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					                          SWAMI VIVEKANAND SUBHARTI UNIVERSITY
                          SWAMI VIVEKANAND SUBHARTI UNIVERSITY
                                  SUBHARTIPURAM,, MEERUT
                                  SUBHARTIPURAM MEERUT
                                  APPLICATION FOR THE GRANT OF STUDY CENTRE
                                    Subharti Puram, NH-58, Bypass Road, MEERUT-250002 (U.P)
INSTRUCTION: Fill all the sections of form. Incomplete form will be rejected. Applicant must sign every page of the form.

                                                             SECTION-I
PERSONAL PROFILE OF THE APPLICANT:


    1.   Name:_____________________________________________________________________
    2.   Father’s Name:_____________________________________________________________
                                                                                                                                Latest Color
    3.   Date of Birth________              _______       19 _______                                                            Passport Size
                                                                                                                                 Photograph
    4.   Sex: M          F                                       5. Nationality____________________
    6.   Full postal address:___________________________________________________________
         _______________________________________________________________
         District: ____________________________ State: _________________________

         Pin code:

    7.   Official communication:
         Tele phone N0. (With STD code):_______________________Tele fax: _____________

         Mobile No.:+91                                / +91
         Email: __________________________________________________________________
    8.   Academic Qualification: ( Use separate sheet, if, necessary)-(Starting From highest Qualification)


           S.No.       Course                             University/Institution                       Year of completion




    9. Profession & Experience: (Use separate sheet, if, necessary)-(Starting form present and fill last 3 professions, if, applicable)




         *-Kindly enclose a copy of photo ID and Address Proof.

      I declare that all the information given by me is complete and correct to the best of my knowledge. I further declare that I shall be
working under Swami Vivekanand Subharti University and I shall abide by all the rules and directions there of.




Date:                                                                                                 Applicant’s Signature & seal
                                                                  SECTION-II
    PROFILE OF THE PROPOSED ACADEMIC HEAD:


   1. Name :_________________________________________________________
   2. Father’s Name :_________________________________________________
   3. Date of Birth :____ - ____ -19_____                                                                                    Latest Color
                                                                                                                             Passport Size
   4. Sex: M               F                                         5. Nationality___________________                        Photograph
   6. Full Postal Address : ___________________________________________
   __________________________________________________________________
   __________________________________________________________________________________
   District: ____________________________________ State: _______________________________

    Pin Code
   7. Official Communication:
   Telephone No. (With STD Code)__________________________Telefax:_______________________

   Mobile No.: +91                                 / +91
   E-mail:_____________________________________________________________________________

   8. Academic Qualification:                (Use separate sheet, if, necessary)-(Starting from the highest qualification)


        S.No. Course                                      University/ Institution                               Year of Completion




   9.     Profession & Experience: (Use separate sheet, if, necessary)-(Starting from the present)




        I declare that all the information given by me is complete and correct to the best of my knowledge. I further declare that I will
        abide by all the rules o Swami Vivekanand Subharti University and the direction given under the same.




Date:                                                                                                       Academic Head’s Signature
                                                                      SECTION-III

INFRASTRUCTURE AVAILABLE:

      1. Host Institution: ________________________________________________________
      2. Year of Establishment: _________________________________________________________
      (Please attach Proof)
      3. Type of the host Institution:                     Trust        Co-operative Society               College UG
            (Thick most appropriate)
Autonomous Institution   Society        College PG & above      Company / Firm
04. Name of all board members with designation: _______________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
05.      Full postal address: _____________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

District: ______________________________________ State: _________________________________

Pin Code:

06. Official Communication:
 Telephone No. (With STD Code)__________________________Telefax:________________________

 Mobile No.: +91                                                            / +91

E-mail:____________________________________ Website: _________________________________

07. Experience in Conducting Academic Programmes in regular/distance made with details:

       S. No.      Course                 Affiliated/Recognized by   Year of Affiliation/Recognition       No. of Students Passed
       01

       Other Details:

       02

       Other Details:


       03
       Other Details:


       04
       Other Details:
       05

       Other Details:
       06

       Other Details:
      (Use separate sheet, if required)




                                                                                                       Applicant’s Signature & seal
Fill the following and enclose proper Proof:
08. Premises Details:             Owned                                           On Rent                   Lease              Others

09. Total carpet area of Institution (sq. ft):_______________________________________________
10. Total site area of Institution (sq. ft):  _______________________________________________
11. HOW TO REACH:
(i)     Nearest Airport                _____________________________________________               Distance from Airport                     _______Kms

(ii)    Nearest Railway station         _____________________________________________              Distance from Railway station             _______Kms

(iii) Nearest Bus Stop                 _____________________________________________              Distance from nearest national state highway _______Kms
12. Infrastructure Details:

        S.NO.       Infrastructure                                                      Units       AREA/SEATING CAPACITY

        1           Class rooms

        2           Computer Laboratory

        3           Library

        4           Reading room. Conference room/ Auditorium

        5           O.H. projector. Multi Media Projector

        6           Administrative Area/ Counseling Rooms


13. Institutional Laboratory and Tie-up Laboratory Details:
         S.NO.       Name of Laboratory                          Owned/ Tie-up Institution/ Lab                       Practical Facilities
         1

         2

         3

         4

         5

         6


14. Library Details:
        S.NO.       Type of Books                               Numbers of units                            List enclosed Yes / No
        1           Reference books

        2           Subject books

        3           Periodicals/ Journals

        4           Newspapers/ Magazines

        5           Course CDs

15. TEACHING STAFF DETAILS:
       Kindly enclose the Bio-Data of faculty members in the following form and attested copy of qualification certificates.
        Name I Father’s Name I Date of Birth I Academic Qualification I Professional I Experience (Teaching & Non-Teaching both ) I
        Level of Association (Full Time/ Part Time) Key Skills I

Total No. of Bio- Data enclosed: ____________________________



                                                                                                                     Applicant’s Signature & seal
   16.NON TEACHING STAFF DETAILS:
   Kindly enclose the Bio-Data of all Non Teaching members in the following format:

     Name! Father’s Name! I Date of Birth! Sex! Academic Qualification! Professional Qualification!
     Experience (Teaching & Non-Teaching both)! Level of Association (Full Time/ Part/ Time)!
     Key Skills! Photocopies of documents attested by Academic Controller.

   Total No. of Bio-Data enclosed: _______________________________

                                                 SECTION IV
   Details of Fee structure for appointment of study Centre & Coordinator in Distance Education
   SVSU, Meerut [I] w.e.f. 01/04/2012
1) Inspection fee – DD of Rs. 10,000/- in favour of "SVSU, Distance Education" payable at Meerut
2) Authorisation Fee – (Kindly refer stream list)- DD in favour of "SVSU, Distance Education"
   payable at Meerut
3) Processing fee Rs. 30,000/-(Non-refundable) DD in favour of "SVSU, Distance Education" payable at
   Meerut

          S.No.    Name of the Stream             DD. No.             Date         Bank

          1

          2

          3

          4

          5

          6

          7

          8


   17. DECLARATION:
   We certify that the particulars furnished above are true to the best of my knowledge. We have no
   objection if the University courses out an inspection to assess the infrastructural facilities and quality of
   the staff etc. We further certify that the host institute shall abide by all the rules and regulations
   prescribed by Swami Vivekanand Subharti University. In case any information furnished by us is found
   wrong or incomplete in any regard, decision taken by Swami Vivekanand Subharti University in this
   regard shall be final and acceptable to us.



   Coordinator’s Signature                                             Academic Head’s Signature

				
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