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UGC-HUMAN RESOURCE DEVELOPMENT CENTRE
MANIPUR UNIVERSITY, CANCHIPUR
IMPHAL 795003
APPLICATION FORM
NAME OF THE COURSE:
1. Name of the Participant : _________________________________________________
2. Father’s/ Husband’s Name : _________________________________________________
3. Sex : Male / Female / Others _________
4. Age and Date of Birth : Age ______ Date of Birth _______/________/___________
5. Whether belonging to : UR / SC / ST / OBC ________________
6. Designation : __________________________ Since __________________
7. Address for Correspondence : _________________________________________________
_________________________________ PIN____________
Mob _______________________________________________
E-Mai _____________________________________________
8. Home Address : __________________________________________________
__________________________________________________
9. Name of the College / University : ___________________________________________________
10. Nature of Appointment : Regular/ Adhoc/ Others specify ________________________
11. Date of Joining : __________________Confirmation ______________________
12. Teaching Experience (in Years) : ________________ Sub of Teaching _____________________
13. Educational Qualification : PhD/ MPhil/ PG _______ Subject __________ Year _______
14. Details of Orientation Programmer/Refresher/Short-Term Courses, etc. attended after 2019
Course/Programme
Dates
Place
Orientation Programme
Refresher Course
Short Term Course
Self-declaration by the applicant
I hereby undertake to participate in all the academic sessions and assignment works during the course and
will abide by the rules and regulations of the UGC-Human Resource Development Centre, Manipur
University, Canchipur, Imphal 795003. I have no objection in rejecting my candidature if any of the
information furnished herewith is found to be untrue.
Place: ………………
Date: ……………….
Signature of the Applicant
PHOTO
Office Use Only
Serial No:.
Regd No:
: Recent Advances in Chemical Research
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A. Certificate of recommendation from the Principal/Head of the Department
I recommend Dr /Mr /Ms. ………………………………………………… (Designation) ..…….…………
of Department of …………………………………. of this University/ College/ Institute for the Refresher
/ Orientation / Faculty induction program / Short Term/ Course. The College is affiliated to
……………………………... (University), for the last 2 years at least. The details furnished by the
applicant in the form have been verified to be correct. If selected he/ she will be relieved on time to
participate in the course conducted by the Human Resource Development Centre, Manipur University,
Canchipur through online mode.
B. Certificate from the Principal/Head of the Department that the College /Institute is within the
purview of section 12 (B) and 2 (f) of the UGC Act.
Note: Teachers working in universities and colleges that are included under Section 2(f) of the UGC Act,
even though they may not yet be fit to be included under Section 12 (B), may participate in the
Orientation Programs and Refresher Courses. The teachers of colleges that do not yet come within the
purview of Section 12(B), but have been affiliated to a university for at least two years, will be permitted
to participate in the programs/courses.
Certified that the University/ College/ Institute is within the purview of Section 12(B) and 2(f) of the
UGC Act. The affiliation No. and date of this college is _____________________.
Place: ………………….
Date: …………………..
Signature of the Principal/HOD
(With Office Seal)
Note
The Application form in pdf format can be downloaded from the University website
www.manipuruniv.ac.in/p/ugc-hrdc. All the relevant columns should be neatly typed in. Take a print out
of the filled-in form and sign in the relevant column. Get it recommended and endorsed by the Principal/
HoD concerned. Please create your mail id in gmail domain to enable you to join in g-meet platform.
Scan copy of the duly filled-in the application preferably in pdf format should be submitted to
office.hrdc@manipuruniv.ac.in with copy to director.hrdc@manipuruniv.ac.in before the deadline.
Submission of the hard copy of the application form at the HRDC office will not be accepted.
Applications incomplete in any form/ not duly endorsed by the Principal/ HoD concerned, etc. will not be
considered and rejected ipso facto.
Provisionally selected participants will be intimated through their personal mail id or WhatsApp only. The
provisionally selected list may also be seen from the University website.
Provisionally selected candidates will have to pay a Registration fee of Rs.1000/- (non-refundable)
through online mode only to confirm their participation in the program to Account No. 4900010002689
in favor of the Director UGC HRDC MU at the Bank of Baroda, MU Campus, IFSC Code:
BARB0UNIMAN. Details or screen shot of the payment should be sent to
office.hrdc@manipuruniv.ac.in with copy to director.hrdc@manipuruniv.ac.in
Please download the ‘General Guidelines’ from the University website www.manipuruniv.ac.in/p/ugc-
hrdc and go through it before filling the application form.