Application No.

(for office use only)

APPLICATION FORM
2016-2017
[FULL TIME GENERAL / 1st SHIFT ONLY]

FOR SEEKING AFFILIATION FOR NEW

POLYTECHNIC COLLEGES /
HOTEL MANAGEMENT AND CATERING TECHNOLOGY
INSTITUTIONS FOR THE
ACADEMIC YEAR 2016-2017
UNDER FULL TIME GENERAL / FIRST SHIFT ONLY
Name of the Trust / Society
Name of the Institution
District
Category [Polytechnic/HMCT]
Mode

:
:
:
:
: FULL TIME GENERAL / 1st SHIFT

Submitted to
The Director of Technical Education,
53, Sardar Patel Road,
Guindy,
Chennai - 600 025.
Telephone Nos. 22351018 / 22350525

APPLICATION No.

(for Office use)

Date of Submission of the Application

--

--

APPLICATION FORM
APPLICATION FOR SEEKING AFFILIATION FOR THE NEW POLYTECHNIC COLLEGES / HOTEL
MANAGEMENT AND CATERING TECHNOLOGY INSTITUTION FOR THE ACADEMIC YEAR 2016-2017
UNDER FULL TIME - GENERAL / FIRST SHIFT PROGRAMME ONLY

REGISTRATION FEE :
S.No

Demand Draft No.

Demand Draft Date

Bank

Amount

Rs. 5,000

Registration Fee
:
` Rs.5,000
Demand Draft drawn in favour of "Director of Technical Education, Chennai" payable at
Chennai should be enclosed.

01.

NAME AND ADDRESS OF THE SOCIETY / TRUST / COMPANY ESTABLISHED UNDER

SECTION 25 OF COMPANIES ACT 1956

Name of the Trust / Society / Company

Address of the Trust / Society / Company

2016 - 2017

Village / Town

Taluk

District

Pincode

Assembly Constituency

Parliament Constituency

Phone

STD Code:

Phone No.:

Fax

STD Code:

Fax No.:

Mobile

E-mail

2|Page

02 (a)

NAME AND ADDRESS OF THE INSTITUTION AT THE PERMANENT SITE

Name of the Institution

Address of the Institution

Village / Town :
Taluk :
District :
Pincode :
Assembly Constituency :
Parliament Constituency :
Phone : STD Code:

Phone No.:

Fax : STD Code:

Fax No.:

Mobile :
E-mail :
02 (b)

DETAILS OF THE SOCIETY / TRUST / COMPANY

Society Registration Act No. or Trust Act No.

or Company Act No.

Registration No.

Date of Registration

Place of Registration

02 (c)
S.No

DETAILS OF MEMBERS / TRUSTEES AND THEIR EXPERIENCE IN RUNNING HIGHER

EDUCATIONAL, TECHNICAL OR OTHER PROFESSIONAL INSTITUTIONS ETC.
Name of the Members of the
Trust / Society / Company

2016 - 2017

Designation
in the Trust /
Society /
Company

Qualification

Experience in running higher

educational, technical or other
professional institutions (in years)

3|Page

02 (d)

TRACK RECORD OF THE APPLICANT IN TERMS OF TECHNICAL / PROFESSIONAL /

NON-PROFESSIONAL INSTITUTIONS RUN / MANAGED BY THE SOCIETY/TRUST

Whether the Trust / Society / Company is

:
running/managing any educational institutions

Yes

No

If YES, then provide the information as per the table given below.
S.N

03.

Name and
Address of the
Institution

Year of
Establishment

Whether
Diploma/
Degree
(UG/PG)

Discipline
conducted

Duration
of the
Course

Annual
Intake
capacity

Whether
approved by
AICTE/Univ./
UGC/State
Govt./Board/
Other Council

DETAILS ABOUT THE CATEGORY OF THE INSTITUTION

Year of establishment

: 2016 - 2017

Category of the Institution

POLYTECHNIC COLLEGE
HOTEL MANAGEMENT & CATERING
TECHNOLOGY

(Please tick the appropriate box)

MINORITY
Linguistic

NONMINORITY
Malayalam

04.

Telugu

Religious
Sourashtra

Christian

Muslim

Others
(Specify)
Jain

PARTICULARS OF THE HEAD OF THE INSTITUTION [PRINCIPAL]

Name

Designation

Qualification

:
Mobile :
Phone : STD :
Fax : STD :

Phone No.

Fax No.

E-mail :
2016 - 2017

4|Page

05.

DETAILS OF THE LANDS [PERMANENT SITE AS APPROVED BY AICTE]

Classification of the Permanent Site

Rural Area

Other than Rural area

(Please Click on any one of the classification)

:

Ownership of Land

Government

Trust

Society

Govt. Leased

Owned

Company

Details of Land

(The Survey No. with sub-division and extent of lands for each survey number to be indicated)
Sl.
No
.

