Annexur

eM -For
matf
orCapt
uri
ngCent
er&Bat
chDet
ail
s
(Tobef
il
ledi
nbyt
heAssessor
)

Ov
eral
lRemar
ks:

AssessmentAgencyName: Assessor
’sName:

Assessor
’si
dent
it
ynumber: Tr
aini
ngPar
tnername:

Tr
aini
ngCent
ername: Compl
eteAddr
ess:

Cent
erI
D: Bat
chi
d:

Jobr
olef
orwhi
chassessment
sconduct
ed: Noofcandi
dat
esi
nthebat
ch:

St
udentPr
efer
redl
anguageofassessment: Assessmentconduct
edi
nthel
anguage:

CenterSPOCName:
Ticktheappr opr i
ateanswer Yes No
IstheInf
rastr
uct ure(No.ofcl
assrooms,StateofLabor
atori
es,
etc.
)presentatt heTraini
ngCenteradequateandsati
sfact
oryto
conductthetraining:
AretheTraineesbei ngassessedforsamej obrol
e,f
orwhichthey
wer
etr
ained:
I
sthet
rai
nerexper
iencedenought
otr
aint
hecandi
dat
es:

Tr
aineeFeedbackf
orm av
ail
abl
e:

Tr
aineeAt
tendanceRecor
dAv
ail
abl
e:

Assessmenti
sconduct
edont
heSchedul
edDat
e:

I
fNo,
Reasonsf
orchangeofDat
e:

EachSt
udent
’si
dent
it
ycheckedbef
oreconduct
ingassessment:

Post
ersofPMKVYdi
spl
ayedi
nCl
assr
oom :

Post
ersofPMKVYdi
spl
ayedi
nCounsel
i
ngRoom :

I
str
ainercompl
etedTOT(
Y/N)

I
fyes,
Checkt
hetr
ainerpr
ovi
sional
cer
ti
fi
edl
ett
er(TakePhot
o)
…………………………………………………………………………………………………………………………………………

Assessor
’sSi
gnat
ure:

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

Cent
erManagerSi
gnat
ureWi
thSeal