|
| 1)
Name
of the Organisation : |
|
| 2)
Structure of the
Organisation |
|
|
|
| |
a.
Proprietorship Firm |
|
|
|
| |
b.
Partnership Firm |
|
|
|
| |
c.
Pvt. Ltd. |
|
|
|
| |
d.
Trust |
|
|
|
| |
e.
Any Other |
|
|
|
| 3)
Address : |
|
|
|
| |
Tel.
No : |
|
|
|
| |
Fax
: |
|
|
|
| |
Mobile
: |
|
|
|
| |
Email
: |
|
|
|
| Password |
|
| Confirm
Password |
|
| 4)
Owner / C.E.O.
information:- |
|
|
|
| |
Name |
|
|
|
| |
Qualifications |
|
|
|
| |
Relevant
experience |
|
|
|
| 5)
Names of the Directors /
Partners:- |
|
| 6)
Who would actively manage
the centre? |
|
| 7)
Business / Education
Experience |
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| 8)
Specify
the nature of association you want
with us:- |
|
|
|
| |
Regional
Counselling and Facilitation
Centre |
|
|
|
| |
e
– Learning Centre |
|
|
|
| |
Counselling
Centre |
|
|
|
| |
Learning
Consultant |
|
|
|
| 9)
Specify
your Investment Capability |
|
| 10)
Specify the region for
which you would like to become a
Regional Counselling and
Facilitation Centre. |
|
| 11)
Please
elaborate on the reasons for
choice of the region. |
|
| 12)
Please
elaborate on the reasons for
getting into this business |
|
| 13)
Any
collaboration with any other
university for any programmes. |
| |
Name
of the University |
|
|
|
| |
Address
of the |
|
|
|
| |
Programmes
being undertaken |
|
|
| |
|
Diploma |
|
|
|
| |
|
Undergraduate |
|
|
|
| |
|
Post
Graduate |
|
|
|
| |
|
Any
other Programme |
|
|
|
| 14)
Infrastructure
Details (If available) |
|
|
| |
Total
Area (Sq. Ft.) |
|
|
|
| |
No.
Of Class Rooms
|
|
|
|
| |
Area
of Class Rooms (Sq. Ft.) |
|
|
|
| |
No.of
Labs(Sq. Ft.)
|
|
|
|
| |
Area
of Labs(Sq. Ft.)
|
|
|
|
| |
Counseling
Area (Sq. Ft.) |
|
|
|
| |
Reception
Area |
|
|
|
| 13)
Staff Details – (If
Employed) |
|
|
|
| |
Name
of Existing Employees |
|
| |
Qualification |
|
| |
Designation |
|
| |
Salary |
|
| 14)
Any other information you would
like to provide us:- |
|
|
DECLARATION
I
/ we declare that the details and
information provided by me / us
here in above are true to the best
of my knowledge and belief. If any
information mentioned in this form
is found incorrect at any point of
time in future, The Parent Body
reserves the right of cancellation
of my membership in Learning
Network.
|
| Date
: |
|
|
|
|
| Place
: |
|
|
|
|
|
|