Registration
Document No.

Registration
Date

Name of the
village

Survey No. with

sub-division

Extent of
Lands
(in acres)

Land
Classification
[Indicate Dry
or Wet Land]

TOTAL
Legal disputes , if any

On Land

YES

NO

On Trust

--YES

If YES, Details
LAND USE CONVERSION
CERTIFICATE Details
LAND USE CLASSIFICATION Details

06.(a)

Certificate No.:

Date:

Certificate No.:

Date:

DETAILS ABOUT THE BUILDING OF THE INSTITUTION AT THE PERMANENT SITE

Whether the Building Plan is approved by the

:
DTCP/competent authority

Yes

No

If YES, then
Name of the authority approved the building plan

Designation of the authority approved the building plan

Date of Approval

Proceedings Number issued by the authority

06 (b)

PHYSICAL INFRASTRUCTURE - COMPLETE DETAILS OF BUILT-UP AREA (R.C.C.)

S.
No

Built-up (Carpet) Area

[in sq.m]

FIRST YEAR
Structure

(a)

Instructional area [INA]

R.C.C.

(b)

Administrative area [ADA]

R.C.C.

(c)

Amenities area [AMA]

R.C.C.

Required Area
(R.C.C.)

Available Area
(R.C.C.)

TOTAL AREA :

2016 - 2017

5|Page

NO

07.

DETAILS OF THE COURSES APPROVED BY AICTE

S.No

Discipline [Course Details]

01.
02.
03.
04.
05.
06.

General /
st
1 Shift

Mode

1st SHIFT
1st SHIFT
1st SHIFT
1st SHIFT
1st SHIFT
1st SHIFT

Full Time
Full Time
Full Time
Full Time
Full Time
Full Time

Approved Intake
for 2016-2017

AICTE Approval
Letter No. & Date

TOTAL ANNUAL INTAKE

08 (a)
S.No

NAME AND ADDRESS OF THE MEMBERS OF THE GOVERNING BODY AS PER THE
COMPOSITION PRESCRIBED BY AICTE
Name

Position

01.

Chairman

02.

Member
Secretary

Qualification

Present
Professional
position /
Occupation

Telephone
Numbers

E-mail

Address

03.
04.
05.
06.
07.

Members

08.
09.
10.
11.

08 (b)
S.No

NAME AND ADDRESS OF THE MEMBERS OF THE ANTI-RAGGING COMMITTEE AS PER

THE COMPOSITION PRESCRIBED BY AICTE
Name

Position

Qualification

Present
Professional
position /
Occupation

Telephone
Numbers

E-mail

Address

01.
02.
03.

2016 - 2017

6|Page

04.
05.
06.
07.
08.
09.
10.

09 (a)
S.
No

I.

PHYSICAL INFRASTRUCTURE - ONLY FOR FIRST YEAR (As per the details furnished in AICTE web
portal. Requirement as per AICTE application process hand book 2016-2017)

Category

Number
Required

Number
Available

Shortage

Built-up
Area
Required

Built-up
Area
Available

Shortag
e

AICTE NORMS
[AREA/ROOM]

INSTRUCTIONAL AREA

Diploma [Engg.]

1.

Class rooms [C]

1 class room for each

division of intake of
60 (66 sqm each)

2.

Tutorial rooms [D]

3.

Laboratory

4.

Workshop

200 sq.m

5.

Computer Centre

100 sq.m

6.

Drawing Hall

132 sq.m

7.

Library and
Reading Room

300 sq.m

II.

1 (33 sqm )
6 (66 sqm each)
01 No.
[200 sq.m]
01 No.
[100 sq.m]
01 No.
[132 sq.m]
01 No.
[300 sq.m]

ADMINISTRATIVE AREA

8.

Principal Office

30 sq.m

9.

Board room

20 sq.m

10.

College Office

11.

Faculty room

12.

Central Stores

30 sq.m

13.

Maintenance

10 sq.m

14.

Security

10 sq.m

15.

House keeping

10 sq.m

16.

Pantry for Staff

10 sq.m

17.

Exam. Office

30 sq.m

2016 - 2017

5sq.m

01 No.
[30 sq.m]
01 No.
[20 sq.m]
01 No.[150 sq.m
for one
programme]
Sanc.Intake [
F
20
F x 5 sq.m]
01 No.
[30 sq.m]
01 No.
[10 sq.m]
01 No.
[10 sq.m]
01 No.
[10 sq.m]
01 No.
[10 sq.m]
01 No.
[30 sq.m]

7|Page

III.
18.
19.
20.
21.
22.
23.
24.

AMENITIES AREA
Toilets
[Ladies]
Toilets
[Gents]
Boys Common
Room
Girls Common
Room
Cafeteria

75 sq.m

75 sq.m

01 No.
[75 sq.m]
01 No.
[75 sq.m]
01 No.
[150 sq.m]
01 No.
[10 sq.m]
01 No.
[10 sq.m]

75 sq.m

75 sq.m

150 sq.m

Stationary Store
& Reprography
First Aid cum Sick
Room

Adequate
[150 sq.m]

10 sq.m

10 sq.m

TOTAL

---

09 (b)

COMPUTER CENTRE - COMPUTERS, SOFTWARE, INTERNET AND PRINTERS

S.
No

Computer Facilities

1.

