TRIBHUVAN UNIVERSITY

Higher Education Reforms Project Implementation Office(HERP)

Kirtipur

APPLICATION FORM

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CAMPUS DETAILS:

Campus Name:
Address:
District: ......
VDC: ......
Municipality: ......
Ward No: ...... PO Box: ...... / Telephone: ...... / ......
Fax: ...... / ......
Email: ......
Website:
Date of campus establishment: Day: …………… / Month: …………… / Year: ……………

Enclosed Documents:

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FACULTY / PROGRAM INFORMATION:

Levels / Name of Program
[Write Faculty Name of each program in brackets: e.g.: BBS (Management)] / Affiliating University / Approved Date
(DD-MM-YYYY) / Starting Date
(DD - MM - YYYY)
Bachelor Level / 1
2
3
4
5
6
7
8
Master Level / 1
2
3
4

Please attach approval letters from relevant university regarding the approval of programs.

STUDENT DATA (Based on the Examination Appeared Regular / Full Students Number of the Academic Year 2070/071):

Levels / Name of Program / Total Student Number
Bachelor Level / 1
2
3
4
5
6
7
8
Master Level / 1
2
3
4

Please attach the namelist of students who appeared in regular examinations in the format attached herewith the application form.

GRADUATE NUMBER IN THE LAST TWO YEARS:

Level / Total number of students graduated in the year 2070 / Total number of graduated in the year 2071
Bachelors
Masters
Total

Please attach copies of transcripts or marksheets or markledger (maintained by the campus) along with fully filled namelist attached herewith this application form.

Does the campus have its own land where the campus buildingsare located? / Yes / No

Please attach government approved copy of the building construction map with all relevant documents.

Have all of the campus' immovable assets been registered in the name of the campus? / Yes / No
If 'Yes' then: / Particulars / Remarks
Area of the land
Type
Uses

Please attach 'Lalpurja' of land, a copy of property revenue paid document, and relevant testimonials of regarding immovable assets.

Does the campus have its statute? / Yes / No

Please attach a clear copy of the statute.

Has the campus completed its audit of the Fiscal Year 2072/73? / Yes / No

Please attach a clear copy of audit report of the fiscal year 2072/073.

Does the campus disclose its financial statement and audit report publicly? / Yes / No

Please attach a clear copy of minutes of disclosure statements (in case of reporting to general assembly and/or publication (in case the statement is published in a publication) and/or screen shot of website (in case of disclosure through website)

Does the campus statute include the following provisions clearly?
a. Transfer of all the campus assets to university or government in case of its dissolution / Yes / No

Please specify section number/name, clause and sub-clause number which states the above: ......

b. Clear criteria for membership in management committee, which does not discriminate potential members based on political, ethnic, religious or other affiliation protected by human rights / Yes / No

Please specify section number/name, clause and sub-clause number which states the above: ......

c. Representation of local body in management committee / Yes / No

Please specify section number/name, clause and sub-clause number which states the above: ......

d. Declaration as a non-profit entity / Yes / No

Please specify section number/name, clause and sub-clause number which states the above: ......

Is EMIS unitestablished? / Yes / No

Please attach a copy of minute regarding the decision of management committee for establishment of EMIS unit including the budget allocations.

Is a focal person for EMIS appointed? / Yes / No

Please attach a copy of decision regarding designating / appointing a focal person for EMIS unit.

Does the campus reportto the concerned entities regularly? / Yes / No

Please attach copies of letters from the campus regarding the reporting to the concerned entities.

Does the campus publish annual report regularly? / Yes / No

Please attach a copy of annual report.

Does the campus publish information of public nature through website or any other medium regularly? / Yes / No

Please attach supportive testimonials regarding the regular publication of information of public nature.

Campus Chief:

Name: ...... Campus Seal:

Signature: ......

Note: Please apply signature and campus' seal on each page of the application form.

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