Application Form for Central funding under the Central Sector Scheme of Free Coaching for SC and OBC students. (To be filled in by an authorized representative of the applicant organization)PART - IEmail Fax No.(STD Code) Tel. No. 1. Name, address of the head office of the Organization / Institution 2. Address of the functional centre for which application is submitted 3. Nature of the Organisation / Institution (e.g. Not for Profit or Commercial or Co-operative Society or Trust etc.) 4. Date of establishment 5. Brief history and brief account of the activities of the organisation since its inception 6. Whether recognized by any State Govt. / Union Territory Admn. And if so, the Name of the State Govt / Union Territory Admn. Indicate the nature of Recognition given (enclose Certificate) 7. Whether registered under Societies Registration Act,1860 or any relevant Act of the State Govt./ Union Territory Admn. Or under any State Law relating to registration of Literary, Scientific and Charitable Societies or as Public Trust or as Charitable Comp, if so: a. Give name of the Act under which registered b. Registration No. and Date of registration (Please attach an attested photocopy thereof c. Period up to which valid Date a. Coaching courses funded by Ministry of Social Justice & Empowerment: (Please attach details of successful Candidates, Roll No, Name & Address along with copy of the published result) 8. Previous year achievement in pre-examination coaching of the organisationCoachedSucceededPercentageLast Year ( Specify) Year Before last 2 Years before last Yesr Group A Exam (UPSC / State / PSC / RRB ) Group B Exam (UPSC / State / PSC / RRB ) Officer Grade Exam ( Bank / Insurance / Companies / PSUs etc) Finishing Jobs courses b. Coaching courses conducted from the institute's own fund a. Brief description of its objects and activities 9. Details of the coaching Institution / Centerb. Constitution of Board of Management / Government Body etc. and the particulars of the memberS.no NameAddressOccupationc. Details of Faculty membersNameQualification Experince in No. of years Working with this Organisation since whenSubject taught d. Constitution / Memorandum of Association and bye-laws of the Organization / Institution (copy may enclosed) e. Details on achivement of the institution in coaching during the previous three years (Copy of annualreport may be enclosed) f. Income & expenditure statement and Bal ance Sheet for previous three year As certified by Chartered Accountant or Government Auditor may be enclosed g. Details of Bank account in SBI or its associate BankAccount No.Bank NameAddressBranch Codek. Certified that the institution has not received any other grant for the same purpose from any other Ministry / department of the Government of India, State/UT Government and any other Government/ Non-Government Organization. PART-II1. Space available with the institution for coaching(a) Number of class rooms(b) Hostel/Dormitories for students(c) Whether the institute is functioning in its own building or in a rented accommdation (d) Details of Library facility available with the Coaching Institution 2. Infrastructure available for coaching(a) Audio-visual aids(a) Photocopier(a) Cyclostyling machines(a) Computer 3. Examination for which the grant is applied for 4. Duration of the programme5. Total Number of candidtates proposed to be coached / trainedOutstationLocalTotal 6. Consolidated amount of fee per candidate for each examination ( Hostel charges etc. not to be included )Date of commencementDate of completionExamination Duration of coaching No. of candidates proposed to be coached Consolidated Fee per candidate ( In Rs.) Total Amount ( In Rs.) Group 'A'Group 'BOfficer Grade Exam to be conducted by Banks/Insurance companies/PSU etc. Finishing Job CoursesTotal It is certified and agreed that the terms and conditions of the scheme have been read, understood and are acceptable to the organisation.PlaceDateFull Name of Secretary/President Name of the Institution / Organisation Office Stamp, Telephone no.SignatureList of Attachments