Computers [S] First Year Students only

2.

Multimedia Computers
Library / Internet Surfing in
Reading room

3.

Computers For Faculty Members

---

4.

Computers For Administrative Office

---

5.

Printers [P]

---

6.

Internet Facility

---

7.

LAN Facility

8.

Legal System Software

List of System Softwares

Sanctioned
intake

Number of Terminals
Required
Available Shortfall

AICTE NORMS

Sanc.Intake [ S.I]
6
[Min. 20 PCs]
1% of Total Students
Intake
[Max. 10]
S

YES / NO

Exclusive - along with LAN

and Internet over and above
the requirement meant for
students
S
10
S.I <=300 =16 Mbps
S.I >300 to 600 = 32
Mbps
P

All

---

03

---

20

(01).
(02).
(03).

9.

Legal Application Software

List of Application Software

10.

UPS

2016 - 2017

Number of UPS

Capacity

8|Page

11.

Computer Table / Chair

No. of Computer Tables :

No. of Computer Chairs :

12.

Air Conditioners

YES / NO

13.

Central Xerox Facility

YES / NO

14.

Mail Server & Client

YES / NO

15.

Computer Specifications
[General, in brief]

09.
(c)

BOOKS, JOURNALS AND LIBRARY FACILITIES:

No

Description

AICTE NORMS

Number of Titles

50 Titles of Books for whole first Year

Number of
Volumes

50 volumes of Books for each division

of 60 students

No. of Journals

1 Journal for each division of 60

students

09 d.

Required

Available

Shortage

GENERAL FACILITIES - ESSENTIAL REQUIREMENTS

S.
No

Description

1.

Language Laboratory

2.

Potable Water supply

3.

Electric supply

4.

Backup Electric supply

5.

Sewage Disposal

6.

Rain Water Harvesting and Solar Energy/ Power Systems

7.

Telephone and Fax

8.

Vehicle parking

9.

Institution Web-site

10.

Barrier Free built Environment for Differently-Abled and

elderly persons including availability of specially designed
toilets for ladies and gents separately.

11.

Safety provisions including fire and other calamities

12.

General Insurance provided for assets against fire,

burglary and other calamities

2016 - 2017

Availability
[YES / NO]

If YES, then
Number Available

9|Page

13.

Road Suitable for use by Motor Vehicle Motorised Road

14.

General Notice Board and Departmental Notice Boards

15.

First Aid, Medical and Counseling Facilities

16.

Appointment of Student Counselor

17.

Establishment of Anti Ragging Committee

18.

Establishment of Grievance Redressal Committee in the

Institute

19.

Establishment of Internal Complaint Committee

20.

Establishment of Committee for SC/ST

09.e GENERAL FACILITIES - DESIRABLE REQUIREMENTS

Public Announcement System at strategic locations

22.

Enterprise Resource Planning software for InstituteStudent-Parent Interaction

23.

Transport

24.

Post, Banking Facility, ATM

25.

CCTV Security System

26.

LCD Projector in class rooms

27.

Group Insurance to be provided for Employees

28.

Insurance for Students

29

Staff Quarters

30.

Strong Room [Storing QPs & ASs]

31.

Security arrangement [Day / Night]

32.

Sufficient halls for Examination

ACADEMIC INFRASTRUCTURE

1.

Class Room 1

2.

Class Room 2

3.

Class Room 3

4.

Class Room 4

5.

Class Room 5

2016 - 2017

Power
Connection (Y/N)

Ventilation (Y/N)

No. of Fans

No. of Lights

Teaching Aids
[BB / OHP / LCD]

Furniture (Nos)

Work Table (Nos)

Details to be provided, whichever necessary

Size [ l x b ]

Category

Available

S.
No

Required

AREA [sq.m]

Capacity

10.

21.

10 | P a g e

6.

Tutorial Room 1

7.

Tutorial Room 2

8.

Laboratory 1

9.

Laboratory 2

10.

Laboratory 3

11.

Laboratory 4

12.

Laboratory 5

13.

Laboratory 6

14.

Workshop

15.

Computer Centre

16.

Drawing Hall

17.

Library

18.

Reading Room in Library

19.

Principal Room

20.

Board Room

21.

College Office

22.

Faculty Room 1

23.

Faculty Room 2

24.

Faculty Room 3

25.

Faculty Room 4

26.

