UGC-HUMAN RESOURCE DEVELOPMENT CENTRE
ANDHRA UNIVERSITY :: VISAKHAPATNAM
ANDHRA PRADESH :: INDIA
Application Form
Name of the Course ________________________________________________
1. Name (all caps) Sri/Smt/Mrs/Dr. : …..…………………………………….………….
2. Present Designation & : ………………………….…………………………
College / UniversityAddress …..…………………………………….………….
…..…………………………………….………….
3. Permanent Address (Residential) : …..…………………………………….………….
…..…………………………………….………….
……………………………………………………
4. Date of Birth : …………………………… Sex: …....…………..
5. Date of Joining in the Degree College / : …..…………………………………….………….
University Service (give details of service …..…………………………………….………….
particulars)
6. Teaching Experience (Graduation / Post- : …..…………………………………….………….
graduation)
7. a) Subjects Taught : …..…………………………………….………….
b) Area of Specialization : …..…………………………………….………….
8. Relevance of this course (Promotion / CAS/
: …..…………………………………….………….
Improvement Teaching techniques)
: …..…………………………………….………….
9. Number of courses attended previously
10. Orientation Course : i)…………………………………………………..
Refresher Course / Short term course : ii) ………………………………………………….
(give details of the dates and place) : iii) …………………………………………………
11 State whether you belong to
: …………………………………………………….
ST/SC/BC/OBC
12. Communication :a) Mobile number : …………………………………………………….
b) Email Id : …………………………………………………….
c) College Phone : …..…………………………………….………….
d) College Email Id : ……………………………………………………
Declaration
I hereby declare that all information furnished in this application is true, complete and
correct to the back of my knowledge. I understand that in the event of any information being
found false, incomplete or incorrect, my application / admission is liable to be rejected /
cancelled.
Signature of the Applicant
The candidate will be relieved for the course when selection is made
Signature of the Principal
With Seal
The Principal and the applicant will be held responsible with regard to the date of joining and service particulars
given in the application.
The completely filled in application may be send through following Email address: asc_au@[Link]
Encl: ID proof of the Participant (University/College ID only)