EXPRESSION OF INTEREST FOR GULBARGA UNIVERSITY

OUTREACH PROGRAM
A: PRELIMINERY INFORMATION
NAME OF THE TRUST
REGISTERED ADDRESS OF
THE TRUST

NAME OF THE INSTITUTE

INTENDING TO OFFER THE
OUTREACH PROGRAM
ADDRESS OF THE INSTITUTE

NAME OF THE AUTHORIZED

SIGNATORY REPRESENTING
THE INSTITUTE/TRUST
LAND LINE NUMBER:
MOBILE NUMBER:
EMAIL ADDRESS:
WEBSITE:
LIST OF COURSES CURRENTLY BEING OFFERED BY THE INSTITUTE
NAME OF THE COURSE
MODE OF INSTRUCTION
AFFILIATING BODY
(PART TIME/FULL
TIME/DISTANCE
LEARNING)

LIST OF PROGRAMS PROPOSED TO BE OFFERED BY THE INSTITUTE

NAME OF THE COURSE

DEGREE TO BE
AWARDED

ELIGIBILITY

PROPOSED COMMENCEMENT OF OPERATIONS:

ACADEMIC CYCLE (JUNE TO SEPT).............
CALENDER CYCLE (JAN TO APRIL)..............
PROPOSED INTAKE (NUMBER OF STUDENTS) FOR EACH COURSE MENTIONED ABOVE
COURSE
PROPOSED INTAKE INTO THE COURSE

ACADEMIC INFORMATION
DETAILS OF TEACHING AND NON TEACHING STAFF
TEACHING STAFF
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:

NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:

NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE: TOTAL: ............ ACADEMIC: .............. INDUSTRY: ......................
SUBJECTS TAUGHT:

NON-TEACHING STAFF
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE:
DESIGNATION:
JOB PROFILE:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE:
DESIGNATION:
JOB PROFILE:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE:
DESIGNATION:
JOB PROFILE:
NAME:
QUALIFICATION:
YEARS OF EXPERIENCE:
DESIGNATION:
JOB PROFILE:

INFRASTRUCTURAL REQUIREMENTS

WHAT IS THE TOTAL AREA OF THE PREMISES (IN SQ.FT.)? ______________________

IS THE PREMISES OF THE INSTITUE OWNED OR LEASED? _______________________
IN CASE OF LEASED PREMISES, WHAT IS THE TENURE OF THE LEASE:
FROM (MM/YYYY)
TO (MM/YYYY)
______________ TO ___________
TOTAL BUILT-UP AREA: _______ sq.ft.
TOTAL CARPET AREA: ________ sq.ft.

AREA SPECIFICATIONS
SR.N
O
1
CLASSROOMS
2
SEMINAR ROOM
3
FACULTY ROOM
4
LABORATORY
5
LIBRARY
6
COMMON ROOM FOR BOYS
7
COMMON ROOM FOR GIRLS
8
TOILETS FOR BOYS
9
TOILETS FOR GIRLS
10
AUDITORIUM
11
INDOOR RECREATION AREA
12
ADMINISTRATIVE AREA
13
DIRECTORS OFFICE
14
CANTEEN FACILITY
15.
OPEN SPACE
16.
COMPUTER LABORATORY

NUMBERS

TOTAL AREA IN SQ.FT

(APPROX.)

TOTAL NUMBER OF COMPUTERS AVAILABLE FOR THE STUDENTS: ______________

DOES THE INSTITUTION HAVE WI-FI CONNECTIVITY? YES/NO
IS SEPARATE HOSTEL ACCOMMODATION FOR BOYS AND GIRLS AVAILABLE FOR
OUTSTATION STUDENTS? YES/NO

LIBRARY FACILITIES
TOTAL NUMBER OF TITLES AVAILABLE: ___________________
TOTAL NUMBER OF JOURNALS SUBSCRIBED: _______
NATIONAL: _____________ INTERNATIONAL: __________________
ARE ANY E-LEARNING RESOURCES AVAILABLE TO THE STUDENTS: YES/NO

ADDITIONAL REMARKS:
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CHECKLIST OF DOCUMENTS TO BE SUBMITTED IN SUPPORT OF THE APPLICATION

Demand draft in favour of YGen Management Consulting Pvt. Ltd towards
application fees.
Letter of intent on the institution/trust/society letter head as per format provided.
Photocopy of the trust deed or society bye-laws
Trust/society registration certificate
Copy of board resolution approving application for Gulbarga University Outreach
program.
Copy of the prospectus (in case of institutions currently offering other programs)
In case of specialised programs proposed to be offered by the institute it is
mandatory for the institute to provide a detailed syllabus of each program specifying
the following
a) Course Objective
b) Number of credit hours for each subject
c) Course outline (course structure)
d) Content of each subject
e) Reference books for each subject
Detailed profile of each faculty member of the institute.
Copy of the lease agreement of the institute for a minimum period of 5 years from
the date of the agreement.
In case of owned premises
Building plan
Details of books currently available in the library including the following
specifications
a) Name of the title
b) Author
c) Publication
d) Volumes available
Details of the journals subscribed

DECLARATION BY THE INSTITUTION

We hereby declare that the information furnished above is true to the best of our
knowledge and agree to abide by the terms and conditions of the application.
On behalf of the institute (To be signed by the authorized signatory)
Signature: _______________
Date: ______________
Name: _____________________________
Stamp and seal of the institute/trust