Academic Partner Registration Form E&ICT Academy IIT Guwahati

Academic Partner Registration Form

E&ICT Academy IIT Guwahati

1.  Name of the Institute ………………………………………………………………………………………………………………...

2.  Type of the Institute (Central Funded/State Funded /Private Funded/others)…………………………….

…………………………………………………………………………………………………………………

3.  Official Address ………………………………………………………………………………………………………………...

4.  Contact Person Name ……………………………………………………………………………………………………………......

5.  Contact No …………………………………………………………………………………………………………………………...

6.  Email ID of Contact Person …………………………………………………………………………………………………….

7.  Year of Establishment<DD/MM/YYYY> …………………………………………………………………………....

8.  Courses Offered (Degree/Diploma/Masters) ……………………………………………………………………………

S. No	Degree	Diploma	Masters
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

9.  Type of Lab setups with sitting capacity

S. No	Type of Labs	Sitting Capacity	Facilities
1
2
3
4
5
6
7

10.  Is e-Classroom /Smart Class available …………………………………………………………………………………

a.  Facility provided in e-Classroom …………………………………………………………………………………………..

b. Sitting Capacity in e-Classroom……………………………………………………………………………………………..

11.  Is Computer Lab Available & Sitting Capacity……………………………………………………………………….....

a.  Software Available ………………………………………………………………………………………………………………..

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

b.  Hardwares and Equipments Available 

□ DSP Kits

□ Power Generator

□ Function Generator

□ FPGA Kits

□ IOT Boards

□ DSO or CRO

□ Computers with Latest Configuration

□ Bread Boards & other Electrical Components

□ Microprocessor Kits

□ Arm Boards

□ Projectors

Other Equipments Available…………………………………………………………………………………………………………

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

Undertaking and Declaration

I/We hereby solemnly undertake/declare that the particulars stated above are true and correct to the best of my/our knowledge and belief. Any information, if found to be incorrect, wrong or misleading, will render/us liable to rejection of partnership.

Authorized Signature & Seal

Name:                     

Designation:

Date:                   

Place: