Application No.

[FULL TIME GENERAL / 1st SHIFT ONLY]

APPLICATION FORM 2012-2013

FOR SEEKING AFFILIATION FOR NEW POLYTECHNIC COLLEGES / HOTEL MANAGEMENT AND CATERING TECHNOLOGY INSTITUTIONS FOR THE ACADEMIC YEAR 2012-2013 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 Commissioner 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 COLLEGE / HOTEL MANAGEMENT AND CATERING TECHNOLOGY INSTITUTION FOR THE ACADEMIC YEAR 2012-13 UNDER FULL TIME - GENERAL / FIRST SHIFT PROGRAMME ONLY

REGISTRATION FEE :
S.No Demand Draft No. Demand Draft Date Bank Amount

` 5,000

: ` 5,000 Demand Draft in favour of "Commissioner of Technical Education, Chennai" payable at Chennai should be enclosed.
Registration Fee NAME AND ADDRESS OF THE SOCIETY / TRUST / COMPANY ESTABLISHED UNDER SECTION 25 OF COMPANIES ACT 1956 : :

01.

Name of the Trust / Society / Company Address of the Trust / Society / Company

Village / Town Taluk District Pincode 2012 - 2013 2|Page

: : : :

Assembly Constituency Parliament Constituency Phone Fax Mobile E-mail

: : : : : : STD Code: STD Code: Phone No.: Fax No.:

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 No.: Fax No.:

Phone : STD Code: Fax : STD Code:

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 Designation in the Trust / Society / Company Qualification Experience in running higher educational, technical or other professional institutions (in years)

2012 - 2013 3|Page

02 (d)

TRACK RECORD OF THE APPLICANT IN TERMS OF TECHNICAL / PROFESSIONAL / NON-PROFESSIONAL INSTITUTIONS RUN / MANAGED BY THE SOCIETY/TRUST Yes No

Whether the Trust / Society / Company is : running/managing any educational institutions

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

03.

DETAILS ABOUT THE CATEGORY OF THE INSTITUTION : 2012 - 2013 : POLYTECHNIC COLLEGE HOTEL MANAGEMENT & CATERING TECHNOLOGY MINORITY Religious Sourashtra Christian Muslim Jain Others (Specify)

Year of establishment Category of the Institution (Please tick the appropriate box)

NONMINORITY

Linguistic Malayalam Telugu

04.

PARTICULARS OF THE HEAD OF THE INSTITUTION [PRINCIPAL] Name Designation : :

2012 - 2013 4|Page

Qualification

: Mobile : Phone : STD : Fax : STD : E-mail : Phone No. Fax No. : :

05.

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

:

Classification of the Permanent Site (Please Click on any one of the classification) Ownership of Land Details of Land

Rural Area Other than Rural area

Government Govt. Leased

Trust Owned

Society Company

(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

: On Land YES NO On Trust YES

--NO

If YES, Details

06.

DETAILS ABOUT THE BUILDING OF THE INSTITUTION AT THE PERMANENT SITE

:

Whether the Building Plan is approved by the competent authority 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 07.
S.No

Yes

No

: : : :

DETAILS OF THE COURSES APPROVED BY AICTE

Discipline [Course Details] General / 1st Shift Mode Approved Intake for 2012-2013 AICTE Approval Letter No. & Date

2012 - 2013 5|Page

01. 02. 03. 04. 05.

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

Full Time Full Time Full Time Full Time Full Time

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 Qualification Present Professional position / Occupation Telephone Numbers E-mail Address

01. 02. 03. 04. 05. 06. 07. 08. 09. 10. 11.

Chairman Member Secretary

Members

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. 04. 05. 06. 07. 08. 2012 - 2013 6|Page

09. 10.

