NOTE:- IF THE FORM HAS BEEN DOWNLOADED FROM THE WEBSITE OR PHOTOCOPIED AFTER BEING DOWNLOADED FROM THE WEBSITE,KINDLY ADD RS.10/-AS THE COST OF FORM IN THE PRESCRIBED FEE FAILING WHICH THE FORM IS LIABLE TO BE REJECTED (Strike out whichever is not applicable) ..........................................SCHOOL.................................................... SCHOOL CODE NO..............................................DISTT.................................................... PIN CODE............................................. Phone No. if any....................... From: The Principal/Headmaster/Headmistress, ...........................................School/College, ................................................. To The Secretary H.P. Board of School Education, Dharamsala,Distt.Kangra-176213 Subject: Sir, AFFILIATION OF INSTITUTION FOR THE PRIMARY/MIDDLE/MATRIC/ SENIOR SECONDARY EXAM. FOR THE YEAR--------------------------------It is requested that affiliation of our institution for the Primary/Middle/Matric/Senior Secondary Examination for the year ------------may kindly be granted. The particulars ,as required in the Regulations are given in the enclosed Proforma. Yours faithfully, Signature ............................................................ Name in full ......................................................... Dated......................................... Seal of Office......................... HIMACHAL PRADESH BOARD OF SCHOOL EDUCATION PROFORMA FOR PROVISIONAL/PERMANENT AFFILIATION FOR INSTITUTION. 1 Name of the Institution ...................................................................................... ......................................................................................... ............................................................................................. 2. Postal address of the Institution: ............................................................................................... .................................................................................................... Pin code....................................................................................... 3. Date of establishment of the Institution:........................................................................................... 4. (a) Classes being taught at present................................................................................................... (b) Classes proposed to be started during the year of affiliation:...................................................................................................... 5. Has your Institution been included in the Survey or Not?........................................................................................................... MANAGEMENT: 6. (a) How the Institution is being managed?.......................................................................................... (b) Name of the Society/Trust:............................................................................................................ (c) Is the Society/Trust Registered/If yes, give registration No. and also enclose the attested copy of the registration certificate: (d)Name of the Head of the School/College/Institution:..................................................................... LAND/BUILDING: 7. (a) Is the building of your Institution owned by the management on a hired accommodation?.................................................................................................................. (b) If hired, supply the following particulars and also attach copy of building Plan: (i) Name of the owner:........................................................................................................................... (ii) Period for which hired:................................................................................................................... (iii) Exact location of the Building........................................................................................................ 8. (a) Is the land on which the building of the Institution has been constructed owned by the Management:? Yes/No. (b) If yes, give details: (i) Name of Mohal / Tikkas............................................................................................................................ (ii) Name of the owner................................................................................................................................. (iii) Name of occupier............................................................................................................................... (iv) Khasra Number................................................................................................................ (v) Area .............................................................................................................................. ACCOMMODATION: 9. (a) Total No. of rooms available in the Institution:.......................................................................... (b) Furnish information regarding each room on a separate sheet on the following proforma: Use of Dimension Specification Whether Capacity of each Room Room of Rooms Kachha or Pucca. to accommodate Pupils. (c) (i) Are sanitary arrangements for Boys and Girls Yes/No. Separately available? (ii) If Yes, give details:........................................................................................................................................ ......................................................................................................................................... PUPILS ON ROLL: 10. Furnish information regarding pupils on roll(at the time of making application ) on a SEPERATE SHEET on the proforma given below:-Class Section Number of Pupils Male Female ............................................................................................................................................................................... ............................................................................................................................................................................... ............................................................................................................................................................................... PLAY GROUND 11. (a) Is there any facility of playground in the institution. Yes/No (b) Is it owned or a hired one? Give details: ............................................................................................................................................................................... ............................................................................................................................................................................... .............................................................................................................................................................................. (c) Distance of Play Ground from the College/School................................................................................................ (d) Dimension of playground (length x Breadth in meters) (e) Total Area of Play Ground in Sqr. Meters.............................................................................................................. (f)Area of Play Ground in hectres for every 250 pupils:.............................................................................................. OTHER RECREATIONAL FACILITIES: 12. Give details of other recreational facilities available in your Institution. ............................................................................................................................................................................... ............................................................................................................................................................................... OTHER PHYSICAL FACILITIES: 13. (a) Details of furniture available in the Institution: ............................................................................................................................................................................... ............................................................................................................................................................................... .............. (b) Are there adequate Desks, Chairs, Tables, Black Board, etc. available for all classes? Yes/No 14. What teaching aids/equipments are available in your Institution:.................................................................... ............................................................................................................................................................................ .,............................................................................................................................................................................. .. 15. Is the facility of Library available? Yes/No (a) No. of books available.----------------------------------------------------------------------------------------- (b) Total value of Books.......................................................................................................................... (c) Attach a statement showing subject wise books available. 16. (a) Are Science Lab. available : Yes/No (b) If yes, give detail of important equipment available in various laboratories on a separate sheet. 17. Give details of the teaching staff available on SEPERATE SHEET IN THE FOLLOWING PROFORMA: Sr.No. Name of Academic Designation Date of Date of Employee Qualification Birth Appointment ............................................................................................................................................................................... ........ 1. 2. 3. 4. 5. 6. ............................................................................................................................................................................... ......... 18. In case of Ten Plus One/Ten Plus Two ............................................................................................................... Institutions,give details of subjects ................................................................................................................... for which affiliation is sought ................................................................................................................. .................................................................................................................. FINANCIAL POSITION 19. (a)What are the resources for running the school give details:............................................................................. ............................................................................................................................................................................... ........ ............................................................................................................................................................................... ............................................................................................................................................................................... ................ (b) Bank Deposit ,if any:............................................................................................................................................... (c) Annual Income from fees:.......................................................................................................... (d) Total Income and expenditure for the previous year: Income............................................................. Expenditure.......................................................................... 20. Particulars of affiliation fee paid: (a) Amount Paid.................................................................................................................. (b) Mode of Payment............................................................................................................ (c) Cash Receipt No. & date:................................................................................................ It is hereby certified that the information furnished in respect of our institution in this proforma is correct to the best of my knowledge and belief and we also undertake to abide by the Himachal Pradesh Board of School Education affiliation Regulations 1992 as amanded from time to time. Signature of Head of the Institution Dated:....................................... Seal of Office. Details of documents attached: 1.............................................. 2............................................. 3.............................................. 4............................................. 5............................................... 6...........................................
