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    1.2018 Affilition From (Chapter Membership)

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    Agilan Selvam
    The document is an application form for affiliation as a student chapter of the Indian Institution of Engineers. It requests information about the applying institute/individual, including name, address, year established, details of director/proprietor. It also requests information about infrastructure facilities like classrooms, library, and photos. Supporting staff details like name, designation, qualifications are also solicited. Finally, it asks for the name of the person who will manage the student chapter and their contact information.

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

    1.2018 Affilition From (Chapter Membership)

    Uploaded by

    Agilan Selvam
    18 views2 pages
    The document is an application form for affiliation as a student chapter of the Indian Institution of Engineers. It requests information about the applying institute/individual, including name, address, year established, details of director/proprietor. It also requests information about infrastructure facilities like classrooms, library, and photos. Supporting staff details like name, designation, qualifications are also solicited. Finally, it asks for the name of the person who will manage the student chapter and their contact information.

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    The document is an application form for affiliation as a student chapter of the Indian Institution of Engineers. It requests information about the applying institute/individual, including name, address, year established, details of director/proprietor. It also requests information about infrastructure facilities like classrooms, library, and photos. Supporting staff details like name, designation, qualifications are also solicited. Finally, it asks for the name of the person who will manage the student chapter and their contact information.

    Copyright:

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

    1.2018 Affilition From (Chapter Membership)

    Uploaded by

    Agilan Selvam
    The document is an application form for affiliation as a student chapter of the Indian Institution of Engineers. It requests information about the applying institute/individual, including name, address, year established, details of director/proprietor. It also requests information about infrastructure facilities like classrooms, library, and photos. Supporting staff details like name, designation, qualifications are also solicited. Finally, it asks for the name of the person who will manage the student chapter and their contact information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Indian Institution of Engineers

    (Incorporated by an Act of Govt. of India)


    Post Box No.- 10901, Bhikaji Cama Bhavan, R.K. Puram, New Delhi – 110066.
    Toll Free: 1800 121 6495 website: www.iieinstitution.com
    Application form for Affiliation (Student’s Chapter)
    Application No. …………………………. Dated……………………………
    (For office use only)

    (Use block letters only)


    1. Information of Institute / Individual:

    a. Name of Institute/Individuals : ....................………………………………………………………

    b. Postal Address : ....................………………………………………………………


    ....................………………………………………………………
    ....................………………………………………………………

    c. Phone/Fax/Email/Telex : ....................………………………………………………………
    ....................………………………………………………………

    d. Year of Establishment : ....................………………………………………………………

    2. Information About Director /Proprietor /Partner :

    a. Name : ....................………………………………………………………

    b. Postal Address : ....................………………………………………………………


    ....................………………………………………………………
    ....................………………………………………………………
    ....................………………………………………………………

    c. Phone/Fax/Email/Telex : ....................………………………………………………………
    ....................………………………………………………………

    d. Date of Birth & age : ....................………………………………………………………

    e. Education Qualification : ....................………………………………………………………

    3. Infra Structural Facilities:


    a. Facilities Available:
    Particulars Nos. of Rooms Seating Capacity Total area (Sq. Ft.)
    Staff Rooms
    Class Rooms
    Library
    Reception
    Toilets
    Any Other
    (Where ever necessary relevant details / documents must be enclosed)

    b. Location of the Institute/Individual : ....................………………………………….………….

    c. Rented/Lease/Own Building: ....................………………………………………………………


    (Attached Relevant Documents)
    4. Institute Photographs Interior And Exterior:

    Building/Floor Photographs of Reception Photographs


    Institute (Elevation) of Institute (Interior)

    Class Rooms Photographs of Director Rooms


    Institute (Interior) Photographs of Institute
    (Interior)

    You can attached more photos in separate sheet

    5. Information About Supporting Staff:

    S. Name Designation Education Total Date of Status


    No. Qualification Professional Appointment Full/Part
    Experience Time

    Information required regarding supporting faculty. (If necessary attach separate sheet)

    6. Name Of Person Who Will Actively Manage the IIE (Student’s Chapter):

    a. Name : ....................………………………………………………………

    b. Phone/Fax/Email/Telex : ....................………………………………………………………
    ....................………………………………………………………

    c. Education Qualification : ....................………………………………………………………

    Signature and Seal of the Institute/Individual

    DD/Cheque/NEFT/RTGS No. ……………………Dated……..…..…….. (`)…………….…………


    in favour of “Indian Institution of Engineers” Payable at New Delhi.

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