09 (a) S. No

PHYSICAL INFRASTRUCTURE - COMPLETE DETAILS OF BUILT-UP AREA Type of Structure [RCC/ACC] FIRST YEAR Required Area [sq.m] Available Area [sq.m]

Built-up (Carpet) Area

(a) Instructional area [INA] (b) Administrative area [ADA] (c) Amenities area [AMA] (d) Circulation area [CIA] [CIA = 0.25 x (INA+ADA+AMA)] 09 (b)
S. No

TOTAL AREA :

PHYSICAL INFRASTRUCTURE - ONLY FOR FIRST YEAR

Category Number Required Number Available Shortage Built-up Area Required Built-up Area Available Shortage AICTE NORMS [AREA/ROOM]

I.
1. 2. 3. 4. 5. 6. 7. 8.

INSTRUCTIONAL AREA
Class rooms [C] Tutorial rooms [D] Laboratory Workshop Computer Centre Drawing Hall Library Reading Room in Library

Diploma [Engg.] C = No. of divisions (1 division=60) [66 sq.m/room] D=C/4 [33 sq.m/room] 06 Nos [66 sq.m/room] 01 No. [200 sq.m] 01 No. [100 sq.m] 01 No. [132 sq.m] 01 No. [300 sq.m] 01 No. 15% x Intake [Max. 150]

II.
8. 9. 10.

ADMINISTRATIVE AREA
Principal Office Board room College Office 01 No. [30 sq.m] 01 No. [20 sq.m] 01 No.

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11. 12. 13. 14. 15. 16. 17.

Faculty room Central Stores Maintenance Security House keeping Pantry for Staff Exam. Office

[150 sq.m] 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] Adequate [150 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] ---

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

AMENITIES AREA
Toilets [Ladies & Gents] Boys Common Room Girls Common Room Cafeteria Stationary Store & Reprography First Aid cum Sick Room

TOTAL 09 (c)
S. No 1.

COMPUTER CENTRE - COMPUTERS, SOFTWARE, INTERNET AND PRINTERS

Computer Facilities Sanctioned intake Number of Terminals Required Available Shortfall AICTE NORMS S= Sanc.Intake [ S.I] 6 [Min. 20 PCs] 1% of Total Students Intake [Max. 10]

Computers [S] First Year Students only Multimedia Computers Library / Internet Surfing in Reading room Computers For Faculty Members Computers For Administrative Office Printers [P] Internet Facility LAN Facility Legal System Software List of System Softwares (01). (02). (03).

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

--------YES / NO --:

Exclusive - along with LAN and Internet over and above the requirement meant for students
P= S 10

S.I. 240 =1 Mbps S.I. > 240 = 2 Mbps

All 03

2012 - 2013 8|Page

9.

Legal Application Software List of Application Software

---

20

10. 11. 12. 13. 14. 15.

UPS Computer Table / Chair Air Conditioners Central Xerox Facility Mail Server & Client Computer Specifications [General, in brief]

Number of UPS Capacity

: :

No. of Computer Tables : No. of Computer Chairs : YES / NO YES / NO YES / NO : : : PREFERRED DESIRED

09 (d)
S. No 1. 2. 3. 4. 5. 6. 7. 8. 9.

BOOKS, JOURNALS AND LIBRARY FACILITIES

Description No. of Divisions (1 division=60) B= B= B= YES / NO : YES / NO : YES / NO : YES / NO : YES / NO : YES / NO : Required Available Shortfall AICTE NORMS First Year : 50 250 x B 03 x B Essential Essential Essential Essential Essential Essential

Number of Titles Number of Volumes No. of National Journals Digital Library facility Reprographic Facility Document scanning facility Document printing facility Internet Multimedia Facilities

09 (e)
S.No 1. 2. 3.

ESSENTIAL AND DESIRED REQUIREMENTS

Description Language Laboratory Water supply Electric supply Availability [YES / NO] Details to be provided. [Number, if so required] REQUIREMENT ESSENTIAL ESSENTIAL ESSENTIAL

2012 - 2013 9|Page

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.

