MADURAI KAMARAJ UNIVERSITY (University with Potential for Excellence) UGC-Academic Staff College Palkalainagar, Madurai-625 021Phone: 0452-2458251 Application for Short term Course/Orientation Programme/Refresher Course in……………………during ………………………(period of the course) 1. Name (in Block Letters) : 2. Gender : Male / Female 3. Age : 4. Community (SC/ST/MBC/BC/Others) : 5. Religion : 6. Minority Status : Yes/No 7. 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 : Years…….. Months …….. 11. Whether the College in which the applicant is employed offers PG Course in the Subject Taught : Yes / No 12. Residential Address, Phone No. & e-mail ID : 13. Any Career advancement held up because of non participation in OP/RC : Yes / No 14. Date of the next Career advancement due : 15. Details of the Orientation Programmes/Refresher Courses attended earlier
The details given above were verified and found to be correct. College Office Assistant College Office Superintendent _____________________________________________________________ Declaration by the Applicant I understand that the attendance for all sessions is compulsory. Therefore, I assure you that I will attend all the sessions and will not ask for leave or permission to come late or leave earlier during the sessions under any circumstances. I will abide by the rules and regulations of the UGC in this regard. 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. 6. Declaration by the Principal to relieve the applicant for the course applied Signature of the Principal & Seal INSTRUCTIONS:
Declaration by the Principal Name of the institution _____________________ I certify that I will relieve _______________________(Name of the applicant) of _______________________ Department to attend the OP/RC/STC to be conducted by the Academic Staff College of MKU during __________ (Period of the course). In case, the applicant is not selected for this course, he/she may be considered for the course in future. Date: Signature of the Principal Station: with Seal | |||||||||||||||||||
Monday 12 March 2012
Revised Application
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Nice post
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