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MADURAI KAMARAJ UNIVERSITY    

University with Potential for Excellence)

                                 UGC-Academic Staff College

                                                     Palkalainagar, Madurai-625 021

Phone: 0452-2458251

  Application for Orientation Programmes/Refresher Courses in……………………

1.     Name                                                      :

2.     Gender                                                    :        Male / Female

3.     Age                                                         :

4.     Community (SC/ST/MBC/BC/Others)           :

5.     Academic Qualifications                                      :

a)      Masters Degree

b)     M.Phil/Ph.D. Degree

6.  Name of the College/University where in     :

    employed

7.  Name of the Department                           :

8.  Designation                                              :

9.  Date of Permanent Appointment                 :

10. Total Years of Teaching Experience            :

11. Whether the College in which the               :        ………..Years……..    …..Months

     applicant is employed offers

     PG Course in the Subject Taught.

12. Residential Address and Phone No.            :

..2..

-2-

13.  Any Career advancement held up because of

       non participation in OP/RC                                :

14.  Date of the next Career advancement due            :

15.  Orientation Programmes/Refresher Courses attended earlier

S.No.	Details of OP/RC	Name of the Academic Staff College	Duration of participation From………To………..
1.
2.
3.

The details given above were verified and found to be correct.

College Office Assistant                                                   College Office Superintentdent

_______________________________________________________________________

Place :

Date  :                                                                   Signature of the Applicant

Certificate

1.  Certified that the above information is correct to the best of my knowledge.

2.  Certified that the College is included in the list of Colleges under Sec.2(f) / 12(B) of

     the UGC Act 1956 / Self Finance.

4.      Certified that the applicant is a permanent / self finance teacher and will be relieved

for the  Programme / Course if selected.      

5.      Specific recommendation of the Principal.

Signature of the Principal & Seal