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									                             UGC-Academic Staff College                                                          Affix
                                         Kumaun University, Nainital                                             Recent
                                     The Hermitage, Mallital, Nainital- 263001
                                     Uttarakhand                                                            Kindly enclose an extra
                                                                                                           passport size photograph
                           Phone & Telefax - 05942-236410                                                  with the application form
Application Form for Orientation Programme/ Refresher Course
01. Name of Orientation Programme/ Refresher Course with subject O. P.-               /R.C. in                                         .
02. Date of Commencement of the Programme/ Course
  for which you are an applicant                                     ____________________________________________________
03. State whether you need hostel accommodation?
  (Limited accommodation available)                                  _____________________________________________________
01. Name of applicant with qualification                             _____________________________________________________
02. Address for Correspondence                                       _____________________________________________________
                                                                     _________________________ State_______________________
                                                            E-mail _____________________________________________________
03. Phone No.                         (STD code) ________________(Off)____________________ (Res.)_______________________
                                                                (M) _____________________________________________________
04. Sex                                                              √       Male            / Female
05. Date of Birth

06. Designation & Institution                                        _____________________________________________________

07. Subject                                                          _____________________________________________________

08. Date of regular selection and appointment                        _____________________________________________________

09. Is appointment on contract basis?                                √       Yes          / No          ________________________
   (If yes kindly mention date of appointment)
10. State whether you have attended any other Orientation
    Programme / Refresher Course in the past, if yes, give details____________________________________________________

11. Any chronic medical problem (please state)                       _____________________________________________________

12. Details of Bank Draft                                            _____________________________________________________

I certify that the above information and particulars are correct to the best of my knowledge.

                                                                                                        Signature of the Applicant
I certify that our college is affiliated to the University of …………………….………………............................................,and further
recommended and forwarded that if the candidate is selected in the course, he/ she will be relieved.

                                                                     Signature of the forwarding             Office Seal
                                                                         authority with Seal

The application should reach the office of the Director, UGC-Academic Staff College, The Hermitage, Kumaun University, Nainital
three weeks before the commencement of the course.
                                                     IMPORTANT INSTRUCTIONS
1. Please enclose a Demand Draft of Rs. 500/- payable at Nainital favoring the Director, UGC-Academic Staff College,
   Kumaun University, Nainital towards Registration fees. (Non-refundable)
2. Every participant will be evaluated and grades “A” to “D” will be awarded. Participants getting grade “D” will be
   required to repeat the course without financial commitment to UGC-ASC.
3. Part time/ Ad hoc/temporary/contract teachers who have been teaching for at least three academic sessions in an institution which
  has been affiliated to a University for at least two years may be permitted to participate in the Orientation Programme/ Refresher
  Course to enhance their skills.
  Office-05942-236410, Mobile-9412086515, 9410591695

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