऩ न क ऩ Organization Head Id Proof Copy स गठन आईड प र प क ऩ Organization Building Ownership Proof/Rent Deed स गठन क ननभ षण स व लभत व प रभ ण / ककय म ड ड Organization Building Photograph स गठन क ननभ षण प ट ग र प Organization Building Map स गठन क ननभ षण क भ नधचत र List of Staff Members स ट प सदस म क स च Affidavit of Organization(RS. 100) स गठन क हरपन भ

DCA प रय जन क य म ग नद शक द र श नद श लय मह म ग ध अ तरर य ह द व व व लय प ट ह द व व व लय, ग ध ह स, वध (मह र ) DCA-09 Project Work Handbook

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