Application Form

UGC-MALAVIYA MISSION TEACHER TRAINING CENTRE(formerly known as UGC-Human Resource Development Centre)
KURUKSHETRA UNIVERSITY KURUKSHETRA(Established by the State Legislature Act XII of 1956)(“A++” Grade, NAAC Accredited)

PROFORMA OF PERSONAL PARTICULARS OF THE TEACHER-PARTICIPANT
Please read the Instructions before filling in this form:(a)This form must be filled in completely and no column should be left blank.
(b)Incomplete form will NOT be considered.
(c)This form must be forwarded through proper channel.
(d)Strike out which is not applicable.
(e)Only those teachers who are selected for a particular course will be informed about the programme.
(f)Every teacher is required to present a seminar paper during the course.
(g)Certificates of completion of course will be given to those participants who attend the course.
(h)The teachers may apply on our office E-mail : ugcasc_kuk@yahoo.co.in

COURSES TO BE ATTENDED:(i) FACULTY INDUCTION PROGRAMME (Common for teachers in all subjects)
Commencing From _______________ To ______________OR(ii) REFRESHER COURSE IN SUBJECT OF.……………….………..
Commencing From _______________ To ______________
OR(iii) SHORT-TERM COURSE/WORKSHOP/WEBINAR/OTHER PROGRAMME

1.

Name: Dr//Mr/Miss/Mrs:…………………………………………

2.

College/Department Address:………………………….…………
…………………………………………………………….………

3.

Affix Passport Size
Photograph

Name of the Affiliating University:………………………………
……………………………………………………….……………

4.

Whether College/Institute/University is included under Section 12(B) of UGC Act. …………… (Yes/No)

5.

Correspondence Address:…………………………………………
……………………………………………………………………
……………………………Pin Code ……………………………
Telephone Number(Off.)………………….(Res.)…………………..Mob…………………….….…...
E_mail ID: ……………………………………………..

6.

Date of Birth:………………………

7. Gender : Male/Female……………………

8.

Whether belonging to Scheduled Caste/Tribe or
OBC or Differently Abled :: ……………………………………...…..
(State Category , if any)

9.

(a) Designation: ………………………………..

(b) Grade Pay :………………………….……

10. Subject:………………………………………
11. First continuous appointment:________________________

12. Date of joining the present job:________________________

13. Due date of next higher grade pay:________________________

PTO

-214. Status of Appointment (Please Tick)(i)Permanent(ii)Adhoc(iv)Part-Time(v)Contract(iii)

15. The type of College/University/Institution (Please Tick):(i)Govt.
(ii)Govt. Aided(iv)Autonomous(v)University Dept.
16. Total Teaching Experience :Temporary(iii)(vi)

Self-Financed
Any OtherYear __________Months ___________

17. Have you already attended any course at Kurukshetra University, Kurukshetra or at any other place? If yes, givedetails :Courses

Subject

Name of theASC/HRDC/RCCB/MMTTC

Duration
FromToOrientation Programme/FIP
Refresher Courses
IIIIII
Short-Term Course
18. Would you require hostel accommodation facilities during the programme:………… (YES/NO)
19. Remarks if any …………………………………………………………………………

DECLARATION/UNDERTAKINGI hereby declare that all information furnished in this application form is true, complete and correct to the best of my knowledge and belief. I
understand that in the event of any information being found false, incomplete or incorrect, my application/admission is liable to be rejected/cancelled. I
undertake to abide by the rules/guidelines of the UGC-Malaviya Mission Teacher Training Centre and to commit solely to the programme during thefull duration.
Place ………………………….
Date …………………………..
(Signature of the Teacher)

Recommendation of the forwarding authority:- Please Tick (√) whichever is applicable.
I herby certify that:(i) Our College/University is included in the list of institutions under Sec.2 (f) of the UGC Act;(ii) Our College comes in the purview of the Section 12 (B) of the UGC Act.
(iii) Our College does not come in the purview of the Section 12 (B) of the UGC Act, but has been affiliated to the Universityof ………………………………………………………………..for at least 2 years;(iv)The application of the above named teacher is forwarded with the recommendation that when selected, he/she will be relieved intime to participate in the above course and will be treated on Duty Leave; and(v) The information given above by the applicant is true, complete and correct.

Date……………..

Signature of Principal/Head of Institution(With rubber stamp)