APPLICATION FORM FOR AFFILIATION

Information About Institution (All fields are mandatory!)
Applying For   Authorized Learning Center Affiliation Type & Fee
Institute Name
Institute Address
City
District State
Pin Country
Mobile
Email
Status of Institution  Trust  Society  Other Year of Establishment

Information About the Chief Executive/Principal/Director of the Institute
Name Photo
Designation/Position Education Qualifiation
Professional Experience D.O.B

Infrastructure Facility
PARTICULARS NO.OF ROOMS SEATING CAPACITY TOTAL AREA (Sq.Ft.)
Staff Room
Class Room
Computer Lab
Reception
Toilets
Any Other
Payment Mode   Google Pay (G-Pay)   Online Payment