Disbursement of PG (GATE/ GPAT) Scholarship

Application to be filled by University Departments Conducting Technical Programs

A: University Information
Table: A1: University Details
Particulars

Instructions

1.
2.
3.
4.

Name of the University

Address of the University
State/UT:
District:

State or UT in which the University is located

District in which the University is located

5.

Town/City/Village

Town/ City/Village where the University is located

6.
7.
8.
9.
10.
11.
12.

Pin:
Land Phone Number
FAX number:
STD Code:
Website address
Bank Name
Bank Account Number

Land line number of the University

Fax number of the University
STD code of the University
website address of the University
Bank name of the University
Bank Account number of the University

13.
14.

Bank IFSC Code

PAN

IFSC code of the University account

PAN number of the University

Information to be furnished

15.

University Type

16.
17.
18.
19.

Woman University
Minority University
Type of Minority
Name of the Minority

20.
21.
22.
23.
24.
25.

Minority Name If Linguistic

Accredited by NAAC
NAAC Accreditation Status
NAAC accredited from date
NAAC accredited till date
Whether the University has
12B status
Whether the University has
2 F status

26.

Select one of the following:

Central University,
State University-Government,
Deemed University-Government,
State University-Private
Deemed University-Private
Any other
Yes/No
Yes/No
Linguistic/Religious
if Religious, then select one of the following:
Muslim
Christian
Sikhs
Buddhist
Zoroastrians(Parsis)
Jain
Give the linguistic details
Yes/No
Five Star etc.

Yes/No
Yes/No

Table: A2: Trust/Society details (in case of Private University/Deemed University)

Particulars

Instructions

Information to be furnished

1.

Name of the Trust/Society

Give name of the Trust/Society

2.

Type of the Trust/Society

3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Registered with
Registration date
Registration Number
Trust/Society Address:
Town / City / Village:
State/UT:
District:
PIN:
Land Line STD Code:
Land Line Number:
FAX Number:

Select either of the following:

Trust
Society
Government
PPP
University
Sec 25 Company
Give details of registration authority

14.

Trust/Society Website:

Details of Board of Governors/Board Members of University

Sr No
1
2
3
4

Title

Last Name

First Name

Designation

Mobile no

e-mail

Highest Qualification

Table: A3: Vice Chancellor details

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Title (Mr./ Ms.)

First Name
Last Name
STD Code
Land Phone Number
Fax Number
Cell Number
Alternate Cell Number
Email ID
Alternate Email ID

Table: A4: Registrar details

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Title (Mr./ Ms.)

First Name
Last Name
STD Code
Land Phone Number
Fax Number
Cell Number
Alternate Cell Number
Email ID
Alternate Email ID

Table: A5: University Web Administrator Details

1.
2.
3.
4.
5.
6.

First Name
Last Name
Administrator Email ID
Mobile Number
Land Line Number
STD Code

Table: A6: Land Details

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Particulars
Total Area in acres
Land registered with
Date of Registration
Land in Northern Hilly Area:
Latitude (North/South):
Latitude Degree:
Latitude Minute:
Latitude second:
Longitude (East/West):
Longitude Degree:
Longitude Minute:
Longitude second:
Land Details

Instructions

Information to be furnished

Yes/No

Owned
Government leased
Private leased

Table: A7: Common Facilities

1.
2.

Particulars
Boys Hostel
Girls Hostel

Instructions
Yes/No
Yes/No

Information to be furnished

3.
4.

Boys Common Room

Girls Common Room

Yes/No
Yes/No

5.

Canteen Facility

Yes/No

6.

Centralized Computer Center

Yes/No

7.

Number of Computers in Centralized Computer Center

8.

Number of Printers in Centralized Computer Center

9.

Language laboratory

Number

10.

Centralized Library

Yes/No

11.

Working Hours from

12.

Working Hours up to

13.

Total Library area in sq m

14.

Library Networking

Yes/No

15.

Reprographic Facility

Yes/No

16.

Number of Multimedia PCs in Library

17.

Reading Room Seating Capacity

18.

Bar Code or RF Tab book handling?

Yes/No

19.

Library Management Software?

Yes/No

20.

List of E-Journal Subscription available

List to be
attached

Table: A8: Other Facility

1.
2.
3.
4.
5.

