This document is an application form for a Regional Centre of Excellence in Ayurveda's Rotational Training Program (ROTP) in Geriatrics and Panchkarma from March 19-24, 2012. The applicant provides their name, father's name, date of birth, sex, registration number, education qualifications, current place of employment, department, designation, years of teaching and professional experience, number of CMEs/ROTPs attended in the current year, contact details, and signature. The head of the applicant's institution must also sign to certify the applicant's details and recommend them for the program without travel or honorarium, considering it as duty leave including travel days.
This document is an application form for a Regional Centre of Excellence in Ayurveda's Rotational Training Program (ROTP) in Geriatrics and Panchkarma from March 19-24, 2012. The applicant provides their name, father's name, date of birth, sex, registration number, education qualifications, current place of employment, department, designation, years of teaching and professional experience, number of CMEs/ROTPs attended in the current year, contact details, and signature. The head of the applicant's institution must also sign to certify the applicant's details and recommend them for the program without travel or honorarium, considering it as duty leave including travel days.
This document is an application form for a Regional Centre of Excellence in Ayurveda's Rotational Training Program (ROTP) in Geriatrics and Panchkarma from March 19-24, 2012. The applicant provides their name, father's name, date of birth, sex, registration number, education qualifications, current place of employment, department, designation, years of teaching and professional experience, number of CMEs/ROTPs attended in the current year, contact details, and signature. The head of the applicant's institution must also sign to certify the applicant's details and recommend them for the program without travel or honorarium, considering it as duty leave including travel days.
APPLICATION FORM FOR ROTP (Geriatrics & Panchkarm) PARTICIPATION AT
Regional Centre of Excellence in Ayurved for Geriatrics Health Care
R.G.Govt P.G.Ayurvedic College Paprola-Himachal Pradesh To Nodal Officer,
Regional Centre of Excellence in Ayurved
for Geriatric Health Care R.G.G.P.G.Ayu.College & Hospital Paprola-H.P-176115. Sir, Kindly enroll me as participant for ROTP (Geriatrics & Panchkarm) being organized by Regional Centre of Excellence in Ayurved for Geriatric Health Care from 19th March 2012 to 24th March 2012. My brief Bio-Data is as below: Name--------------------------------------------------------Fathers Name---------------------------------------------Date of Birth-----------------------------------------------Sex----------------------------------------------------------Registration No: -------------------------------------------- (State-----------------------) Education Qualification-----------------------------------Name of Institution where presently serving---------------------------------------Department------------------------------------------------Designation-----------------------------------------------Experience in Years: a. Teaching--------------------------------b. Professional---------------------------Number of CME/ROTP attended during current year: --------------------Present Correspondence Address :-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Telephone Contact No: -----------------------------------------E.Mail : . Signature of Applicant Dated------------------Certificate of Head of Institution Certified that the particulars furnished above by applicant Dr..are correct as per records available with the institution. He is recommended for the ROTP applied without TA/DA or Honorarium. He will be considered on Duty Leave during ROTP period including Journey days. Signature Head of Institution Dated-----------------