Faculty Room 5

27.

Central Stores

28.

Maintenance Room

29.

Security Room

30.

House Keeping Room

31.

Pantry for staff

32.

Exam Office

33.

Gents Toilet

34.

Ladies Toilet

35.

Boys Common Room

36.

Girls Common Room

37.

Cafeteria

38.

Stationary Store &

Reprography

39.

First Aid cum Sick Room

40.
TOTAL :

2016 - 2017

11 | P a g e

REQUIREMENT FOR FIRST YEAR ALL THE FACULTY & STAFF SHOULD BE ON PAY
ROLL.
Faculty for First year
: Faculty : Student Ratio = 1 : 20 must be computed based on
Sanctioned intake only.
Librarian

: One

Physical Education
Director
Technical Supporting Staff

: One
:

Workshop Instructor
Skilled / Lab Assistant :
Administrative Staff (As per

one
Minimum 3 for first year
: Minimum 3

Institutions requirement )

Basic servants (As per

: Minimum 4

Institutions requirement )

11 (a)

FIRST YEAR FACULTY AND STAFF REQUIREMENTS FOR SANCTIONED INTAKE OF

____________

S.No

First year

HOD

Lecturer

TOTAL

AICTE NORMS &

GUIDELINES

English
Faculty : Student
Ratio = 1 : 20

Mathematics
1.

Physics
Chemistry
Engineering
TOTAL

(i)

TOTAL SANCTIONED INTAKE

(ii)

TOTAL STAFF REQUIRED [at the ratio of 1 : 20]

(iii)

TOTAL STAFF AVAILABLE [ON THE PAY ROLL] -

(iv)

STAFF STUDENT RATIO [BASED ON PAYROLL] -

Requirement Of Principal, Librarian, Physical Education Director,

Non Teaching Technical And Others

Required

2.

Principal

ONE

3.

Librarian

ONE

4.

Physical Education Director

ONE

5.

Non-Teaching Technical Staff :

WORKSHOP INSTRUCTOR

: One

SKILLED / LAB ASSISTANTS (As per requirement)

: Minimum 1 for each lab.

UNSKILLED ASSISTANTS (As per requirement)

: As per requirement

6.

Number of Ministerial Staff

: Minimum 3

7.

Number of Basic Servants

: Minimum 4

8.

Whether AICTE Pay Scales implemented

: state YES / NO :

2016 - 2017

Available

12 | P a g e

Name of the
Faculty
Member with
Stamp Size
Photo

2016 - 2017
Total
emoluments

Institution

Present Basic
Pay

Teaching

Scale of Pay

Date of
Joining

Date of Birth &

Age

Years

Corresponding
Specialization

Position

Qualification
with Class
obtained
starting from
the highest
Degree

Institution

Department

Total
emoluments

Present Basic
Pay

Scale of Pay

Date of
Joining

Corresponding
Specialization

Qualification
with Class
obtained
starting from
the highest
Degree

Date of Birth &

Age

Stamp Size
Photo

Designation

11 (b)
FACULTY - QUALIFICATION AND EXPERIENCE

I. PRINCIPAL - QUALIFICATION
NAME OF THE PRINCIPAL :

Position

Signature

II. PRINCIPAL - EXPERIENCE

Industry
Years

III. TEACHING FACULTY - QUALIFICATION

Signature

13 | P a g e

IV. TEACHING FACULTY - EXPERIENCE

S.No

Name of the faculty

Member

Teaching
Institution

Position

Industry
Years

Institution

Position

Years

Total
emoluments

Present Basic
Pay

Scale of Pay

Date of
Joining

Date of Birth &

Age

Previous
Experience

Qualification
with Class
obtained
starting from
the highest
Degree

Signature

Physical
Education
Director

Librarian

Name of the
Faculty Member
with Stamp Size
Photo

Designation

V. LIBRARIAN AND PHYSICAL EDUCATION DIRECTOR

2016 - 2017

14 | P a g e

S.
No
Name of the Staff

S.
No

2016 - 2017
Date of Birth &
Age
Date of
Joining
Scale of Pay
Present Basic
Pay

Date of Birth &

Age
Date of
Joining
Scale of Pay
Present Basic
Pay

Signature

Previous
Experience

Previous
Experience

Signature

Qualification

Qualification

Total
emoluments

Designation

Designation

Total
emoluments

Laboratory

VII. MINISTERIAL STAFF

Place of Work

Name of the Staff

Department

VI. WORKSHOP AND TECHNICAL SUPPORTING STAFF

15 | P a g e

12 (a)

EQUIPMENTS

1.

Whether Equipments for all the Laboratories / Workshops prescribed

as per syllabus is available

YES / NO

2.

Whether all the existing equipments are entered in Stock Register ?

YES / NO

3.

Whether all the existing equipments are in working condition or not ?

YES / NO

4.

