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									                              DIRECTORATE OF DISTANCE EDUCATION
                KUVEMPU                        UNIVERSITY
                      IT-PROGRAMMES - B.Sc.(IT) & M.Sc.(IT)

                   APPLICATION FOR A STUDY CENTRE

1. Name of the Organisation             :    ..............................……………………..………

2. Name of the Head of the Organisation              : .......................................................….…

3. Postal Address (with PIN Code)                    : .............................................……..…….
                                                     ..........................................................……
   Email Address                                     : ................................................…….…...

4. Communication            Telephone
   Numbers                  (with STD code)

                            Office                   : ...........................................................….

                            Residence                : ...........................................................….

                            Mobile                   : ..............................................….……….

                            Fax No.                  : .......................................................….....

                            Email                    : ................................................................

5. Status of the Organization                        : ...................................................…..…...

   a) Proprietary / Pvt. Ltd./                       : ...............................................…......…...
      Trust / Society / etc.
   b) Year of establishment                          : ................................................................
   c) Nature of activity                             : ..........................................................…..

6. a) Qualifications of the owner / Head             : ..........................................................…..
      of the Organization

   b) Working experience of Owner / Head : .........................................................…...
      (Particularly in the IT field)

   c) Enclose Bank statement of the orgn.            : .........................................................…...
      for last three months

7. Assessment of the SC w.r.t. location

   a) Location details:                              : ........................................................……

   b) Owned/ On Lease / Rent / etc.                  : ...........................................................….
                                            Page 1 of 3
     c) Commercial / Residential area                : ............……......................................…..
        (Attach Rent / Ownership / Deed)

     d) Visibility from Road &                       : ................................................………....
        availability of Parking space

     e) Popularity of the location &                 : ................................................…………
        availability of transport.

     f) Distance to nearest KU-IT SC                 : ...............................................………….

8.     Total carpet area and its layout               : ...............................................………....
       (Attach a plan)

9.     Infrastructure of Centre

       a) No. of Class Rooms with seating            : ..............................................…………
           capacity of each class room
       b) Number of computers & their configuration : ………………………………
       c) Availability of UPS              : ..................................................….…...
       d) Availability of generator for
          power backup                     : .....................................................
       e) Audio-visual equipments like TV, : ...................................................….…...
           VCR, OHP, etc.
       f) Printers                                   : ...................................................….…...
       g) Scanners                                   : ...................................................….…...
       h) CD writer                                  : .......................................................…....
       i) Networking                                 : .......................................................……

10. Faculty Details:
       a) Permanent faculty

                Name              Qualifications           Experience                      Expertise in
                                                                                           IT Subjects




                                           Page 2 of 3
           b) Visiting faculty

                       Name                    Qualification                   Experience                       Expertise in
                                                                                                                IT Subjects




   11. Library Details:

         a)    No. of books on IT                                :   .............................................................
         b)    No. of Journals subscribed                        :   .............................................................
         c)    Seating Capacity of library                       :   .............................................................
         d)    CD Library, if available                          :   .............................................................

   12. Any existing collaboration / proposed collaboration with any other university
       for IT or any other programme...........................................................................
        ............................................................................................................................

   13. Details of non-refundable DDs towards Study Centre registration fees:
           a) Crossed DD.No………….dated……….drawn from …………..payable to
              Finance Officer, Kuvempu University, payable at Shanakaraghatta,
              Shimoga, for Rs.25,000/-
           b) Crossed DD.No………….dated……….drawn from …………..payable to
              Universal Education Trust, payable at Bangalore, for Rs. 5000/-



Date:                                                       Signature             : ..........................………........…...

Place:                                                      Name                 : ..............................……….…..….

                                                            Designation : ......................……………............

                                                            Seal                  : …………………………………..




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