U G C ACADEMIC STAFF COLLEGE GOA UNIVERSITY

Ph/Fax : 0832 2452119

Email : ascgu@yahoo.com

asc@unigoa.ac.in

APPLICATION FOR REFRESHER / ORIENTATION COURSE

INCOMPLETE APPLICATIONS WILL NOT BE ENTERTAINED

To:

The Director

UGC-Academic Staff College

2nd Floor,Library Building

Goa University,

Taleigao Plateau,

Goa 403 206

Sir,

I wish to join the Orientation / Refresher Course in _____________________________________

to be held from ____________________ to ______________ I shall abide by the terms and

conditions of the course / programme and will attend each and every session and will participate in

every possible way.

My particulars are given below :

1. Name : Dr./Mrs/Miss/Mr. _________________________________________________________

______________________________________________________________________________

2. Qualifications : __________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

3. Designation : ____________________________________________________________________

Status : Temporary / On probation / permanent :_________________________________________

4. University : ______________________________________________________________________

5. Office Address : __________________________________________________________________

_________________________________________________________Ph. No._________________

Residential Address :_______________________________________________________________

_________________________________________________________Ph. No. ________________

6. Date of Birth : ________________________OBC/SC/ST_____________ Male/Female_________

7. Subject: __________________________ Area of Specialization :__________________________

8. Length of Service : ________________ Years ________________ Months___________________

9. Teaching Experience :_____________________________ Basic Pay Rs. _____________________

a) Degree College : _________________ Years ________________ Months __________________

b) P G Department :_________________ Years ________________ Months __________________

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10. Shortest Route of Journey :_________________________________________________________

11. Do you need hostel accommodation ? Yes / No. ___________

12. Details of Programmes (organised by Academic Staff College) Already attended :

(i) Orientation : Date :__________________________ Name of ASC ______________________

(ii) Refresher : Date : _________________________ Name of ASC ______________________

Date : _________________________ Name of ASC ______________________

13. Details of the other Seminar / Workshops attended : ____________________________________

______________________________________________________________________________

______________________________________________________________________________

14. Publications : a) Articles _________________________________________________________

______________________________________________________________________________

b) Books ___________________________________________________________

_______________________________________________________________________________

The particulars given above are correct to the best of my knowledge

Yours faithfully

Date : ( Signature of the Applicant )

__________________________________________________________________________________

As per the revised guidelines from UGC, vide UGC letter No. F.No. 2-1/98(ASC/ER) dated 5.3.2002 selected

participants have to pay an admission fee (non-refundable) of Rs. 500/- at the time of admission.

Selected participants are requested to bring at the time of registration a DD for Rs. 500/- in the name of the

Registrar, Goa University, payable at State Bank of India, Goa University branch.

——————————————————————————————————————————————————

ENDORSEMENT BY THE H.O.D/PRINCIPAL

To:

The Director,

Academic Staff College

Goa University

Sir,

I am forwarding herewith the application of Shri/Smt. _____________________________________

____ _________________________ who is on the teaching staff of the Department/College for

participation in the Orientation/Refresher course to be held at Goa University, Taliegao Plateau

between _____________________________________________________ both days inclusive. Our

college satisfies with section 2(f) of the U.G.C. Act.

Date… … … … … … … ..

Signature of the H.O.D/ Principal

with

Seal of the Department/ College

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Category: UGC (NET), University