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MANONMANIAM SUNDARANAR U N I V E R S I T Y A state university, Recognized by UGC, DEC Accredited with B++ Grade by NAAC


APPLICATION FORMAT

Date:_____________ The Director Directorate of Distance and Continuing Education (DD & CE) Manonmaniam Sundaranar University Tirunelveli, Tamilnadu Subject :

Application for the appointment of Study Centre Coordinator, 'Authorized Study Centre' (ASC)’

Sir, I have carefully read and understood the duties, roles and responsibilities of the Study Centre Coordinator, Authorized Study Centre (ASC). All the duties to be performed as Study Centre Coordinator, terms and conditions of my appointment are acceptable to me. I hereby submit my application along with detailed Bio-Data and related documents for your kind consideration. You are requested to provide me an opportunity to work as “Authorized Study Centre Coordinator-Authorized Study Centre (ASC) at _______________________________ (location, city and state) of your university of repute. I shall follow the instruction issued to me by the Directorate of Distance & Continuing Education (DD & CE), MSU and Infoster from time to time. The information furnished below is true to best of my knowledge. Yours sincerely, Signature of Applicant with Seal fix self attested recent photograph of applicant


Application Form Name of Institution ______________________________________________________ Full Address___________________________________________________________ _____________________________________________________________________ ___________________________Distt. _____________ Pin code_________________ Phone (with STD Code)__________________________________________________ Fax: ___________________ Url: ________________ E-Mail: ___________________ Institution established year: ______________________________________________ Running courses in present: ______________________________________________ Courses run by Institute of University : ______________________________________ Enrolled students this year _________ last year _________before last year_________ Programmes __________________________________________________________

Society / Trust/ Company Details Name of Society / Trust / Company_________________________________________ Registered under Act____________________________Year_____________________ Is there any other activity running___________________________________________ Established year_________________________Last year turn over________________ Name of Chairman_____________________Secretary _________________________ City_________________Distt.___________________State______________________ Phone_______________________________________Fax;_____________________ Url (If any)______________________________E-Mail : ________________________

Signature of Coordinator with Date


Programme Co-ordinator Details Name of Administrator / Centre Head__________________________________________ Full Permanent address ____________________________________________________ _______________________________________________________________________ _________________________Distt.___________Pin code________________________ Phone (with STD Code)____________________________________________________ Fax________________Url (If any)________________E-Mail:______________________ Academic Qualification ____________________________________________________ Professional Qualification___________________________________________________ Experience______________________________________________________________ Identity Proof_______________________PAN Card No.___________________________

Infrastructure Details Carpet Area________________________Constructed Area____________________ No. of Rooms ___________Rooms Size:__________________________________ Class Room_____________Reception___________Guest Room_______________ Counseling Room____________________Conference Room__________________ Nos. Of Computer ___________________Printers___________________________ Licensed Softwares __________________Network Connectivity________________ Any other facility (attach separate sheet)___________________________________ ___________________________________________________________________

Signature of Coordinator with Date


Faculty Details Full Time Faculty Sr. No.

Name

Academic / Technical Qualification

Experience

Part Time Guest Faculty Sr. No.

Name

Academic / Technical Qualification

Experience

Guest Faculty Sr. No.

Name

Academic / Technical Qualification

Experience

Signature of Coordinator with Date


Rs. 20/- NON JUDICIAL STAMP PAPER (SAMPLE COPY)

I___________________________________________ Son of _________________________________ R/O ________________________________________________________________________________ _____________________________________________________________________________________ solemnly declare that all the information given in Study Center Form and attached information is correct to best of my knowledge and belief. I hereby declare that I am/my Institute has not been involved in any moral turpitude. I agree to abide by the rules and regulations of Manonmaniam Sunadaranar University and Infoster education to accept any modification made by them time to time. I understand that any dispute between Institute and the Manonmaniam Sundaranar University / Infsoter Education will be settled in jurisdiction of Tiruneveli, Tamilnadu. Check List 1, Society / Trust / Company Registration with memorandum (xerox copy). 2, Rent/ Lease agreement. 3. Photograph of Institute (front view, Class Room, Reception). 4, Photograph of Society / Trust / Company Chairpersons and Administrator. 5, List of publications. 6, Detailed list of hardware, software and other equipments in the Library. 7, List of Management members of Institute and Society / Trust / Company with phone and address. 8. Balance Sheet of last 1 year of Society / Trust / Company. 9. Tie-up agreement with local school / colleges / University programme wise covering

Photograph of Society / Trust / Company. Chairperson

Photograph of Administrator / Center Head

Seal and signature of Institute Head/ Administration

Seal and signature of Society / Trust / Company chairman


Resource Provider: ‘Technology Driven Distance-Educations of M.S. University,Tirunelveli, Tamilnadu 1/23 Saroj Bhawan, Stanly Road, Civil Lines, Allahabad – 211 001 Ph: 092514 44040, 094153 38611 Mail: msu.infoster@gmail.com www.infoster.in


http://www.infoster.in/Forms/NewStudyCenterFrom