UGC-ACADEMIC STAFF COLLEGE H.P. UNIVERSITY SUMMER HILL, SHIMLA-171 005 Application Format PHOTO Orientation Programme................................ from ....................................... to .................................... or (to be affixed) Refresher Course.............................................. from ................................. to ....................................... (Kindly, fill-up all the columns, Incomplete application will be rejected) I PERSONAL INFORMATION 1. Name in Block Letters .......................................................................................... Other....................................... 2. College/Department Address ................................................................................ ................................................................ District ............................................... State: ............................................. Pin: Phone No. STD Code .............. Phone No. .........................Fax No......................... 3. Date of Birth : 4. Name of the Affiliating University: ..................................................................................... Y E A R Please Tick ( ) Appropriate 5. Sex : 6. Community : Male Female General SC ST OBC Others ..................... 7. Correspondence Address (othere than College/Dept. Address)................................. ........................................................................................................................... ............................................................... Dist......................... State................................... Phone No. STD Code................ Phone No. ................... Mobile No. .................................. Email................................................................... II DETAILS OF TEACHING EXPERIENCE 1. Date of first Appointment: 2. Date of Regular Appointment: 3. Status of Appointment: 4. Teaching Experience : (College & University) 5. Classes Handling: 6. Research Guidance: Email :
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, Web: ascshimla.org 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. Place: Date Signature of the Applicant 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 FOR OFFICE USE ONLY Selected for the ........................................................ Orientation Programme/ Refresher Course in ........................................................... commencing from ................................................................ Place: Date: Director cum Professor
