Affiliation Application Form

  1. Type of Application – New / Renewal (Please encircle)
  2. Name of the Centre / Institute
  3. Address
  4. Contact No. –
  5. E-mail –
  6. Web address (if any)
  7. Head of Institution/Center/TP and designation with mobile no.
  8. Year of establishment of the Centre / Institute –
  9. Available training facilities
    (a) Floor space – ( Own/ Rented)
    (b) No. of equipment –
    (c) No. of Class Room –
    (d) Library facilities –
  10. Name of the ultrasound courses offered with duration
    (a)
    (b)
    (c)
    (d)
    (e)
  11. How long the courses are running
    (a) Certificate courses –
    (b) Diploma courses –
    (c) Other courses –
  12. Any other course run by the Centre/Institute
  13. Any previous recognition/affiliation – Yes/No (if yes, please attach a copy)
  14. No. of training manpower (faculties) – (Please attach their short profiles)
  15. Trade License No. with validity –

Please attach following documents along with the application

  1. Forwarding letter in a letter-head pad of the organization to the President, BSU
  2. Application Fee as Pay Order in favour of “Bangladesh Society of Ultrasonography”
  3. Details of the course modules & syllabus
  4. Copy of the Trade License
  5. Permission of BMDC/UGC/any other recognized institution (if any)
  6. Short Organogram of the Training Provider Organization
  7. Brief profile of the trainers/faculties
Download Affiliation Application Form
[.pdf] / [.doc]