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PG Guide Ship Application

This document is an application form for recognition as a Post Graduate Teacher in the Nursing faculty, requiring detailed personal, educational, and professional information. Applicants must have a minimum of three years of teaching experience post-graduation and must submit various attested documents. The form must be filled out in block letters and verified by the Principal or Head of the Institution, who will be responsible for the accuracy of the information provided.

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principal.smcn
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2K views3 pages

PG Guide Ship Application

This document is an application form for recognition as a Post Graduate Teacher in the Nursing faculty, requiring detailed personal, educational, and professional information. Applicants must have a minimum of three years of teaching experience post-graduation and must submit various attested documents. The form must be filled out in block letters and verified by the Principal or Head of the Institution, who will be responsible for the accuracy of the information provided.

Uploaded by

principal.smcn
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

APPLICATION FOR RECOGNITION AS POST GRADUATE TEACHER

[Read the instructions carefully before filling up the proforma]


To be filled in BLOCK LETTERS only

FACULTY
NURSING Affix recent
passport size photo
NAME OF THE attested by the
INSTITUTION / Principal
COLLEGE

NAME OF THE
APPLICANT

DESIGNATION

DEPARTMENT/
SPECIALIZATION

DATE OF BIRTH AGE

QUALIFICATION UG PG PhD Any Other

Name of the
University

Name of the Degree

Year of Passing
(DD/MM/YYYY)

Apex body/
Karnataka Council
registration number
TEACHING EXPERIENCE *
(Must have minimum of 03 Years of teaching experience after completing Post graduation)

Designation Name of the Institute From To Total


sl.no DD/MM/YYYY DD/MM/YYYY

TOTAL EXPERIENCE IN YEARS

DOCUMENTS TO BE ENCLOSED.*

(Copies of the documents attested by the Principal / Head of the Institution)

1. Institution’s Affiliation Notification for the present year issued by RGUHS.


2. SSLC Marks card [Proof of Date of Birth]
3. UG & PG Degree Certificate
4. Appointment Order
5. Duty Joining Reports
6. Promotion Orders
7. Teaching Experience Certificates.
8. Karnataka State Nursing Council registration certificate.
9. Form No-16 (If not issued by the current institution, please provide the bank statement for
the salary received from the currently working institution)
10. Notarized Notary (wherever applicable)
*All Criteria are subjected to Modifications/Change as per Apex body Regulations.
Name and Signature of the Applicant Name and Signature of the HOD
with Seal

Endorsement by the Principal / Head of the Institution

The information provided by the teacher is verified from the office records and found to be correct.
I shall take the sole responsibility for any wrong information provided and liable for any action taken by
the university.

Place:
Date:
Signature of the Principal/
Head of the Institution with Seal

Note:
1. The Prescribed Performa must be duly filled by the applicant in his own handwriting and
submitted to the university through the principal’s office.
2. The Principal should verify all the information provided especially, qualification, experience,
and service details and Student: Guide ratio before sending the proforma to the university.
3. Ensure that attested copies of all relevant documents are furnished along with the application.
4. Incomplete / incorrect /applications with false information will be rejected and they are
liable for disciplinary action by the university.
5. Principal will be held solely responsible for any false information provided.

*******

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