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Home > ANREM > ANREM Application form

ANREM
ANREM Application form | INSTRUCTIONS |

Adv .No: ANREM/01/15

:ANREM:

(Chare Chare Sikkha Ghare Ghare Sikkha) 

APPLICATION FORM

Address: H/No-10, Ashok Path, Beltola, Guwahati, Kamrup (M), Pin- 781028, Assam

Website: www.ajmalfoundation.org

e-mail: anremassam@gmail.com

Last date of submission: 25/08/2015

Instructions for filling up the application form have been uploaded in the website. Before filling up the application form please read the instruction carefully.

SL.No

Particulars

Details

01

Name of applicant educational institution/school:

 

 

02

Details of applicant institution/school:

Postal address & year of establishment

 

 

03

Name of promoting/sponsoring organisation (trust/society/NGO) & postal address:

 

 

04

Name of head of promoting/sponsoring organisation, along with his/her postal address and contact details:

 

 

05

Whether School Managing Committee constituted, if yes, furnish details of the members with contact details:

 

06

Name of Headmaster/ Principal with postal address, phone no. and qualification:

 

 

07

Whether any Govt. permission received, if yes, furnish documentary proof:

 

08

Type of school (Boys/Girls/Co-ed):

 

 

09

Number of students enrolled (academic session 2015-16) as follows, with class-wise break-up: (Furnish Details)

(a)boys            :

(b)girls:

(c)total:

 

 

10

Applicable for schools where students have appeared in HSLC exam:

a.   Results of last HSLC exam (2015) – no of students passed and their division:

b.   Total appeared-    (Furnish Details)       

1st Div-                             

2nd Div-                               

   3rd Div-

 

11

Detail Fee structure of institution/school:

( monthly/yearly/others) (Furnish Details)

 

 

12

Extracurricular activities:

a.      Sports facilities

b.     Cultural activities (annual day, school week, debates, extempore speech, quiz etc)

 

 

13

Library facility, if yes, no of books available:

 

 

14

Is there prescribed uniform for students?

(Yes/No)

 

15

Details of toilet facilities with number of lavatories {Staff /Student(Boy’s & Girl’s)}

 

 

16

Whether potable drinking water is available? If yes, what is the source & facilities available?

 

 

17

Status of land and area under possession (ownership/lease/gift/others):

 

 

18

Type of building (kutcha/concrete/any other):

 

 

19

Please attach or e-mail a photograph of the front view of the school building:

 

 

20

 

List of teachers along with qualification, computer literacy, subjects taught in class shown against each teacher: (Furnish Details)

 

 

 

21

Whether any inspection conducted by Inspector of School or any other Govt agency? If yes, date of last such inspection.

 

 

22

Medium of instruction (Assamese/Bengali/Bodo/English/any other):

 

 

 

 

 

23

Curriculum (CBSE/SEBA/any other):

 

 

24

Details of Bank account of institution/school:

Or concern person:

Name of the account holder:

Name of bank & Branch:

A/C. No:

IFSC No. of the Branch :

 

 

 

 

 

 

25

Names of other schools/ colleges/ educational institutions within 5 km radius showing distance in bracket:

 

26

Names of religious/cultural centers within 5 km radius showing distance in bracket:

 

 

 

27

Electricity connection:                                                                              Yes/No

 

 

28

Communication facility (nearest station name with distance in KM):

a.      Railway:

b.     Bus:

c.      Steamer:

 

 

29

Mention five major problems faced by you in running the institution /school:

(a)

(b)

(c)

(d)

(e)

 

30

What are your expectations from ANREM in respect of the above mentioned problems; please specify with facts and figures if possible.

 

 

I, solemnly declare that the above statements are correct and true to my knowledge. If they are found not authentic or false, the authorities concerned may reject our application. Mere submission of application shall not make any right to claim benefit under the project.

 

 

Signature:

Name in capital letters:

Seal:

Date:

 

Place:

 

 

Download Application Form

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