Generator facility Sewage Disposal Telephone and Fax First Aid facility Vehicle parking Institution Web-site [Website address to be provided] Barrier Free built Environment for Differently-Abled and elderly persons including availability of specially designed toilets for ladies and gents separately. Safety provisions including fire and other calamities General Insurance provided for assets against fire, burglary and other calamities All weather approach road General Notice Board and Departmental Notice Boards Medical and Counseling Facilities Strong Room [Storing QPs & ASs] Security arrangement [Day / Night] Sufficient halls for Examination Public announcement system at strategic locations for general announcements / paging and announcements in emergency Enterprise Resource Planning (ERP) Software for Student-Institution-Parent interaction Transport Post, Banking Facility / ATM CCTV Security System LCD (or similar) projectors in classrooms Group Insurance to be provided for the employees Insurance for students Staff Quarters Principals Quarters Guest House Sports Club / Gymnasium Auditorium / Amphi Theatre Boys Hostel Girls hostel

ESSENTIAL ESSENTIAL ESSENTIAL ESSENTIAL ESSENTIAL ESSENTIAL ESSENTIAL ESSENTIAL ESSENTIAL ESSENTIAL ESSENTIAL ESSENTIAL

ESSENTIAL FOR EXAM PURPOSE

DESIRED DESIRED DESIRED DESIRED DESIRED DESIRED DESIRED DESIRED DESIRED DESIRED [150 sq.m] DESIRED [30 sq.m] DESIRED [100 sq.m] DESIRED [250 sq.m] DESIRED Adequate DESIRED Adequate

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10.

ACADEMIC INFRASTRUCTURE
AREA [sq.m] Details to be provided, whichever necessary [BB / OHP / LCD]Teaching Aids Power Connection (Y/N)

Work Table (Nos)

S. No

Category

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.

Class Room 1 Class Room 2 Class Room 3 Class Room 4 Class Room 5 Tutorial Room Laboratory 1 Laboratory 2 Laboratory 3 Laboratory 4 Laboratory 5 Laboratory 6 Workshop Computer Centre Drawing Hall Library Reading Room in Library Principal Room Board Room College Office Faculty Room 1 Faculty Room 2 Faculty Room 3 Faculty Room 4

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Ventilation (Y/N)

Furniture (Nos)

No. of Lights

Size [ l x b ]

No. of Fans

Available

Required

Capacity

25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39.

Faculty Room 5 Central Stores Maintenance Security House Keeping Pantry for staff Exam Office Gents Toilet Ladies Toilet Boys Common Room Girls Common Room Cafeteria Stationary Store & Reprography First Aid cum Sick Room Language Laboratory TOTAL :

11 (a)
S.No 1.

FACULTY AND STAFF REQUIREMENTS

Discipline FIRST YEAR English Mathematics Physics Chemistry Engineering TOTAL Faculty : Student Ratio = 1 : 20 Sanct. Intake HOD Lecturer TOTAL AICTE NORMS & GUIDELINES

Principal : 1 HOD : 1 per Dept. Lecturer : Intake / 20

(i) (ii) (iii) (iv) 2. 3. 4. 5.

TOTAL SANCTIONED INTAKE TOTAL STAFF REQUIRED [at the ratio of 1 : 20] TOTAL STAFF AVAILABLE [ON THE PAY ROLL] STAFF STUDENT RATIO [BASED ON PAYROLL] Principal Librarian Physical Education Director Non-Teaching Technical Staff : FOREMAN WORKSHOP INSTRUCTOR SKILLED / LAB ASSISTANTS

: : : : : : : : : : ONE ONE ONE

The ratio between the Foreman to Workshop Instructor = 1 : 5 for the entire 3 years One Lab. Assistant for

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each laboratory
UNSKILLED ASSISTANTS 6. 7. 8. Number of Ministerial Staff Number of Basic Servants Whether AICTE Pay Scales implemented : : : : YES / NO :

One Assistant for each Department As per Institutions requirement As per Institutions requirement

11 (b)

FACULTY - QUALIFICATION AND EXPERIENCE

I. PRINCIPAL - QUALIFICATION NAME OF THE PRINCIPAL

Qualification with Class obtained starting from the highest Degree Date of Birth & Age

:
emolumentsTotal Present Basic Pay emolumentsTotal Date of Joining Corresponding Specialization Present Basic Pay Scale of Pay

Stamp Size Photo

Signature

II.

PRINCIPAL - EXPERIENCE
Teaching Industry Years Institution Position Years

Institution

Position

III.

