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					                                    Sikkim Manipal University
                                                of
                             Health, Medical & Technological Sciences
                                             Gangtok

         APPLICATION FORM FOR BECOMING A LEARNING CENTER FOR
                      IT & MANAGEMENT PROGRAMS


Kindly fill up this form and attach supporting documents.


   1.     Name of the Trust/ Society / Registered Institution:
          (Please attach Deed)


   2.      Registration Number and State where Registered:

   3.      Address with Pincode:-

           a) Postal Address:



           b) Email Address:

           c) Website, if any, then URL:

    4.      Telephone Nos with STD Code:

               a.   (O)        -
               b.   (R)        -
               c.   (Mobile)   -
               d.   (FAX)      -

   5.    Name of the Institution under the Society / Trust where Training will be imparted:


   6     Address with Pincode:-

           a. Postal Address:


           b. Email Address:

           c. Website, if any, then URL:

   7.      Telephone Nos with STD Code:

               a)      (O)         -
               b)      (R)         -
           c)      (Mobile) -
           d)      (FAX)    -


8.    Name of the Head of Institution:


9.     Working Experience of management:
      (Particularly in IT field)


10.   Assessment of the Center with respect to location:

       a. Location Prime / on Road etc.
       b. Commercial / Residential
       c. Owned/ On Lease / Rent etc.
         (Attach Lease/Rent Deed)
       d. Visibility from Road & Parking space.
       e. Familiarity of the location

12.   Total carpet area and its layout:


13.   Infrastructure of Center

       a. No. of Class Rooms :

       b. Seating capacity of each class room & furniture :

       c. Total no. of students who can be trained at a time :

       d. Air conditioning :

       e. Training Aids such as overhead projectors / boards :

       f. Computer / TV / VCR based classroom :

       g. UPS for computer System :

       h. Room for Counseling :

       i. Conference / Meeting room :

       j. No. of Computer Labs :

       k. No. of computers in each lab and total no. of computers :

       l. Configuration of Computers :
         m. Softwares used and their source:

         n. Any specialized multimedia lab with CD-ROM/Speakers/Headphones:

         o. Educational CD available:

         p. Networking in lab and its type (UTP/OFC/ETC):

         q. Internet Connection & Type:

         r. No. of Modems:

         s. Number of printers:

         t. Staff room and other facilities provided to staff:

         u. Generator for Power backup:

14.     Faculty/Lab Assistants/Support Staff *:
      (Give name, qualifications, experience and date of joining)

         a) Center Manager / Center Head / Technical Head:


         b) System Administrator:


         c) Web Administrator:


         d) Network Administrator:


         e) Senior Faculty Members:


         f) Junior Faculty Members:


         g) Lab Assistants:


         h) Clerical staff:


         i) Counselors:


         j) Any other Supporting Staff:
   15. Library :-

            a. No. of books in Library*:

            b. No. of Newspapers/Periodicals/Magazines:

            c. No. of Technical and Non Technical book:

            d. Seating arrangement in library (No. of students who can be accommodated at a

               time):

            e. No. of librarians:

            f. Annual budget for library (Average):



   16. Any collaboration / proposed collaboration with any other university for IT or any
other programs:

       a. Name of the University:
       b. University Address:

       c.    Programs being undertaken:

             I. Diploma :
            II. Undergraduate :
            III. Post Graduate :
            IV. Any other Program :
                                           CERTIFICATE


It is certified that on approval of our institution as the University Learning Center of SMU, we
will not conduct any competing IT program of any other University from the same premises.
Any existing arrangements will be cancelled. In case of any doubt in this regard the decision of
SMU will be final.

It is certified that we are willing to start to install VSAT.

We agree that the advertisements will be centrally controlled by ManipalU on behalf of SMU
and we agree not to do any advertisement on our own in print / electronic media without the
concern & permission of ManipalU / SMU.

We certify that we will abide by all decisions taken by SMU from time to time which are related
to the programs such as publicity norms, conduct of programs and procedures to be followed.

We undertake to verify and certify that students registered for University programs are eligible in
all respect as per the laid eligibility condition and will arrange to produce all original certificates
/ documents to prove their eligibility as and when required.

We certify that we possess or will procure approval of the relevant licensed software for
imparting instructions.



Place:                                                  Signature:

Date:                                                   Designation:
                                                        Stamp:




Note: Enclose demand draft for Rs.10,000/- in favor of “Manipal Universal Learning (P) Ltd.”,
Payable at Manipal / Udupi as Processing Fee.
NORMS FOR CREATING LEARNING CENTERS:

For effective and efficient functioning of a Learning Center, it is of prime importance that the
organization is owned and managed by professionals. The institute should preferably have
experience of conducting undergraduate and postgraduate programs of recognized/deemed
universities in IT field. The number of learning centers to be created in a city will depend on the
size of the city and the number of students likely to be enrolled. However, as a guideline, another
center may not be created within five kilometers radius in a small city and within three
kilometers in a big city. The following infrastructure may be a guiding principle for approval of
the University Learning Center.

Location of Center:
   Covered area of at least 1500 sq. feet., suitably modified for labs and classrooms.

Requirements:
   a) At least 12 computers of Pentium/Celeron configuration.
   b) Two printers.
   c) Facility of Library.
   d) Appropriate dust proofing and air-conditioning.
   e) Classroom with seating capacity of 30 each.
   f) Permanent faculty of which at least one will be a MCA or B.Tech (Computers) and others
      could be subject specialists.
   g) Support staff including lab assistants.
   h) Generators
   i) Public Conveniences

In addition the Learning Center should have Licensed Software or they will be provided software
at academic price by SMU for 10 Desktops (if available). They should also be willing to install
VSAT.

The above requirements will be for a student strength of 100. Additional infrastructure may be
required for additional students.