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Application Form For Orientation Course

This document contains an application form for an orientation course at the Academic Staff College at Jawaharlal Nehru University in New Delhi, India. The application requests information such as the applicant's name, date of birth, category, contact details, academic and employment history, research interests, and publications. It includes sections for details of prior orientation or refresher courses attended, special subject interests, and a processing fee. The form must be certified and sponsored by the applicant's college or university.

Uploaded by

Amit Kurmar Sharma
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174 views3 pages

Application Form For Orientation Course

This document contains an application form for an orientation course at the Academic Staff College at Jawaharlal Nehru University in New Delhi, India. The application requests information such as the applicant's name, date of birth, category, contact details, academic and employment history, research interests, and publications. It includes sections for details of prior orientation or refresher courses attended, special subject interests, and a processing fee. The form must be certified and sponsored by the applicant's college or university.

Uploaded by

Amit Kurmar Sharma
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UGC –ACADEMIC STAFF COLLEGE

Jawaharlal Nehru University


JNU New Campus
New Delhi 110067
Ph: 011-26742532, 26742566
Fax: 26742532

Application Form for Orientation Course

Name (Block Letter) Dr/Mr/Ms ____________________________

____________________________________ Photograph
D M Y
Date of Birth

Category SC ST OBC General


Male Female

Visually Challenged Physically Challenged

Institutional/College/University Address Mailing Address:


________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
State ___________________________________
State ___________________________________
PIN _________
PIN ___________
Telephone (STD code) _____________________
Telephone (STD code) _____________________
______________________
Mobile _________________________________
FAX ___________________ email: __________________________________

Website URL ____________________________ __________________________________

Academic Career:

Examination Subject (s) & Specialisation % of University Year


Marks/Grade
Post Graduation
M. Phil.
Ph. D.
PDF #

Research Interest/Post Doctoral Work: _________________________________________________


____________________________________________________________________________

#
Post Doctoral Fellowship

1
Details of Employment (in chronological order):

Institution Designation Period Nature of Duties

From To

Details of courses attended (RC/OC) previously:

NAME OF COURSE ASC WHICH CONDUCTED WHEN THE COURSE WAS


THE COURSE HELD

Subjects of your special interests: _______________________________________________

Details of Publications ∗ : _______________________________________________________


____________________________________________________________________________

I hereby declare that the entries made in this application form are true to the best of my
knowledge and belief. It is also certified that my college is included in the list of the
colleges under Section 2(f) 12-B of the UGC Act.

Signature of Applicant
Dated:

∗
If you require more space, please attach a separate sheet and mention it.

2
Certificate from College/University

Certified that Dr/Mr./Ms. _______________________________________________ has


been working in this College/University as lecturer in the pay scale of Rs.8000-
13500/10,000-15,200 in (subject) ______________________since ___________. We shall
be happy to sponsor him/her if selected for the course to be conducted by the Academic
Staff College, Jawaharlal Nehru University, New Delhi-110067.

Also Certified that this College is included in the list of Colleges under Section 2(f) 12-b of
the UGC Act.

Signature of Principal/Registrar
Date:
Name
Designation
Address
Office Seal

PROCESSING FEE

Please attach to this form a non-refundable processing fee of Rs. 200/- through an account
payee bank draft in favour of the Finance Officer, Jawaharlal Nehru University, New
Delhi, payable at the State Bank of India, JNU, Code No. 1624. On the reverse side of the
draft please write the name of the course applied for, your own name and your address.
We regret that cash/cheques/ P.O. etc. are not acceptable.

DRAFT NO.: ___________________________________DATE:________________

ISSUING BANK & BRANCH:___________________________________________

AMOUNT (In words): _________________________________________________

PLEASE NOTE:

1. The last date for receipt of an application form is 60 days before the start of the course. Any application
form is valid for 1 ½ years after its receipt. We process only those application forms which are
accompanied by the processing fee (photocopies of the draft are not accepted).

2. PLEASE BRING A RELIEVING ORDER FROM THE APPROPRIATE AUTHORITY AT THE TIME
OF JOINING THE COURSE. NO ONE SHALL BE ALLOWED TO SIT IN THE COURSE
WITHOUT A RELIEVING ORDER.

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