APPLICATION FORM FOR THE PERMISSION/RECOGNITION BY THE INDIAN ASSOCIATION OF PHYSIOTHERAPISTS
| 01 | NAME OF THE COLLEGE | ___________________________________________________________________________ | ||||
| 02 | ADDRESS | ___________________________________________________________________________ | ||||
| 03 | MANAGEMENT: GOVT/PVT. (NAME) | ___________________________________________________________________________ | ||||
| 04 | ADDRESS | ___________________________________________________________________________ | ||||
| ___________________________________________________________________________ | ||||||
| TELE | _________________________________ FAX: __________________________ | |||||
| ___________________________________________________________________________ | ||||||
| 05 | NATURE OF THE COURSE: Degree/P.G.) | ___________________________________________________________________________ | ||||
| 06 | DURATION OF THE COURSE | ___________________________________________________________________________ | ||||
| 07 | COURSE AFFILIATION (University) | ___________________________________________________________________________ | ||||
| 08 | GOVERNMENT PERMISSION VIDE ORDER NO. | ___________________________________________________________________________ | ||||
| 09 | INTAKE ADMISSION CAPACITY | ___________________________________________________________________________ | ||||
| 10 | NAME OF THE PRINCIPAL | ___________________________________________________________________________ | ||||
| 10a | QUALIFICATIONS | ____________________________ | (b) I.A.P No_____________________________________ | |||
| 11 | INFRASTRUCTURE: PERMANENT / TEMPORARY | ________________________________________ | (Please give approved plan copy) | |||
| 12 | INFRASTRUCTURE FACILITIES AVAILABLE: | ___________________________________________________________________________ | ||||
| a) | ACADEMIC: | (Attach approved plan) | ||||
| b) | CLINICAL : | Own Tie Ups (attach copy of the MOU'S with Hospitals) | ||||
| Recognition fees paid Vide | D.D No | ____________________ | Drawn on | _________________________________Bank | ||
| Dated : ____________________ | ||||||
We hereby certify that to the best our knowledge the information given above is true.
SIGNATURE OF THE PRINCIPAL SIGNATURE OF THE CHAIRMAN
ANNEXURES TO BE ENCLOSED WITH DETAILS (Use Separate Paper
1.OBJECTIVE OF THE COURSE AND THE COLLEGE.
2. CRITERIA FOR ADMISSION.
3. BIO-DATA OF THE PRINCIPAL
4. COPY OF GOVERNMENT APPROVAL
5. COPY OF THE AFFILIATION ORDER FROM THE UNIVERSITY.
6. COPY OF THE TRASCRIPT APPROVED BY THE UNIVERSITY.
7. DETAILS OF THE TEACHING STAFF WITH CADRE AND PAY STRUCTURE
8. DETAILS OF THE HOSPITAL WITH DEPARTMENT WISE BED DISTRIBUTION
9. EXISTING INFRASTRUCTURE AND FUTURE EXPANSION PLAN OF THE COLLEGE.
10. SOURCE OF FOUNDING FOR THE PHYSIOTHERAPY COLLEGE.
(Please attach copy of the audited balance sheet of latest assessment
year)
11.DETAILS OF THE TRUST / MANAGEMENT
Applications for recognition of the Institute by “INDIAN ASSOCIATION OF
PHYSIOTHERAPISTS” should be completed enclosing all the additional
information as required and sent to
1. CONVENOR U.G COMMETE,
Dr.Nilima Patel PT,
104 ASHOK APARTMENTSNEAR DINESH MILL,
AKOTA ROAD,
BARODA 20.
Ph. No.- 0265-2312301, Mob No.- 09898012306
Email: drnspatel@rediffmail.com
2. Dr. Sanjiv K. Jha,PT
702\B1Shanai Residency
Opp.Hotel Amar Vilas
A.B road
INDORE 452010
Email: sanjiv1972@yahoo.com
sanjivkjha@physiotherapyindia.org
Kindly enclose a Demand Draft for Rs.20,000/-
favoring "The Indian Association of Physiotherapists" and the Demand
Draft payable at “Surat” as the inspection fees.
Kindly download the criteria of recognition of institutions by IAP from
the website www.physiotherapyindia.org or write to the secretary for the
needful.
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