(AN ISO 9001:2008 CERTIFIED)

City Road, Patiala Chowk, Jind 126102, Haryana Website :- www.daksh.co E-Mail :- dakshcollege@gmail.com Tel:- +91 1681 - 227005, 9991713055, 8930217005

____________________________________________
Please fill up this form and attach supporting documents. 1. Name of the Trust/Society/Registered Institution/Others: (Please attach Deed)

a) Registration Number and State where Registered:

b) Postal Address:

City: State: Pin code c) Email Address:

d) Website, if any, then URL:

e) Telephone Numbers with STD code: i. Off

Ii. Res. iii. Mobile 1|Page

iv. FAX

2.

Name of the Institution under the Society/Trust where Training will be imparted:

a) Postal Address:

City:

State:

Pin code b) Email Address

c) Website URL (if applicable):

d)

Telephone Numbers with STD Code: i. Off ii. Res. iii. Mobile iv. FAX

3. Name of the Academic Co-coordinator (if applicable)

4. Name of the Centre Owner:

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5. Assessment of the Center with respect to Location: a) Location/Road etc. b) Commercial/Residential

c) Owned/On lease/Rent etc. (Attach Lease/Rent Deed if Any) d) Visibility from Road & Parking Space e) Familiarity of the Location

6. Total carpet area (Please attach the layout plan) 7. Infrastructure of Center a) Number of Class Rooms b) Seating Capacity with Furniture c) Air Conditioning d) Training Aids such as overhead projector/boards e) Computer/TV/VCR based classrooms f) UPS for Computer System g) Number of Counseling Rooms h) Conference/Meeting rooms i) j) Number of Computer Labs : Number of computer in each lab : YES

: : : YES : YES : YES

NO NO NO

NO : :

: :

k) Total Number of Computers (Please attach configuration details) 3|Page

l) Please Attach the Software used and their source m) Any specialized multimedia lab. With CD-ROM/Speakers/Headphones : YES NO

n) Educational CD available o) Networking in lab. And its type (UTP/OFC/ETC) p) Internet Connection & Type q) Number of Modems r)Number of Printers s) Staff room and other facilities provided to staff t) Generator for Power backup :YES

:YES : : Specify Specify

NO

NO

8. Total Number of Faculty/Lab. Assistants/Support Staff (Provide name, qualification and experience in separate list) 9. Library (Attach List of Books): a) Number of books in Library b) Number of Newspaper/Periodicals/Magazines c) Number of Technical and Non-Technical Book : : :

d) Library Seating Capacity (Number of students who can Be accommodated at a time) e) Number of Librarians f)Annual Budget for library (Average)

I Understand that the above information is correct and true to the best of my knowledge and has been nothing concealed there in. franchise fees can not be refunded any circumstance.
Name of Applicant: Designation: Signature:

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Date: .

Signature of Authority study center with Seal

Kindly enclose the following documents along with the application form for becoming Admission and Information Centre:
1. Memorandum / Details of Society, Trust or Limited Company. Also include

2. 3. 4. 5. 6. 7.
8.

the resolution for becoming the DAKSH Admission and Information Centre. Photo ID Proof in form of copy of Driving License, Passport, Voter ID Card etc. Copy of PAN Card. Floor Plan / Map of the Area. Configuration of the Equipments / Facilities in a separate list. List of Books available in Library. Bio Data of Faculty Member with copy of their educational certificates. Demand Draft in the favor of DAKSH INSTITUTE PAYABLE AT JIND\RS. 75,000 ( SEVENTY FIVE THOUSAND RS. ONLY )

For any queries or details please contact the following : Mr. Dr. Gulab Singh Parmar 08930217005 , director@daksh.co Mr. R. K. Rajput 09991713055 . dakshcollege@gmail.com dakshcollege@gmail.com

Mr. Vinod Mishra - 09215578815 .

. AN ISO 9001:2008City Road, Patiala Chowk,

Jind 126102, Haryana Website :- www.daksh.co E-Mail :- dakshcollege@gmail.com Tel:- +91-1681-227005, 09991713055,08930217005

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