Particulars
Potable Water Supply:
Backup Electric Supply:
Barrier free Environment:
CCTV Security:
Notice Boards:

Instructions
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No

Information to be furnished

6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.

General Insurance:
Post office
Bank in the Campus
ATM facility
Staff Quarters:
ERP Software:
Insurance for Students:
Group Insurance:
First Aid:
Public Announcement System:
Medical & Counseling:
Sewage Disposal System:
Projectors in Classrooms:
Safety Provisions:
Vehicle Parking:
Telephone & FAX for students
Transport Facility:
All Weather Approach(Motorized Road):

Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No

Table: A10: Questionnaire

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

Particulars

Instructions

Are all approved teaching faculty being paid as per VI pay commission?
Are all the teaching faculty teaching technical courses, as per AICTE qualification?
Percentage Budget Grant Received from Government?
Whether University is operating from Permanent Site/ Temporary Site?
Whether mandatory disclosure is uploaded in University website?:
Whether the University following ICAI Institute of Chartered Accountants of India) Accounting
Formats?
Fees to be charged, Reservation policy, Admission policy and Document retention policy are duly
approved by State Government/University?

Yes/No
Yes/No
Give Percentage
Yes/No
Yes/No
Yes/No

Information to be
furnished

Yes/No
7

8.
9.
10.
11.
12.
13.

Fees to be charged, Reservation policy, Admission policy and Document retention policy are
uploaded in University Website?
List of faculty and data uploaded on the University Web site
Courses and Approved Intake uploaded on the University Web site
Is the Cafeteria shared among other departments?
Is Library and Reading Room shared among other departments?
Is the Computer Centre shared among other departments?

Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No

B. UNUIVERSITY DEPARTMENT INFORMATION

Table: B1: Department Details

1.
2.
3.
4.
5.

Particulars
Name of the Department
Address of the Department
State/UT
District
Town/City/Village

6.
7.
8.
9.
10.
11.

Pin
Land Line Number
FAX number
STD Code
Website address
e-mail address of the Department

Instructions
Name of the Department

Information to be furnished

Name of State/UT
District in which the Department is located
Town/City/Village where the Department is located
Land line number of the Department
Fax number of the Department
STD code of the Department
website address of the Department

Table: B2: Contact Person- Head of the Department

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Title (Mr./ Ms.)

First Name
Last Name
Designation
STD Code
Land Phone Number
Fax Number
Cell Number
Alternate Cell Number
Email ID
Alternate Email ID

Table: B3: Area and other Requirement (Refer AICTE Approval Process Handbook) / Annexure-I
Number
Required
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

13.

14.
15.
16.
17.
18.

Number
Available

Total Area
Required

Total Area
Available

Shortfall

INSTRUCTIONAL
Class Room
Tutorial Room
Drawing Hall
Seminar Hall
Laboratory
Work Shop
Research Laboratory
Additional Workshop
Animal House
Studio-Material
Museum. Studio-Display Room
ADMINISTRATIVE
Principal/Director /Office/Reception Area/Other office/Board Room/Office All
Inclusive/Department Office/Cabin for Head of the Department/ Faculty
Room/Store/maintenance/Security/House keeping/ Pantry for Staff/Exam
Control Office/ placement office/ Others (All inclusive as applicable)
AMENITIES_AREA
Cafeteria/ Student Activity/ Common Room/Stationary Store/ Toilet/ Others
(All inclusive as applicable)
Computational Facility in the Department
Number of PC exclusively available to students
Internet Bandwidth in Mbps:
Number of Printers available to student:
Number of PCs available to Faculty Members:
Number of Legal System software:

10

Table: B4: Course Details (Add more columns as per requirements)

1.

Course Name-1

2.

Programme:

3.

Name of the Course:

4.
5.

Department:
Full Time/Part Time:

6.
7.

Shift:
Level of the Course:

8.

Course Duration:

9.

Year Started:

10.

Approved Intake 08-09

1st shift/2nd shift

UG/PG/Diploma/Post Diploma/Post Graduate
Certificate/Fellowship
enter course duration in years
(1/2/2.5/3/3.5/4/4.5/5/5.5/6/6.5
Enter the year in which the course was started in the
institute
Enter approved intake without supernumerary seats

11.

Approved Intake 09-10

Enter approved intake without supernumerary seats

12.

Approved Intake 10-11

Enter approved intake without supernumerary seats

13.

