MGU

MAHATMA GANDHI UNIVERSITY

Recognized By University Grant Commission (UGC) Recognized By Distance Education Council(DEC) and Joint Committee of UGC-AICTE-DEC

APPLICATION FORM FOR STUDY CENTRE

A. PROGRAME APPLIED FOR :

IT PROGRAMS MANAGMENT PROGRAMS PROFESSIONAL PROGRAMS TRADITIONAL PROGRAMS SKILL DEVELOPMENT PROGRAMS LATERAL ENTRY PROGRAMS

B. Details of the Institution : Name of the Institution

Name of the Parent Body (Trust/Society/etc.) Year of Establishment Registration No. District & State

Head of the Institution

Name

Designation

Email ID Website Address Telephone Numbers

Mobile Numbers

C. Details of the Management: Member 1 Name Brief Address Designation Email-ID Phone No. Member 2 Name Brief Address Designation Email-ID Phone No. Member 3 Name Brief Address Designation Email-ID Phone No. Member 4 Name Brief Address Designation Email-ID Phone No. Member 5 Name Brief Address Designation Email-ID

Phone No. D. Are You Associated with any University/Institution for Distance or Regular

Education ? If so, give Details.

S.No. Name of the Institution Name of the University/Institute Associated Since(yyyy) Mode (Regular/Distance) Programmes being offered No. Of Students

E. About the Proposed Institution :

Head
Regd. Address (with Pin Code) Address for Correspondence (with Pin Code) Email ID Tel. No. Mobile No. Name of the nearest prime location/Road of your town/city Parking Space Available Is Property Commercial or Residential ? Is Property Owned or Rented ? Total Carpet Area (In Sq.ft.)

Particulars

Nearest MGU Study Center ( Name & Address)

F.Connectivity
Nearest Airport (Name & Distance) Nearest Railway Station (Name & Distance ) Nearest Bus Stand (Name & Distance ) F. Faculty and Staff Details : S.No. Name Deptt.* Designation Qualification Exp. In yrs. Full Time/ Part Time

*Departments: Academics,Administration,Accounts,Database,Support G. Details of the Project Co-ordinator Name Qualification Exp. (In Years) Appointed Since Mobile No.

Email Address

G. Library Details S.No. 1. 2. Category Reference Books Text & subjects Books Count

3. 4. 5.

Journals Subscribed Newspaper Subscribed Course CDs Date:_____________ ____________________________ Authorised Signatory (With Name)

Checklist for Submission of Application Form

S.No. 1. 2. 3. 4. Particulars Registration Certificate & Memorandum of Society, Trust or Company Resolution of Society, Trust or Company for Tying Up with MGU Address proof of Institution (Lease Deed/Rent Agreement/Sale Deed/Ownership Documents) Photo ID Proof of Head of Institution & Project Co-ordinator Yes No

Date:_____________

____________________________ Authorised Signatory (With Name)

(Please take the print on the Institution Letter Pad)

UNDERTAKING I___________________S/O,D/O_____________________R/O________________________________ _______________________submitting the application form Tying up with MGU in the capacity of ____________________Designation of ______________________________(Name of the Institution) here by declare and solemnly affirm that: 1. I have carefully read and understood all the guidelines, specifications and other information published by the Mahatma Gandhi University on the Website. 2. I agree to adhere to all the norms, guidelines etc. and to fulfill all the formalities and submit the documents as prescribed from time to time by the Mahatma Gandhi University and other competent authorities. 3. I understand and agree that fees paid by me with the application form or on account of processing fee, for conduct of inspection, for grant of approval of my application or any other fee or charges, as prescribed for tying up once paid, will be non-refundable. Withdrawal of my proposal or rejection by the University at any stage for reason whatsoever shall not entitle me to claim any amount or compensation from the University. 4. In case of any disputes or for any unforeseen issue(s) or issues not covered in the guidelines, specifications and other information published by the University, the decision of the University shall be final and binding on me and all other concerned. 5. I agree that the University reserves the right to withdraw any location or any Discipline/Programme or its nomenclature at any time without assigning any reason and to make modifications in any information published anywhere whenever deemed necessary. 6. In the event of any disputes between the parties, which are not covered bt the arbitration clause, the courts of Meghalaya shall have exclusive jurisdiction.

Date:_____________

____________________________ Authorised Signatory (With Name)

Kindly put institution PHOTOGRAPHS