TEACHING FACULTY - QUALIFICATION

AgeDate of Birth & Qualification with Class obtained starting from the highest Degree Corresponding Specialization Date of Joining Scale of Pay Designation Department

Name of the Faculty Member with Stamp Size Photo

Signature

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IV. TEACHING FACULTY - EXPERIENCE

S.No Name of the faculty Member Teaching Institution Position Years Institution Industry Position Years

V. LIBRARIAN AND PHYSICAL EDUCATION DIRECTOR

AgeDate of Birth & Date of Joining Present Basic Pay Qualification with Class obtained starting from the highest Degree emolumentsTotal Scale of Pay Designation Previous Experience

Name of the Faculty Member with Stamp Size Photo

Signature

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Librarian

S. No

S. No

VII.

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Name of the Staff DirectorPhysical Education Department Laboratory Designation Qualification ExperiencePrevious Date of Birth & Age Date of Joining Scale of Pay Present Basic Pay emolumentsTotal

MINISTERIAL STAFF

Place of Work

Designation

Qualification

VI. WORKSHOP AND TECHNICAL SUPPORTING STAFF

ExperiencePrevious

Date of Birth & Age

Date of Joining

Scale of Pay

Present Basic Pay

emolumentsTotal

Signature

Name of the Staff Signature

12 (a)
1. 2. 3. 4. 5. 6.

EQUIPMENTS
Whether Equipments for all the Laboratories / Workshops prescribed as per syllabus is available Whether all the existing equipments are entered in Stock Register ? Whether all the existing equipments are in working condition or not ? If not, list out the equipments that are not in working condition Whether any equipments are likely to be purchased in respect of the Courses for which extension of approval is applied If YES, list out the equipments : : : : : YES / NO YES / NO YES / NO (list to be enclosed) YES / NO (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 [ L SCHEME ]

S. No List of Equipments Quantity Required Quantity Available Adequate or Not If Not, Whether Order has been placed? If YES, Purchase Order details Remarks

1.

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,

4 SETS

2.

4 SETS 4 SETS

3.

4.

4 SETS

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capillary Tube, digital stop watch and funnel. 5. 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. 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

6.

4 SETS

7.

4 SETS

8.

4 SETS

II.
S. No

SECOND SEMESTER ENGINEERING PHYSICS II PRACTICAL [ L SCHEME ]

List of Equipments Quantity Required Quantity Available Adequate or Not If Not, Whether Order has been placed? If YES, Purchase Order details Remarks

1.

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

4 SETS

2.

4 SETS

3.

4 SETS 4 SETS

4.

5.

4 SETS

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unknown resistance 6. POTENTIOMETER SETUP Potentiometer, two cells (Leclanche cell and Daniel cell), Battery eliminator, Rheostat, Key, two way key, Galvanometer, resistance, jockey connecting wires 7. high and 4 SETS 4 SETS

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)

8.

4 SETS

9.

4 SETS 4 SETS

10.

III.
S. No

I & II SEMESTER ENGINEERING CHEMISTRY I & II PRACTICAL [ L SCHEME ]

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:
1. 2. 3. 4. 5. 6. 7. Indane (DBC) gas Connection 1 Sufficient 1 2 1 1 1

Exhaust Fan (High capacity) Fire Extinguisher First Aid Box (Full set) Safety chart Chemical Balance Fractional weight box

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8. 9.

PH meters Working Table accessories Burette 50ml Pipette 20ml bulb) (with safety with all

5 8

Glassware and Other Items :

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 35 35 50 35 5 3 60 100 80 1000 500 35 35 35 5 5 5 35 5 100 35 (Polythene) 35 10 1 30 for gas 30 15 10 30 1000 35 35 5

Conical Flask 250ml Funnel 3 (Polythene) Porcelain Tile 6x6 Measuring Cylinder 100ml Measuring Cylinder 500ml Reagent Bottle (White) 250ml Reagent Bottle (White) 125ml Reagent 250ml Bottle (Amber)

Test tubes 15 x 1.5 mm Test tubes 15 x 2.5 mm Test tube stand Test tube holder Test tube cleaning brush Glass Trough Beakers 1000 ml Beakers 500 ml Beakers 250 ml Beakers 100 ml Glass Rods 15cm Watch Glass 3 Wash Bottle 1000 ml Nickel Spatula Kipps Apparatus Burner Nipple Bunsen Burner connection

