Centre Details Form

Name of Center : …………………………………………………………………………………………………

Address of Center : ……………………………………………………………………………………………….

………………………………………………………………………………………………….…………………..

………………………………………………………………………………………………….…………………...

District ………………….…………….……………….. State ……………………...………………..…..………

Pin Code: ………….……………….….. Nearest Railway Station: …………………………………………..

Phone No.: Off. …………..……………..…….……… Mobile: ……………………...…………………………

E-mail ID: ………………………………………………………………………….……………………………..

Name of Contact Person : …………………………………………………………………………..……………

Year of Establishment : …………………………………………………………………………..……………...

PAN Card No. : ………………………………………………………..

Details of Faculty:

S. No. / Name / Qualification / Teaching Experience / Subjects Which Can Teach
1
2
3
4
5
6
7
8

Details of Administrative Staff:

S. No. / Name / Qualification / Experience / Designation
1
2
3
4
5
6
7
8

Experience of Previous Training / Courses Conducted:

S. No. / Sector / Course / Name of Project / Duration / No. of Students Trained
1
2
3
4
5

Infrastructure Details:

Total Area of Centre in Sq. Ft. : ……………………………..

No. of Class Rooms: …………………

Size of classroom ((in Sq Ft.) and chairs

Classroom 1 / Size / Chairs / Capacity
Classroom 2 / Size / Chairs / Capacity
Classroom 3 / Size / Chairs / Capacity
Classroom 4 / Size / Chairs / Capacity
Classroom 5 / Size / Chairs / Capacity
Classroom 6 / Size / Chairs / Capacity
Classroom 7 / Size / Chairs / Capacity
Classroom 8 / Size / Chairs / Capacity

No. of Computers: …………………………………

No. of Computer Labs: …………………………….

Reception / Front Office (Area in SQ Ft.) ……………………………………

Toilets : …………………………………

Internet Connection: Yes: ……………. No.: ……………..

Name of Centre Contact Person ………………..……..…..….

Signature of Centre Contact Person: ………………..………..

Date: …………………………

Guidelines

  • Centre should have minimum 2 classrooms of 25-30 students.
  • Centre should have basic facilities such as sufficient space / faculties / classrooms etc.
  • Centre Should attach 3-4 Photographs of the facilities.
  • Attach Photocopy of PAN Card and ID Proof like Aadhar Card/Voter I Card/Passport Copy.
  • Attach Ownership Proof of Centre or Rent Deed.
  • Attach Resumes of Faculty / Administrative Staff.