If not, list out the equipments that are not in working condition

(list to be enclosed)

5.

Whether any equipments are likely to be purchased in respect of the

Courses for which extension of approval is applied

YES / NO

6.

If YES, list out the equipments

(list to be enclosed)

12 (b)

LIST OF EQUIPMENTS AND ITS ADEQUACY [FOR A BATCH OF 30 STUDENTS]

I. FIRST SEMESTER ENGINEERING PHYSICS I PRACTICAL [ M SCHEME ]

S.
No

1.

2.

3.

4.

5.

6.

List of Equipments

MICROMETER
(SCREW
GAUGE) SETUP - Screw
gauge, graph sheet and
irregular glass plate.
VERNIER
CALIPERS
SETUP - Vernier Calipers
and Solid Cylinder
CONCURRENT
FORCES
SETUP - Vertical drawing
board, two Z pulleys, three
sets of slotted weights (5 x
50g) and twine thread
POISEUILLES
METHOD
SETUP - Burette stand,
graduated burette without
stopper,
rubber
tube,
beaker,
capillary
Tube,
digital stop watch and
funnel.
STOKES METHOD SETUP
Stokes Apparatus, high
viscous liquid (Castrol oil),
glass beads of Different
radii, digital stop watch and
screw gauge
SURFACE
TENSION
SETUP - Beaker with water,
capillary tube, iron stand
with
clamp,
pointer,
travelling microscope and
hydro static bench.

2016 - 2017

Quantity
Required

Quantity
Available

Adequate
or Not

If Not,
Whether
Order has
been placed?

If YES,
Purchase
Order
details

Remarks

4
SETS

4
SETS
4
SETS

4
SETS

4
SETS

4
SETS

16 | P a g e

7.

8.

SONOMETER SETUP Sonometer, screw gauge,

tuning fork, rubber hammer,
slotted weight hanger set (5
x 0.5kg) and paper rider
DEFLECTION
MAGNETOMETER SETUP Deflection
Magnetometer,
meter scale and two bar
magnets

4
SETS

4
SETS

II. SECOND SEMESTER ENGINEERING PHYSICS II PRACTICAL [ M SCHEME ]

S.
No

1.

2.

3.

4.

5.

6.

List of Equipments

Quantity
Required

REFRACTIVE
INDEX
SETUP
Travelling
Microscope, Beaker with
transparent liquid and Saw
dust

SPECTROMETER. SETUP Spectrometer,

Sodium
vapour lamp, Reading lens
and Glass prism
SOLAR CELL SETUP Solar cell Kit for drawing the
V - I characteristics
LAWS OF RESISTANCES Battery
Eliminator,
key,
rheostat,
ammeter,
voltmeter, Connecting wires
and two known standard
resistances
METRE BRIDGE SETUP Meter
Bridge,
variable
resistance box, Leclanche
cell, plug Key, galvanometer,
high
resistance,
jockey,
connecting
Wires
and
unknown resistance
POTENTIOMETER SETUP Potentiometer, two cells
(Leclanche cell and Daniel
cell),
Battery eliminator,
Rheostat, Key, two way key,
Galvanometer,
resistance,
jockey
connecting wires

2016 - 2017

Quantity
Available

Adequate
or Not

If Not,
Whether
Order has
been placed?

If YES,
Purchase
Order
details

Remarks

SETS

4
SETS

4
SETS
4
SETS

4
SETS

4
SETS

high
and

17 | P a g e

7.

8.

9.

10.

JOULES
CALORIMETER
SETUP- Joules Calorimeter,
Battery eliminator, Rheostat,
Key, Ammeter, voltmeter,
stop clock, thermometer,
digital
Balance
and
connecting wires
COPPER
VOLTAMETER
SETUP- Copper Voltameter,
Battery eliminator, Rheostat,
Key, Ammeter, stop clock,
digital balance, emery sheet
and Connecting wires
P-N JUNCTION DIODE
SETUP - P-N Junction Diode
forward characteristics kit
LOGIC GATES SETUP Logic
gates
testing
apparatus kit with bread
board for Mounting ICs and
Integrated circuit chips ( IC
7404 NOT Gate, IC 7408
AND Gate, IC 7432 OR
gate, IC 7400 NAND Gate,
IC 7402 NOR Gate)

4
SETS

4
SETS

4
SETS
4
SETS

III. I & II SEMESTER ENGINEERING CHEMISTRY I & II PRACTICAL [ M SCHEME ]

S.
No

List of Equipments

Quantity
Required
(in Nos)

Quantity
Available

Adequate
or Not

If Not,
Whether
Order has
been placed?

If YES,
Purchase
Order
details

Remarks

Non-Consumable Items:
gas

Connection

1.

Indane
(DBC)

2.

Exhaust Fan (High capacity)

3.

Fire Extinguisher

4.

