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    Institutional Membership Form

    Uploaded by

    srinivasa rao
    This document is an application form for institutional membership with ICT Academy, an initiative of the Government of India and state governments in partnership with industry. It requests contact details for the institution such as name, address, phone, and email. It also requests details about key personnel like the chairman, principal, and ICT coordinator. Finally, it provides the annual subscription fees for institutional membership and states the terms and conditions to be agreed upon.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Institutional Membership Form

    Uploaded by

    srinivasa rao
    49 views2 pages
    This document is an application form for institutional membership with ICT Academy, an initiative of the Government of India and state governments in partnership with industry. It requests contact details for the institution such as name, address, phone, and email. It also requests details about key personnel like the chairman, principal, and ICT coordinator. Finally, it provides the annual subscription fees for institutional membership and states the terms and conditions to be agreed upon.

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    ICT Form

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    This document is an application form for institutional membership with ICT Academy, an initiative of the Government of India and state governments in partnership with industry. It requests contact details for the institution such as name, address, phone, and email. It also requests details about key personnel like the chairman, principal, and ICT coordinator. Finally, it provides the annual subscription fees for institutional membership and states the terms and conditions to be agreed upon.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    49 views2 pages

    Institutional Membership Form

    Uploaded by

    srinivasa rao
    This document is an application form for institutional membership with ICT Academy, an initiative of the Government of India and state governments in partnership with industry. It requests contact details for the institution such as name, address, phone, and email. It also requests details about key personnel like the chairman, principal, and ICT coordinator. Finally, it provides the annual subscription fees for institutional membership and states the terms and conditions to be agreed upon.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    ICT ACADEMY

    An Initiative of Government of India, State Government and Industry

    APPLICATION FOR INSTITUTIONAL MEMBERSHIP


    CONTACT DETAILS

    Please write in block letters

    Name of the Institution :

    Address of the Institution :

    Pin code :

    Phone No : Fax No :

    Email : Website :

    CHAIRMAN / SECRETARY / CORRESPONDENT DETAILS

    Name :

    Designation :

    Mobile : Email :

    PRINCIPAL DETAILS

    Name :

    Mobile : Email :

    DETAILS OF THE COORDINATOR ASSIGNED FOR ICT ACADEMY

    Name :

    Department :

    Designation :

    Mobile : Phone :

    Email :

    SUBSCRIPTION DETAILS

    DD/Cheque No : Date :

    Bank & Branch :

    Amount :
    (In words)

    ICTA/AS/R/IMF/01
    INSTITUTIONAL MEMBERSHIP SHEET

    Date of Establishment :

    PROGRAM & FACULTY DETAILS

    Head of the Department No.of No.of Students UG No.of Students PG


    Departments Faculty
    Name Mobile Email Members I II III IV I II III

    Electrical & Electronics

    Electronics & Communications

    Computer Science

    Information Technology

    Electronics & Instrumentation

    Instrumentation & Control

    Civil

    Mechanical

    Computer Applications

    Commerce

    Electronics Science / Communication

    Any Other ICT Streams

    Placement Director Name:

    Mobile: Email :

    Placement Officer Name:

    Mobile:

    Institution Membership - Annual Subscription Fees

    Type of Institution Fee per Year

    Engineering Colleges / Deemed University ` 70,000 + (9% CGST + 9%SGST)

    Arts & Science Colleges ` 25,000 + (9% CGST + 9%SGST)

    Subscription Fee should be paid as DD/Cheque in favour of “ICT Academy”, payable at Chennai.

    We have read the brochure and membership details applicable to members of ICT Academy, and we agree to abide by them in its completely.

    Date : College Seal Authorized Signatory

    For office use only


    Membership Number Date of Subscription

    Receipt Number RM Name

    Receipt Date Renewal Date

    ICTA/AS/R/IMF/01

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