A Statutory Body of the Govt. of India

All India Council for Technical Education

(A Statutory Body of the Govt. of India)

Ministry of Human Resource Development, Govt. of India

Nelson Mandela Marg, New Delhi - 110067

Expression of Interest for Participation in proposed

Leadeship and Development Programme under UKIERI Phase-III

Note:

This is a proposed programme and will be conducted only after approval of Competent Bodies.

The short listing of the applicants for Leadeship and Management Programme under UKIERI Phase-III will be done by a duly constituted Committee.

Applicants participated in similar Workshop under UKIERI/VELT/One week residential programme under PMKVY-TI will not be considered for Leadership Programme under UKIERI Phase-III.

Personal Details:

Name
Date of Birth
Gender
Category
Post held
Pay Scale and Present Basic Pay (with effective date)
Total Experience
Address
Contact Number
E-mail

Educational Qualification (From Diploma/Degree onwards)

Degree/Diploma

University/Board

Year of Award

Class

Experience:

Period / Position /Designation / Institution / Job Responsibilities
From / To

B :Institutional Details :

Permanent ID
Name of Institute
Year of Establishment
Address
City
State
Pin Code
Type of Institute
(Government/Aided/Private)
Name of Head of Indtitution
Contact Number
Mail ID
Number of MoU/Agreements with Industries (If any)
Total Income from Consultancy during FY 2015-16 (If any)

C: Further Information Details

Please give an overview of your Institute (size, courses etc).(Max 200 words)
What, in your opinion, are the main developments or changes you would like to see happen in your institution over the next 2 years in the field of Academics/ Administration/ Governance. (Max 200 words)
What do you see as the main challenges or potential barriers for successfully implementing the above developments?(Max 200 words)
How participation in Leadership and Development Programme under UKIERI-III will help in transforming and improving the Quality of your Institution?(Max 200 words)

Above information are correct and I have not attended any similar programme under UKIERI/VELT.

(Name and Signature of applicant)

This is to certify that all the above information related to ...... and Institute...... are verified from the records and are correct to best of my knowledge. In case the applicant is selected for the programme he/she will be relived as per the schedule of the training.

(Signature of Head of Institute with Seal)

Date:

Place:

Note: The scanned copy of completed application should be sent by e-mail to latest by 28th April, 2017 (Closing time 05:00 pm). Application after due date will not be considered. Incomplete application/application not signed by Head of Institute will not be accepted.