Application Form for Central funding under Central Sector Scheme of Free Coaching for SC/OBC student
(To be filled in by an authorized representative of the applicant organization)
PART - I
1. Name, address, telephone No. Fax No./e-mail ID _________________________________
of the head office of the organization/ _________________________________
institution.
2. Address and Telephone No. of the ________________________________
functional centre for which application ________________________________
is submitted.
3. Nature of the Organization/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 organization since ______________________________
its inception ______________________________
6. Whether recognized by any State ______________________________
Government/Union Territory Admn. And
if so, the name of the State Government/
Union Territory Adm. 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 a charitable company,
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 _______________________________
8. Previous years’ achievements in pre-examination coaching of the organization.
(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)
Year
Group A Exam (UPSC/State PSC/RRB)
Group B Exam (UPSC/State PSC/RRB)
Officer Grade Exam (Banks/Insurance companies/PSUs etc)
Finishing Jobs courses
Coached
Succeeded
%age
Coached
Succeeded
%age
Coached
Succeeded
%age
Coached
Succeeded
%age
Last year
(specify)
Year before last(specify)
2 years before last(specify)
b) Coaching courses conducted from the institute’s own fund.
(Please attach details of successful candidates, Roll No., Name & Address along with copy of the published result)
Year Group A Exam (UPSC/State
PSC/RRB)
Group B Exam (UPSC/State
PSC/RRB)
Officer Grade Exam (Banks/Insurance
companies/PSUs etc.)
Finishing Jobs courses
Coached Succeeded %age Coached Succeeded %age Coached Succeeded %age Coached Succeeded %age
Last year
(specify)
Year before
last(specify)
2 years
before
last(specify)
9. Details of the coaching institution/center
(a) Brief description of its objects and ______________________________________
activities ______________________________________
(b) Constitution of Board of Management/Government Body etc. and the particulars of the member:
Sl.No. Name Address Occupation
(c) Details of faculty members:
Name Qualification Experience in
No.of years
Working with this
Organization since
when
Subject taught
(d) Constitution/Memorandum of Association
and bye-laws of the Organization/Institution
(copy may be enclosed)
___________________________________________
(e) Details on achievement of the institution in ___________________________________________
coaching during the previous three years
(copy of annual report may be enclosed) ___________________________________________
(f) Income & expenditure statement and ___________________________________________
Balance 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 bank:
Account No:
____________________________________
Bank Name:
____________________________________
Address:
____________________________________
Branch code:
____________________________________
(k) 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 – II
1. 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 accommodation
(ii) Details of Library facility available with the Coaching Institution ________________
2. Infrastructure available for coaching
(a) Audio-visual aids
(b) Photocopier
(c) Cyclostyling machines
(d) Computer
3. Examination for which the grant is applied for: _______________________________________
4. Duration of the programme ____________________________
(Indicate the date of commencement
and date of completion)
5. Total Number of candidates proposed to be coached/trained
Outstation: ____________________
Local: _________________
Total: ________________
6. Consolidated amount of fee per candidate for each examination
(Hostel charges etc. not to be included)
Examination
Duration of coaching
No. of candidate proposed to be coached
Consolidated Fee per candidate (In Rs.)
Total Amount(In Rs.)
Group ‘A’
Group ‘B’
Officer Grade Exam to be conducted by Banks/Insurance companies/PSUs etc.
Finishing Job courses
Total
It is certified and agreed that the terms and conditions of the scheme have been read, understood and are acceptable to the organization.
Place
Date
Signature
Full Name of Secretary/President
Name of the Institution/Organization
(Office Stamp, Tel.No.)
Details of documents attached
(a)
(b)
(c)