International Medical & Educational Group
STUDY CENTER - APPLICATION FORM

Please note, this is a questionnaire that we wish to get your feedback on. This will help us to understand your organization better and your market better. Please fill this as per actual conditions.

Once we are satisfied with your application, we shall support your marketing efforts and also conduct seminars for you in your country. This may take Ten minutes of your time

Just type "NA" where ever Not Applicable

* Fields Are Mandatory
Institution Details
Full name of Institution * Year of Incorporation *
Incorporation Certificate  
Address * Country *
Name and address of any branch or associated institutions (if applicable) and whether they will also offer the courses
Branch 1 Branch 2
Branch 1 Photo Branch 2 Photo
Telephone * Fax
E-Mail *
Principal/Directors Name * Institution Established Date * calendar
Are you registered with your local Ministry of Education? * Yes No
Have you operated this institution under any other name? * Yes No
Current Course Details
List here other courses that are offered at your institution and the approximate number of students enrolled each year. Please indicate whether the students are full-time or part-time *
List any professional or examining bodies which recognise your institution as a teaching centre. State whether this is an internal or external courses centre *
List any Courses held at your institution with the approximate numbers sitting at any one time. (These should be Courses of recognized examining bodies.) *
# Course Students per Annum
1
2
3
4
5
6
7
8
9
10
Facilities & Equipment
What facilities and equipment can your institution offer to students wishing to study the courses? Classrooms *
Photo:
Number of lecture rooms (capacity: 40 students +) Please list any teaching aids (eg Overhead Projector) *
Photo:
Number of large classrooms rooms (capacity: 20 - 39 students) Please list any teaching aids *
Photo:
Number of small classrooms (capacity: 8 - 19 students) Please list any teaching aids *
Photo:
Specialist Rooms
Number of large computer rooms (capacity: 16 students +) Please list hardware/software provision *
Photo:
Number of other Labs
Please list hardware/software provision *
Photo:
Programs Interested
Programs am interested to offer in my Center * LAB BASED FULL TIME Distance and ONLINE
Staff Details
Please give details of the member of staff who will be the academic head of the programmes you wish to run.
Staff Name Qualifications
Years with Institution How are they employed? Full-time Part-time
Upload Resume
Please give details of any other academic staff currently employed by your institution who will be teaching on programmes.
Staff 1
Staff Name Qualifications
Subjects taught
Years with Institution How are they employed? Full-time Part-time
Upload Resume
Staff 2
Staff Name Qualifications
Subjects taught
Years with Institution How are they employed? Full-time Part-time
Upload Resume
Staff 3
Staff Name Qualifications
Subjects taught
Years with Institution How are they employed? Full-time Part-time
Upload Resume
Staff 4
Staff Name Qualifications
Subjects taught
Years with Institution How are they employed? Full-time Part-time
Upload Resume
Staff 5
Staff Name Qualifications
Subjects taught
Years with Institution How are they employed? Full-time Part-time
Upload Resume
Staff 6
Staff Name Qualifications
Subjects taught
Years with Institution How are they employed? Full-time Part-time
Upload Resume
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