UGC Academic Staff College Application Format 2011

UGGCC--AACCAADDEEMMIICC SSTTAAFFFF C COOLLLELGEGEE
H.P. UNIVERSITY SUMMER HILL, SHIMLA-171 005

Application Format
Orientation Programme................................ from ....................................... to ....................................
or
Refresher Course.............................................. from ................................. to .......................................
(Kindly, fill-up all the columns, Incomplete application will be rejected)
PHOTO
(to be affixed)

I PERSONAL INFORMATION
1. Name in Block Letters ..........................................................................................
2. College/Department Address ................................................................................
................................................................ District ...............................................
State: ............................................. Pin:
Phone No. STD Code .............. Phone No. .........................Fax No.........................
Designation . Other.......................................
Subject ............................. Basic Pay...........................................
UGGCC--AACCAADDEEMMIICC SSTTAAFFFF C COOLLLELGEGEE
H.P. UNIVERSITY SUMMER HILL, SHIMLA-171 005
U G C - A C A D E M I C S T A F F C O L L E G E
Mobile No. .................................. Email...................................................................
D D M M Y E A R
General SC ST OBC
Male Female
Lect. Sr.Lect. Sl.Gr.Lect.
Email :ascshimla@hotmail.com, Web: ascshimla.org
: 0177- 2830102 : 0177-2831364, , PBX: 2831998, 2830709, 2830635, Ext. 5540-44

DETAILS OF COURSES ATTENDED
Course Institution Period
From To
Orientation Programmes
Refresher Courses
1.
2.
3.

I hereby undertake to praricipate in the programme/course and to do the project work during
the course under the guidance of resource persons and to accept the hospitality rendered by
Academic Staff College apart from following the rules and regulations of the ASC. The particulars
given above are true to the best of my knowledge and belief.
CERTIFICATE OF RECOMMENDATION FROM THE PRINCIPAL
I recommend Dr./Mr./Ms. .............................................................................. Lecturer /
Senior Lecturer / Selection Grade Lecturer (Strike off which ever is not applicable) for the
Orientation Programme/Refresher Course in .................................................................................
If selected He/She will be relieved on time to participate in the above course at Academic Staff
College. Certified that this college is affiliated to ...........................................................................
University for the last two years. Also certified that the details of courses attended by him/her
are verfied and found correct.
Place:
Date: Signature of Principal/HOD
With Office Seal
Place:
Date Signature of the Applicant
FOR OFFICE USE ONLY
Selected for the ........................................................ Orientation Programme/ Refresher Course in
........................................................... commencing from ................................................................
Place:
Date: Director cum Professor
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