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VISVESVARAYA TECHNOLOGICAL UNIVERSITY, BELAGAVI

Application For Affiliation

Region

Appilcation For

INSTITUTION DETAILS

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Name of the Institution

Address of the Institution

Village/Town/City

District

PIN

STD Code

Land Line Number 1

Land Line Number 2

Fax

E-mail Id

Web site

Year of Establishment

Date of the First approval by AICTE

Year of first affiliation to the University

Type of Institution

Minority Institute ?

Type of Minority

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Name of the Minority

SC/ ST Institute?

Women Institute ?

Any Other

Bank Account Number

Name of the Bank and Branch

IFSC Code

Address of the Bank

PAN Number

2(f) Status

12 (B) Status

DETAILS OF PARENT ORGANIZATION

Type of organization

Name of the Trust/Society

Address of the Trust / Society

Village/Town/City

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District

PIN

STD Code

Land Line Number

Fax

E-mail Id

Web site

Year of Establishment

Registration Number

Date of Registration

Name of the President/Chairman

Address of the President/Chairman

Village/Town/City

District

PIN

STD Code

Land Line Number

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Fax

E-mail Id

DETAILS OF GOVERNING COUNCIL

Dates

GOVERNING COUNCIL MEMBERS (Annexure-1)

List of Other Institutions managed by the Trust/Society (Annexure-2)

DETAILS OF THE PRINCIPAL

Name

Father's Name

Date of birth

Address

Principal Ex-Officio member secretary of the Governing

Council

No. of times the Governing Council meeting is convened in

the last academic year

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Village/Town/City

District

PIN

STD Code

Landline Number

Fax

Mobile Number

E-mail Id

Doctorate degree Specialization

Master's degree Branch Specialization

Bachelor's degree Branch Specialization

Other qualifications

Date of joining the Institute as Principal

Appointment type

Experience Total

Teaching

Research

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Industary

No. of Published Papers in National Level Journals

No. of Published Papers in International Level Journals

No. of Articles/Chapters published in Books

No. of Full Papers in Conference Proceedings

Ongoing Projects/Consultancies Brief details

Completed Projects/Consultancies Brief details

No. of Research Guidance

No. of Research candidates Guiding

No. of Books published as single author/co-author or as

editor

ranng ourse, eac ng-earnng vauaton ecnoogy

Programmes, Faculty Development Programmes

Attended(not less than one week duration)

No. of Papers presented inConferences/Seminars/Workshops/Symposia

Invited Lectures delivered and Chairmanships at

International/National/Regional/Local conference/seminar,

etc.

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BUILDING DETAILS

Building Status

No. of Buildings in the campus

Total built up area Planned (in Sqm)

Total built up Area ready (in Sqm)

Total Instructional area (Carpet Area) ready (in Sqm)

Total Administrative area (Carpet Area) ready (in Sqm)

Total Amenities area (Carpet Area) ready (in Sqm)

Total Circulation area ready (in Sqm)

LAND DETAILS (Annexure-3)

INSTRUCTIONAL AREA (Annexure-4)

ADMINISTRATIVE AREA (Annexure-5)

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LIBRARY FACILITIES

Titles Volumes E-Journals

Area (in Sqm) Library Networking

Type of Access

COMPUTATIONAL FACILITIES

AMENITIES AREA (Annexure-6)

CIRCULATION AREA (Annexure-7)

International

Journals

National

Journals

Member of E-

consortium

Budget for

current Year (in

Lakhs)

Reading Room

Capacity (in

Numbers)

Reprographic

Facility

No. of Multimedia

PCs

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Wi-Fi Facility

FINANCIAL DETAILS FOR THE CURRENT YEAR

Income

Funds from Central Government

Funds from State Government

Funds from approving body

Funds from UGC

Number of PCs

for Students

Number of PCs

for Faculty

Number of PCs in

Administrative

Office

Number of PCs in

language Lab

Total No.of PCs

available in the

College

Number of

Printers

Internet

Bandwidth (

in Mbps)

Name of the

service provider

Number of

PCsConnected to

LAN

Internet

Contention

Ratio

PROGRAM COURSE DETAILS (Annexure-8)

FEE STRUCTURE (Annexure-9)

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Funds from other Bodies

Funds from Donations

Funds from Student Fees

Funds from other / Internal Revenue

TOTAL 0

Expenditure

Teaching Staff Salary

Non-teaching Staff Salary

Remuneration to Visiting/Guest Faculty

Library

Equipment

Building Maintenance

Consumables

Other

TOTAL 0

Expenditure incurred in the Last 5 years towards Library, Equipment and Furniture

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Y-4 Y-3 Y-2 Y-1

Library

Titles

Volumes

National Journals

Equipment

Furniture

TOTAL 0 0 0 0

International

Journals

FACULTY DETAILS (Annexure-10)

STAFF DETAILS (Annexure-11)

DETAILS OF ADMINISTRATIVE, LIBRARY STAFF, PHYSICAL EDUCATION & PLACE

STUDENTS DETAILS (Annexure-13,14,15)

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HOSTEL FACILITIES

Boys Girls

Tariff Tariff

Tariff Tariff

Tariff Tariff

Tariff Tariff

Tariff Tariff

Tariff Tariff

Backup Supply

LAB DETAILS (Annexure-16)

Number of rooms

having 1 Student

/room

Number of rooms

having 2 Students

/room

Number of rooms

having 3 Students

/room

Num er o rooms

having 4 Students

/room

Number of rooms

having more than 4

Students / room

If any other Please

Specify

Total No.of Students

in the Hostel

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Library

Internet Facility

DETAILS OF THE MEASURES TAKEN TO PREVENT RAGGING & SEXUAL

Constitution of Anti-Ragging Committee

Constitution of Anti-Ragging Squad

Constitution of Anti-Sexual Harassment Committee

Constitution of Anti-Sexual Harassment Squad

Affidavit obtained from all Students

Appointment of Counselors:

