UGC ACADEMIC STAFF COLLEGE
MIZORAM UNIVERSITY
Tanhril, Aizawl, Mizoram-796009
(Incomplete Form will not be entertained)
APPLICATION FORM
For Participation in the UGC sponsored

ORIENTATION PROGRAMME /REFRESHER COURSE SHORT TERM COURSE
IN SUBJECT OF
Commencing from To
(Strikeout whichever is not applicable and mark √ to your choice)
First Name Middle Name Surname
1.Name of applicant
(In Capital Letters)
2. Date of Birth 3. Sex Male Female
4. Category SC ST OBC General
5. Education Qualifications PG M.Phil Ph.D
6. Name and address of the college/Institution where the applicant is employed :
________________________________________________________ STD Code
________________________________________________________ Telephone No.
__________________________PIN CODE Fax
E-mail
7. University to which the College/Institution is affiliated :
_____________________________________________________________________________________
8. Correspondence Address : STD Code
_______________________________________________ Telephone No.
_______________________________________________ Mobile No.
____________________PINCODE E-mail
9. Designation Asst.Prof. Asst.Prof. (Senior Scale) Asst. Prof. (Selection Grade)/Assoc. Prof.
10. Date of appointment as Ass.Prof.
11. Nature of Appointment Permanent Temporary/Adhoc Part Time Contract
12. Pay Band and AGP OR Consolidated Pay
13. Date or due date of placement In
Asst. Prof. (Senior Scale) and / or
Asst. Prof. (Selection Grade)/ Assoc. Prof.
14. Teaching Experience : Total Y M Degree Classes PG Classes
(In years) at Senior College / University
Teaching subject Specialization
15. Have you attended any Orientation Programme and/or Refresher Course so far ?
If yes, give dates and name and address of the Academic staff College/Institute.
Orientation Programme
(1) Date To
Adress
Refresher Course
(2) Date To
Address
(3) Date To
Address
(4) Date To
Address
16. Hostel Accommodation Required Not Required
I declare that the information given above is correct to the best of my knowledge.
I hereby undertake to participate in all the academic sessions and assignment work during the course
and will abide by the rules and regulations of th UGC Academic Staff College.
Place : _____________________
Date : _____________________ Signature of the Applicant

RECOMMENDATION OF THE FORWARDING AUTHORITY
(1) I recommend Dr./Mr./Ms. ____________________________________ for the Orientation
Programme/Refresher courses in the subject of ___________________________ who has a total teaching experience of _________ years _______ months in our Institution. He/She will be relieved on time to participate in the above course at UGC Academic Staff College. If selected and no work will be allotted to him/her during the duration of the programme.
(2) Certified that this college is affiliate to _____________________ University for the last 5
years.
Place : __________________________
Date : __________________________ Signature of the Principal/Director/ Head
Office
Seal
MIZORAM UNIVERSITY : ACADEMIC STAFF COLLEGE
APPLICATION FORM
(Application form for admission to the Workshop in Computer Application for College Teachers)
1. Full Name (Block Letters) : Dr/Mr./Mrs. ………………………………………………….…….
2. Name of the College/University : ….………………………………………………….…….………….……
3. Designation : Lecturer Senior Lecturer/Reader
4. Date of Birth : …………………………………………………….…….………….…….
5. Gender : Male Female
6. Address for Correspondence : ….………………………………………………….…….………….…….
…………………………………………………….…….………….……..
Phone …………….…….………….…….………….…….…….…….
E-Mail …………….…….………….…….………….…….…….……
7. Nature of Appointment : Regular Temporary
8. Category : SC ST OBC
General
9. Teaching Experience as Lecturer : ………………. (years) ………………. (months)
10. Refresher Courses/ Orientation Courses Attended :
Name of the ASC Course Dates (from-to)
11. Whether accommodation is required in the Mizoram University Guest House : Yes/No
Signature of the Applicant
I hereby certify that,
i) Our College comes under the purview of Section 2(f) of the UGC Act or has been affiliated to
……………………………………………… for at least five years.
ii) The applicant has the teaching experience of ……… years in Undergraduate/Post Graduate
Course(s).
iii) The details of his/her attendance are Refresher Course are entered in the Service Register.
iv) The application of Dr/Mr./Mrs. ………………………………………………………………. for Workshop in
Computer Application for College Teachers is forwarded and recommended to the Director, UGCASC,
Mizoram University, Aizawl for consideration. If selected, he/she will be relieved in time to
participate in the above course.
Signature of the Principal/HoD
(with Seal)
Note: Course Outline:
i) MS Windows XP
ii) MS Word 2007
iii) MS Excel 2007
iv) MS PowerPoint 2007
v) Internet