First Aid Box (Full set)

5.

Safety chart

6.

Chemical Balance

7.

Fractional weight box

8.

PH meters

9.

Working Table
accessories

with

all

Sufficient

Glassware and Other Items :

1.

Burette 50ml

35

2.

Burette stand

35

3.

Pipette 20ml (with safety

35

2016 - 2017

18 | P a g e

bulb)
4.

Pipette 10ml

5.

Conical Flask 250ml

35

6.

Funnel 3 (Polythene)

50

7.

Porcelain Tile 6x6

35

8.

Measuring Cylinder 10ml

9.

Measuring Cylinder 1000ml

10.

Reagent
250ml

Bottle

(White)

60

11.

Reagent
125ml

Bottle

(White)

100

12.

Reagent
250ml

Bottle

(Amber)

80

13.

Test tubes 15 x 1.5 mm

1000

14.

Test tubes 15 x 2.5 mm

500

15.

Test tube stand

35

16.

Test tube holder

35

17.

Test tube cleaning brush

35

18.

Glass Trough

19.

Beakers 100 ml

35

20.

Glass Rods 15cm

100

21.

Watch Glass 3

35

22.

Wash Bottle
1000 ml

23.

Nickel Spatula

24.

Bunsen Burner
connection

25.

Plastic Buckets (15 lts)

10

26.

Tripod Stand (Iron)

30

27.

Filter Paper Round sheets

28.

Standard flask 100 ml

(Polythene)

35
35

for

gas

30

sufficien
t Nos.
35

IV. SECOND SEMESTER WORKSHOP PRACTICE [ M SCHEME ]

S.
No

List of Equipments

Quantity
Required
(in Nos)

Quantity
Available

Adequate
or Not

If Not,
Whether
Order has
been placed?

If YES,
Purchase
Order
details

Remarks

FITTING SECTION
1.

4 Bench vice

30

2.

12 Flat Rough file

30

2016 - 2017

19 | P a g e

3.

12 Flat smooth file

30

4.

10 Try angular file

30

5.

8 Half round file

30

6.

8 Square file

30

7.

10 Round file

30

8.

150 mm Try square

30

9.

150 mm Steel rule

30

10.

6 mm Dot punch

30

11.

6 mm Center punch

30

12.

Hacksaw Frame

30

13.

6 leg vice

14.

6 mm Prick punch

15.

Hand shearing machine

16.

Ball Pan lbs Hammer

30

17.

6.8 mm Drill Bit

18.

8.5 mm Drill Bit

19.

10.2 mm Drill Bit

20.

M8 tap set

21.

M10 tap set

22.

M12 tap set

23.

Bench drilling machine

24.

Deep cut Hacksaw frame

25.

2 x 1 Surface plate

26.

Scriber

30

27.

Tap wrench

10

WIRING SECTION
1.

6 Insulated handle cutting

pliers

30

2.

8 Insulated handle screw

driver

30

3.

Pound hammer

30

4.

Wire Cutter

30

5.

250V Line Tester

30

6.

10 cm Poker

30

7.

4 Connecting Screw driver

30

8.

2 x 1 Wiring board

30

9.

Multi meter

10.

Required
numbers
of
switches
and
sufficient
consumables

Adeq

PLUMBING SECTION

2016 - 2017

20 | P a g e

1.

Hand operated bending Tool

2.

Sprit level

3.

Try Square

4.

Measuring Tape

5.

Hand drilling Machine

6.

Hacksaw Frame with Blade

7.

Junior Hacksaw frame

8.

Pipe/tube Cutter

9.

Water meter

10.

Cutting Plier

11.

Grip plier

12.

Slip Joint Plier

13.

Screw Driver

14.

D/E Spanner(6 to 32 mm)

set

15.

Box Spanner(6 to 32 mm)

set

16.

Jumper Bit

17.

Flat Chisel

18.

Sledge Hammer

19.

Pipe vice

20.

Pipe Die Set

21.

Pipe wrench

22.

Shifting Spanner

23.

Wire Brush

24.

Personnel
Equipments

25.

Teflon Tape/ Solution

Sufficient
quantity

26.

Emery Sheet

Sufficient
quantity

2016 - 2017

Protecting

Sufficient
quantity

21 | P a g e

27.

GI Pipes & Accessories

Sufficient
quantity

28.

PVC Pipes & Accessories

Sufficient
quantity

29.

Other Consumables

Sufficient
quantity

13.

DETAILS OF THE FINANCIAL STATUS OF THE TRUST

S.No

Amount [ Rs. ]

Description

1.

Endowment created with AICTE

2.

Current / Savings Account

Name of the Bank

Account Number with Amount

3.

Land Value

4.

Building Value

5.

Total Investment on Library Books till date

6.

Total Investment on Equipments till date

7.

Expenditure on Salary

8.

Annual Budget Recurring

9.

