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Information About Institution (All fields are required !)

Application Type   Authorized Learning Center   District Coordinator
District Coordinator Code
Technical Experience in this Area which makes you eligible for District Coordinator Program
Institute Name
Institute Address
City
District State
Pin Country
Fax Email
Phone Mobile +91-
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.
Check this box if Institute Address and Head of the Institute Address are the same.
Address of Head Email
City
District State
Pin Country
Fax Phone
Mobile-1 +91-

Infrastructure Facility

PARTICULARS NO.OF ROOMS SEATING CAPACITY TOTAL AREA (Sq.Ft.)
Staff Room
Class Room
Computer Lab
Reception
Toilets
Any Other

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