Approved Intake 11-12

Enter approved intake without supernumerary seats

14.

Approved Intake 12-13

Enter approved intake without supernumerary seats

15.

Approved Intake 13-14:

Enter approved intake without supernumerary seats

16.
17.

NRI:
PIO:

Yes/No
Yes/No

Course Name-2

Course Name-3

Write Name of the Program: Engineering and

Technology/Pharmacy/MCA/Management/Hotel
management and Catering/Architecture and Town
Planning/Applied Arts and Crafts
Enter name of the course approved by the affiliating
University and running in your Institute
Enter Name of the department

11

18.

Foreign Collaboration

Yes/NO

19.

Affiliating Foreign Body

Enter Name of the Foreign University/Board (as

applicable)

20.

Number of Foreign students

admitted/to be admitted
21. Annual Fees Approved for
13-14
22. Course Type:
Aided/Self-Finance
23. Mode Of Conduct:
Regular/Distance
24. Entrance Exam
GATE/GPAT
Table: B5: Ombudsman Details
1.
2.
3.
Sr No

Whether Ombudsman Appointed

Date of Appointment
Appointment valid up to

Yes/No
Enter date
Enter Date

Name of the Ombudsman Committee Members

Designation

Profession

Associated with

Mobile Number

e-mail address

Fax No

e-mail address

Fax No

1
2
Table: B6: Grievance Committee Details
1.
2.
3.

Sr No

Whether Grievance Committee Appointed

Date of Appointment
Appointment valid up to

Yes/No

Name of the Grievance Committee Members

Designation

Profession

Associated with

Mobile Number

1
2
12

Table: B7: Anti Ragging Committee Details

1 Constitution of Anti-Ragging Committee:

Yes/No

2
3
4
5
6

Yes/No
Yes/No
Yes/No
Yes/No/No-Hostel

Constitution of Anti-Ragging Squad:

Affidavit obtained from all Students:
Appointment of Counselors:
Affidavit obtained from parents of all the students:
Affidavit obtained from students staying in Hostel:

7 Affidavit obtained from parents of students staying in Hostel:

Sr No

Name of the Anti Ragging Committee Members

Yes/No/No-Hostel

Designation

Profession

Associated with

Mobile Number

e-mail address

Fax No

1
2

13

Enrolment Id (EID)

Aadhar Card (UID)

Total fees other than tuition fees

Tuition Fees

Econ Backward (Yes/No)

Is Physically Handicapped (Yes/No)

Reserve Category (Yes/No)

Category

Religion

Admitted Under TFW (yes/NO)

Alternate Email Address

Email Address

Roll Number

Admitted to (enter Course name)

Date of Admission(mm/dd/yyyy)

Date of Birth(mm/dd/yyyy)

Gender

Mobile Number

STD code

Residence Phone

Father's Name

Mother's Name

Year2 (% marks) or CGPA

Year1 (% marks) or CGPA

Last Name

Middle Name

First Name

Title

Sr No

Table: B8: Student Details

14

Enclosures:

Affidavit in the format provided

Undertaking from the student in the format provided

15

No. of Publication in International Conference

No. of Publication in National Conference

Total Experience in Year

Alternate Email Address

Enrollment Id

Aadhar Card(UID)

Other Allowances in Rs.

HRA in Rs.

DA %

Basic Pay in Rs.

Have you ever applied to AICTE for any grants/assistance

Would you like to work as Expert Member on various

Is Physically Handicapped

No of books Published

International Publications

No. of Doctorate Students Guided

No. of PG Projects Guided:

Patents

IFSC Code

Bank Branch Name

BankName

BankAccountNumber

Research Experience in Years

Total Work Experience in Years

Teaching Experience in Years

Area of Specialization

Other Qualification's

UG Degree

PG Degree

Doctorate Degree

Date of Joining

PF Number

Salary Mode

Course

Programme

PayScale

Faculty Type

Appointment Type

Gross Pay per Month

Appointment FT/PT

Exact Designation

Fax Phone #

Email Address

Mobile Phone #

Land Line #

STD Code

PAN

Date of Birth

Caste

Religion

State

City/Village

Postal Code

Address Line2

Address Line1

Mother's Name

Father's Name

Gender

Middle Name

First Name

Surname

Title

Sr No

Table: B9: Faculty details