Annual Budget Non-recurring

Audit Report [Income / Expenditure]

10.

YES / NO

ENDOWMENT FUND CREATED BY THE TRUST WITH AICTE

Name and
Place of Bank

Amount
(Rs. in Lakhs)

Deposited in the bank

(name)

Date of
Maturity

Instrument No. and date

DETAILS OF BANK BALANCE AMOUNT

Type of
Account

Whether Account in the

name of Trust / College

Name and
Place of
Bank

Account
Number

Balance as
On date

Amount
( ` in Lakhs)

Extent (sq.m)

Built-up
area (sq.m)

Guideline

Market Value (`)

Current
Savings
VALUE OF LAND AND BUILDING
Survey
Number

2016 - 2017

Location

Value (`)

22 | P a g e

14.

Sl.
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.

DOCUMENTS, REGISTERS AND RECORDS

The following Documents, Registers and Records should be maintained / available in the Institution and
it should be produced for verification at the time of inspection to the inspection committee members.
Name of Register / Record

Maintained / Available
(YES / NO)

AICTE Web-portal Copy granting approval for Institution / Programmes(s)

AICTE Letter of Approval Copy for Institution / Programmes(s)
Department wise faculty profile
Department wise Non-Teaching Staff Profile
Attendance for teaching and non-teaching staff
Advertisement for recruitment of faculty members
Minutes of the meeting of Staff Selection Committee
Appointment / offer letters issued to faculty members
Joining report of staff members
Copy of Regulations, curriculum and syllabi (programme wise)
Master time table for all courses and all sections with classroom arrangements
Academic calendar
Accession register for library
Stock register for equipment and machinery
Stock register for consumable
Stock register for furniture
Stock register for tools
Minutes of the meetings of the Governing council of the college
Minutes of the meetings of the Regd. Society / Trust / Company of the college
Audited statement of accounts of the college
Cash book of the college
Acquittance register
Fee receipt books (including counterfoils)
Funds position / bank certificates / FDR copies to indicate financial stability
Composition of the Governing council
Composition of the Anti-Ragging Committee
Trust Deed
Registered Land Documents and Sale Deed
Land Use Certificate
Land Conversion Certificate
Land Classification certificate
Village Map
Combined field map of lands
Encumbrance Certificate for land
Patta, Chitta and Adangal for land
Field Measurement Book for land
Documentary proof for ownership of lands exclusively earmarked for the College
Approved Existing Building Plan
Building Sketch [Complete details of Rooms, Labs, W/S, Stores, Library etc.]
Legal Opinion
Copy of Certificate obtained under sec. 37B of TNLRA 1961
Certificates for fire/boiler/electrical safety from competent authorities.
Certificate from Health Inspector
Certificate from PWD Supt. Engineer / Panel Engineer approved by respective
District Collector, for the structural stability of all buildings
Building and equipment insurance certificate.

2016 - 2017

23 | P a g e

LIST OF ENCLOSURES TO BE ENCLOSED ALONG WITH THE APPLICATION FORM

1.
2.
3.
4.
5
6
7
8
9
10
11

12

Registration Fee [ Rs. 5,000]

AICTE Web-portal Copy granting approval for Institution / Programmes(s)
AICTE Letter of Approval Copy for Institution / Programmes(s)
Notarized Undertaking in Rs. 100 stamp paper
Trust Deed
Registered Land Documents and Sale Deed
Land Use Certificate issued by Revenue Divisional Officer
Land Conversion Certificate issued by Revenue Divisional Officer for Wet Land
Land Classification certificate issued by Revenue Divisional Officer
If Wet Land, Certificate under Section 47 (A) of Tamil Nadu Town and Country
Planning Act, 1971
Certificate under Section 37-B on Tamil Nadu Land Reforms (Fixation of Ceiling
on land) Act 1961 (Tamil Nadu Act 58 of 1961).
Copy of the Form No.38, viz. the application form for permission by Public Trust
under subsection (1) of Section 37-B of the Tamil Nadu Land Reforms (Fixation
of Ceiling on Land) Act 1961 along with the covering letter addressed to
(1) Principal Secretary to Government, Revenue Department, Chennai 9;
(2) Commissioner of Land Reforms, Chepauk, Chennai 5 and

13
14
15
16
17
18
19
20
21
22
23
24
25
26
27

(3) Assistant Commissioner (Land Reforms) or equivalent cadre under the

jurisdiction where the Institution is located.
Village Map
Combined field map of lands
Encumbrance Certificate for land
Patta, Chitta and Adangal for land
Field Measurement Book for land
Documentary proof for ownership of lands exclusively earmarked for the College
Approved Building Plan
Copy of the proceedings issued by DTCP for approval of building plan
Copy of the Challan towards payment of infrastructure and basic amenities
charges to DTCP for approval of building plan
Building Sketch [Complete details of Rooms, Labs, W/S, Stores, Library etc.]
Legal Opinion
Certificates for fire/boiler/electrical safety from competent authorities.
Certificate from Health Inspector
Certificate from PWD Supt. Engineer/ Panel Engineer approved by respective
District Collector for the structural stability of all the building
Building and equipment insurance certificate.