Affidavit obtained from parents of all the students

Affidavit obtained from students staying in Hostel

Affidavit obtained from parents of students staying in Hostel

ANTI-RAGGING COMMITTEE (Annexure-17)

ANTI-RAGGING SQUAD (Annexure-18)

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Financial Position

Fixed Deposit in the name of the Trust/Society/ College

Current / S.B. Accounts

Loans, if any (Provide details)

GENERAL INFORMATION

Working Hours of the institute

UG

From To

Part time

No. of working days per week

ANTI-SEXUAL HARRASHMENT COMMITTEE (Annexure-19)

ANTI-SEXUAL HARRASHMENT SQUAD (Annexure-20)

1stshift

2ndShift

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Curricular Aspects

Vision and Mission Statement and Institutional goals

Teaching- Learning and Evaluation

How is learning made student-centric?

Research, Consultancy and Extension

Student support and progression

Details of dropout Annuxure-2

Governance and Leadership

How frequently is the syllabus for various courses offered by

your University revised and upgraded?

What are the steps taken to introduce learner-centric

programs?

How do you assess students 'knowledge, needs, and skills

before the commencement of teaching programme?

What are the mechanisms adopted for self- appraisal of

Faculty?

Is there a Research Committee to facilitate and monitor researchactivities?

students in research activities through its academic

Mechanism developed to get feedback from students. Provide

feedback analysis and action taken

Do you have Alumni Association in your college? If yes,

frequency of interactions and nature of feedback support.

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Innovative and Best Practices

OTHER FACILITIES

Potable Water Supply

Institution Website

Bio- Matrix

Bank / ATM

Staff Quarters

Backup Electric Supply /Capacity

General Insurance for Institution

Group Insurance for employes

Please provide organizational chart and specify the roles and

years to translate quality to its various administrative and

Quality Assurance within the existing Academic and

Best Practices? How does your college ensure that the Best

promote the overall development of students form

disadvantaged sections? Please provide their incrementalfeedback on the performance of the college to arrive at

student satisfaction index? Please provide the supporting

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Insurance for students

Public Addressing System

Projectors in Class Rooms

Telephone & Fax

All Weather Approach (Motorised Road)

Medical & Counseling Facility

Fire extinguisher

Transport Facility

CCTV Security

HRMS Software

First Aid Facility

Sewage Disposal System

Vehicle Parking

Playground

Canteen facility

Student Welfare officer

Language Laboratory(Minimum 25 PCs up to total intae of !"""#$urther additional 25 PCs per intae of !"""%&

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Medical facilities for boys and girls

NSS activity

NCC activity

No. of Xerox Machine available

EMIS

Red Cross Society

SC/ST Book Bank

ANY OTHER INFORMATION THE INSTITUTION WISHES TO FU

DETAILS OF FEE PAID

Bank Name

Bank Branch

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Mode of Transaction

Transaction Id

Amount

Date

DECLARATION

1

2 The Institute will abide by the rules and regulations of the University as applicable from time to

3 Any changes in faculty position will be intimated to University from time to time

4 The Institute will abide by the conditions laid down by the University as applicable from time t

5 The facts furnished above are true to the best of our knowledge

Trust/Society will not offer any courses affiliated to any other Universities in the same campus

onwards.

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University

University

University

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Working HoursInvestment till the Date

(in Lakhs)

Library

Management

Software

Bar Code or RF Tab book

handling

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No.of Legal

System

Softwares

No.of Legal Application

Softwares

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(in Lakhs)Y- Current year

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Y

0

MENT STAFF (Annexure-12)

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ARRASHMENT

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PG

From To

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NISH

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time.

time.

rom the academic year 2016-17 and

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Y-1

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Father's Name Designation

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GOVERNING COUNCIL

Qualification Profession Add

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EMBERS (Annexure-1)

ess Village/City Tq

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District State PIN

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Contact Number E-Mail Id

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Sl.No. Name

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List of Other

Address of Institution

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nstitutions managed by the Trust/Society (Annexure-2)

Year of Establishment Type of Programme offered

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Area Survey No

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Land ownership details Total area (in acres)

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Land Registered in the Name of

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Land registered with Land registration date

LAND DETAI

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Registration Number Survey Number

S (Annexure-3)

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Land Use Certificate issued by

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Purpose of MortgageBudget for land acquisition (if

rented)

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Level Course

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INSTRUCTIONAL

Room

Type

Room

Number

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Wall painting Electrification & Lighting

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Building Number Building Name

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Furnitures & Fixtures

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Carpet Area (Sqm) Flooring

AMENITIES AREA (Annexure-6)

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Air Conditioning Furnitures & Fixtures

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Building Number Building Name

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Area Type Area (in Sqm)

CIR

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Furnitures & Fixtures

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Level Course

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Number of Students Admitted Proposed Intake

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Applied for Accreditation status

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Validity of Accreditation

From To

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Level Course

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Admission Quota Approved Tuition Fee

FEE STRUCTURE (Annexure-9)

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Other fees Total Fees

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

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0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

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0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

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0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

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0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

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0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

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0

0

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e Father'

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Name Date of birth

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Address

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Caste Category

AILS (Annexure-10) Copy the Sheet for each Depa

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Date of Appointment Designation

tment

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DepartmentDate of Joining the

Institution

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Branch (type here)

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Doctorate degree

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Master's degree

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Bachelor's degree




















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Experience

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Research

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