Wire Gauge with asbestos center Plastic Buckets (15 lts) Tripod Stand (Iron) Filter Paper Round sheets Burette stand Standard flask 100 ml Pipette 10ml

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IV. SECOND SEMESTER WORKSHOP PRACTICE [ L 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. 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. 4 Bench vice 12 Flat Rough file 12 Flat smooth file 10 Try angular file 8 Half round file 8 Square file 10 Round file 150 mm Try square 150 mm Steel rule 6 mm Dot punch 6 mm Center punch Hacksaw Frame 6 leg vice 6 mm Prick punch Hand shearing machine Ball Pan lbs Hammer 6.8 mm Drill Bit 8.5 mm Drill Bit 10.2 mm Drill Bit M8 tap set M10 tap set M12 tap set Bench drilling machine Deep cut Hacksaw frame 2 x 1 Surface plate Scriber Tap wrench 30 30 30 30 30 30 30 30 30 30 30 30 5 5 1 30 5 5 5 5 5 5 5 5 2 30 10

WIRING SECTION
1. 6 Insulated handle cutting pliers 30

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

8 Insulated handle screw driver Pound hammer Wire Cutter 250V Line Tester 10 cm Poker 4 Connecting Screw driver 2 x 1 Wiring board Multi meter Required numbers of switches and sufficient consumables

30 30 30 30 30 30 30 5 ---

13.
S.No 1. 2.

DETAILS OF THE FINANCIAL STATUS OF THE TRUST

Description Endowment created with AICTE Current / Savings Account Name of the Bank Account Number with Amount : : : : : : : : : : : : Date of Maturity Instrument No. and date YES / NO Amount [ ` ]

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

Land Value Building Value Total Investment on Library Books till date Total Investment on Equipments till date Investment on Equipment till date Expenditure on Salary Annual Budget Recurring Annual Budget Non-recurring Audit Report [Income / Expenditure]

ENDOWMENT FUND CREATED BY THE TRUST WITH AICTE Name and Amount Deposited in the bank Place of Bank ( ` in Lakhs) (name)

DETAILS OF BANK BALANCE AMOUNT Type of Whether Account in the Account name of Trust / College Current Savings VALUE OF LAND AND BUILDING Survey Location Number

Name and Place of Bank

Account Number

Balance as On date

Amount ( ` in Lakhs)

Extent (sq.m)

Built-up area (sq.m)

Guideline Value (`)

Market Value (`)

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14.

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.
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. Name of Register / Record 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 Maintained / Available (YES / NO)

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14.
32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45.

DOCUMENTS, REGISTERS AND RECORDS

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 for the structural stability of the building Building and equipment insurance certificate.

LIST OF ENCLOSURES TO BE ENCLOSED ALONG WITH THE APPLICATION FORM

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Registration Fee [ ` 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 Land Use Certificate issued by Revenue Divisional Officer Land Classification Certificate issued by Revenue Divisional Officer Land Conversion Certificate issued by Revenue Divisional Officer, if it is Wet Land 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 (3) Assistant Commissioner (Land Reforms) or equivalent cadre under the jurisdiction where the Institution is located. 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

YES YES YES YES YES YES YES YES YES

NO NO NO NO NO NO NO NO NO

YES

NO

11. 12.

YES YES

NO NO

All the New AICTE approved Diploma level Institutions for the year 2012-2013 are requested to submit the application in the above prescribed format along with the enclosures for affiliation for the year 2012-2013. 2 Hard Copies with Hard / Soft bound 1 Soft copy in CD along with the application 2012 - 2013 23 | P a g e

 Soft copy of application, after duly filled in, should also be sent through E-mail adpdote@gmail.com with Filename as <College name> . doc.

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. 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 State Government. 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:

vii. viii. ix. x.

xi.

xii. xiii. xiv.

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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

Endorsement of the Principal I, Thiru. / Tmt. ___________________________ on behalf of son the / daughter of

Thiru.

_____________________

(college

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:

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