All the New AICTE approved Diploma level Institutions for the year 2016-2017 are requested to submit
the application in the above prescribed format along with the enclosures for affiliation for the year 20162017.

2 Hard Copies of the application with Hard / Soft bound

1 Soft copy of Application in word format with Filename as <Institution_name.doc>

1 soft copy of Application duly signed in pdf format as Filename <Institution_name.pdf>
The above soft copies should be submitted in a CD
The above soft copies should also be sent by email to adpdote@gmail.com with Filename as
<College name> . doc.
2016 - 2017

24 | P a g e

UNDERTAKING
That I have read and understood the contents of the application and the same are true and correct on
the basis of my personal knowledge and on the basis of the records of the institution.
In connection with my / our application for the grant of affiliation of _____________________________
________________________________________________ (Name of the Institution) to conduct ___________
courses with _________ sanctioned intake, and hereby undertake to comply with the following:i.
ii.
iii.
iv.
v.
vi.

vii.
viii.
ix.
x.

xi.

xii.
xiii.

xiv.

That infrastructural, instructional and other facilities are being provided as per the AICTE norms,
standards and guidelines prescribed from time to time.
That the admission to the course will be made only after recognition is granted by the AICTE and
affiliation is granted by the State Board of Technical Education and Training, Tamil Nadu.
That the admission of students, satisfying the eligibility conditions will be made on the basis of marks
obtained in the qualifying examinations or as per the State Government policy in force.
That there shall be reservation of seats for SC/ST/BC/MBC/other categories as per the policy of the State
Government.
That the tuition and other fees will be charged at rates prescribed by the Competent authority.
That there shall be teaching and non teaching staff appointed as per the guideline of the AICTE / State
Government. The staff will be paid salary as may be prescribed by the AICTE / State Government from
time to time.
That the management shall discharge the statutory obligations relating to provident fund, pension,
gratuity, etc., in respect of all its employees.
That the management will make adequate funds available for providing satisfactory facilities and for
proper programme implementation announced from time to time.
That the accounts of the institution will be properly maintained and audited annually by the audit
authorities or chartered accountant and will be open for inspection.
That the institution will involve all the eligible staff members in the invigilation work, evaluation work and
any other academic assignments prescribed by the Directorate of Technical Education, Chennai from
time to time
In the event of non-compliance by the ___________________________ (Name of the Trust / Society /
Company / College / Institution, etc.,) with regard to the norms and standards of any other conditions laid
down / prescribed by the State Government / State Board of Technical Education and Training, Tamil
Nadu / Directorate of Technical Education, Chennai from time to time, the concerned authorized authority
will be free to take all necessary measures for effecting withdrawal of its affiliation, without consideration
of any other issue and that all liabilities arising out of such a withdrawal would solely be that of the
institution / management.
That the institution shall take all our efforts to eradicate ragging and AICTE / State Government / UGC
rules and regulation on ragging will be strictly enforced.
That the existing AICTE / State Government / Directorate of Technical Education, Chennai regulations
and the new regulations announced from time to time will be strictly enforced and intimated to the
authorities.
That we are aware of the fact that monitoring and enforcement of academic discipline in our campus shall
be as required by regulations of State Government / State Board of Technical Education and Training,
Tamil Nadu / Directorate of Technical Education, Chennai.
Principal
Name:

Chairman / Managing Trustee / Secretary / any other

authorized signatory
Name:

Note : A notarized undertaking in Rs.100 stamp paper duly signed by the Principal and the authorized
signatory of the trust is to be enclosed
2016 - 2017

25 | P a g e

Endorsement of the Principal

I,

Thiru.

Thiru.

Tmt.

___________________________

_____________________

on

behalf

of

son

daughter

the

(college

of

name)

___________________________ hereby declare that the particulars furnished in the

application are correct to the best of my knowledge.
Principal
(Name in Capital Letters)
Seal
Place:
Date:

Declaration by the Management

I,

Thiru.

Tmt.

___________________________

son

daughter

of

Thiru. _______________ on behalf of the trust, viz., ___________________________

hereby declare that the particulars furnished in the application are correct to the best of my
knowledge. No programme(s) will be started without the prior approval of the AICTE and the
grant of affiliation by the State Board of Technical Education and Training, Tamil Nadu for the
academic year concerned and all the original documents related to the particulars given in
the application will be produced at the time of inspection and whenever called for.

Chairman / Secretary
(Name in Capital Letters)

Seal
Place:
Date:

2016 - 2017

26 | P a g e