ACADEMIC STAFF COLLEGE

UNIVERSITY OF JAMMU
Jammu Tawi - 180 006
APPLICATION FORORIENTATION/REFRESHER COURSE
1. Affix PP 2. Appented on more photo

Course for which Application is made

1. Orientation course

2. Refresher course In ......................

I. 1.1 1.2 1.3 1.4

PERSONAL INFORMATION Nameof the Teacher Date of Birth Sex (Tick) Qualification(Tickmark)
Sr. Scale Due on (Mention Date) Mr./Miss/Mrs./Dr. .................................................................

[ilIJ
~M.PhiLI Ph.D.IB. Ed 1M.Ed I ..............................................................................................

1.5

Residential Address

"""""""""""""""""""',"""""""""""""""""""""""""""

.Pin code........................ Phone Number (0) (R) (M)

E-mail II. 2.1 2.2 DETAILS OF EMPLOYMENT a) Designation (b) Department / College (Please indicate the Discipline) 2.3 2.4 2.5 c) Affiliated with University (d) Official Address State Pin code North/South Phone

2.6, Zone III 3.1 3.2 3.3 3.4 3.5

DETAILS OF TEACHING/EXTENSION EXPERIENCE Date of first appointment in College

Date of first appointment in University

Date of regular appointment after confirmation in College/University Status of present appointment (Tick) Teaching/ Extension Experience (in College / in University Permanent/Probationer/Temporary/Adhoc/Part-time at UG leveL for yrs.) PG leveL...............

IV. 4.1 4.2 4.3 4.4 V. 5.1

DETAILS OF RESEARCH EXPERIENCE (IF ANY)

Area of specialization
Title of Researchwork (if any) No. of Publication

No. ofthe researcn projects completed (if any) DETAILS OF PREVIOUS EXPERIENCE IN ATTEND1NG ORIENTATION/REFRESHER COURSE Haveyou attended any GeneralOrientationCourse a) Duration
if yes, please indicate

4 weeks/3 weeks

b) From I c) Name of the Asc: a) Duration

b) From c) Name of Asc

I to I

5.2

Have you attended any Refresher course earlier if yes, please indicate

4 weeks 13weeks r . J to

I I

5.3 5.4

Details of Application made for any other Course in the ASC Would you like that any specific topic having relevance to the modern technology I trend in the subject should be included in the course?
I)

(a) If yes, Please specify 1 5.5

2

Would you like to present a paper in any of the session? If yes, Please specify the topic of your interest. I, hereby undertaketo participate in the course and do the assignment work during the cour$,eunder the guidance of Resource Persons and abide by the rules and regulation of University IUGC. ..

Date

Signature of the applicant

CERTIFICATEOF RECOMMENDATIONFROMTHE HEAD/ PRINCIPAL

1)

I, recommend Dr.lMrs.lMs ...............................................................................................................................

'.............................

for the course in Hel She willbe relieved in time to participate in the above mentioned course at Academic Staff College, if selected';
2)

Certified thatthiscoliege/Deptt. isaffiliated to .

.'

...T',..I,University " .. "I

'

for the Last 5 years and ISrecommended under section 12 (F) of the UGC Act. 3)
Date Office Seal

Certified that the Particulars given above are true and correct and nothing has been concealed there to. ..

Signature of the Head/Principa'i

For Office
Allowed
I

Not Allowed

S.O.

Director