Ea Form PDF Details

In the continually evolving landscape of higher education, the importance of maintaining and extending academic affiliations through structured processes cannot be overstated. The "Application Form for Extension of Affiliation (By Natural Growth) (UG)" specifically caters to colleges and institutions currently affiliated with the Maharashtra University of Health Sciences, Nashik, seeking to expand their academic offerings to the next higher class or level of undergraduates. This form is pivotal for the academic year 2016-2017, serving as a detailed request to the Registrar of Maharashtra University of Health Sciences under the aegis of Section 69 of the Maharashtra University of Health Sciences Act, 1998. It meticulously outlines the requirement for submission, including the necessity of forwarding three copies of the application armed with a Demand Draft for the prescribed fee before the stipulated deadline in October. The form encompasses comprehensive details such as the name and address of the college, payment details, information concerning the initial affiliation, and specifics about the requested extension including the anticipated number of students, faculty details, existing and required infrastructure and teaching facilities, and the legal endorsements or approvals that affirm the institution’s status and capability to elevate its educational provision. Additionally, the document emphasizes compliance with university statutes, ordinances, rules, and regulations, underscoring the methodical approach required to ensure a successful extension of affiliation by natural growth.

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Form NameEa Form
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Avg. time to fill out2 min
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Proposal for academic year

College Code

 

 

 

 

 

 

 

 

 

 

 

(For Office use only)

 

2016 - 2017

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Maharashtra Universit y of Health Sciences, Nashik

Application Form for Extension of Affiliation (By Natural Growth) (UG)

(Under Section 69 of the Maharashtra University of Health Sciences Act, 1998)

Course : BASLP

Instructions : The College / Institutions presently affiliated to this University applying for Extension of Affiliation by Natural Growth shall submit three copies of application forms with D.D. of prescribed fee drawn in favour of the “Registrar, Maharashtra University of Health Sciences, Nashik” on any Nationalised Bank on or before the last day of October of the year preceding the year from which the Extension of Affiliation by natural growth is sought.

(Please refer fee Schedule)

To,

The Registrar

Maharashtra University of Health Sciences,

Mhasrul, Dindori Road,

Nashik – 422 004.

Sir,

I am / we are submitting herewith an application with a request for Extension of affiliation for next higher class in this College / Institute for the academic year 2016 – 17 under section

69 of the Maharashtra University of Health Sciences Act, 1998:

1) Name and address of the

 

 

 

 

 

 

 

 

College / Institute :

_________________________________________

 

_________________________________________

 

_________________________________________

 

_________________________________________

 

PIN code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone No. (O) _____________________________

 

 

_____________________________

 

Fax No.

_____________________________

 

Email Address : ____________________________

2) Payment details :

i) Name of the drawee Bank : __________________

 

__________________________________________

ii)D.D. No. _____________ Dated ______________

iii)Amount Rs. _______________________________

iv)University Receipt No. & Date ________________

(For Office use only)

3)(a) Date and Number of First Affiliation letter :____________________________________

(Attach Xerox Copy)

OR

b) Date and Number o First Affiliation letter for increase intake :_______________________

(Attach Xerox Copy)

 

 

 

4) Request for Extension by Natural Growth

(Please tick in the appropriate box)

i.e. from

First Year to Second Year

 

 

 

 

 

 

 

Second Year to Third Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Internship Training

5)Date and Number of First Affiliation letter : _______________________________________

(Attach Xerox Copy)

6)Whether it is obligatory to start the above Next Higher Class under the provisions of Statutes / Ordinance / Rules / Regulations framed by the University ?

If yes, give reasons thereof :

7)Anticipated number of students to be enrolled for the above : ________________________

(Give details for each Class)

8)Whether the College has created infrastructure teaching facilities for the Next Higher Class including the existing facilities. If yes,

a.Attach list of approved Teaching Staff as per the proforma.

(As per format attached)

b.Attach list of Non-teaching Staff.

c.Information regarding Hospital :

(As per proforma attached)

d.Information regarding teaching facilities at College.

(As per proforma attached)

9)Information regarding College Establishment :

a.Date of Establishment of the College : ____________________________________

b.Latest Central Council approval letter : No. _______________ Dated____________

(Attach Latest Xerox copy of letter)

c.Latest Central Govt. approval letter : No. ________________ Dated____________

(Attach Latest Xerox copy of letter)

d. Latest permission from Maharashtra Govt. G.R. No. _____________Dated________

(Attach Latest Xerox copy of GR)

10) Status of affiliation :

(Tick mark the appropriate box)

Permanent

Temporary (Yearly)

Periodic

11) Sanctioned intake capacity by the University

__________________________________

12) Name of the Principal

:-

Nature of appointment

:-

(Tick mark the appropriate box)

 

___________________________________________

Permanent

Temporary

 

Officiating

 

 

 

 

Approved

Not Approved

 

 

 

 

 

(If approved attach Xerox copy of approval letter)

 

 

 

 

 

Residential Address

:-

___________________________________________

 

 

___________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

PIN Code :-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone No. (Office)

______________________

 

 

(Resident)

______________________

 

 

(Mobile)

______________________

 

 

(Fax)

______________________

 

 

Email Address : ____________________________

Place _________________________

Name and Signature of the Principal

Date ________________________

Seal of the College.

CHECK - LIST

(Extension of Affiliation by Natural Growth (UG))

(Please attach papers as per check list)

Sr. No.

Documents description

1.Demand Draft of prescribed fees

2.First Affiliation letter

3.Details for each class

4.Undertaking by Dean/Principal

regarding remittance of outstanding affiliation fee

5.Information about approved teaching staff

6.Information about non-teaching staff

7.Information regarding Hospital

8.Information regarding teaching facilities at College

Enclosed at Page No. of application form

Yes Appendices Page No.

A

B

C

D

E

F

G

H

(On College letter head)

Appendix ‘D’

Undertaking by Dean/Principal regarding remittance of outstanding Affiliation Fee

I, Principal of _____________________________________College hereby

undertake the responsibility to remit the outstanding affiliation fee of Rs_______________/- within three months from the date of Inspection, I am aware of the

fact that if the said fee is not remitted in due period, the affiliation of our College will not be granted for the academic year_______________.

Date :

Place:

Dean / Principal

Faculty : Allied Health Sciences

 

 

 

 

 

 

 

Appendix ‘E’

 

 

 

 

 

Statement Showing the Information of Approved Teaching Staff

 

 

 

 

 

Name of the College

:

 

 

 

 

 

 

 

 

 

 

 

 

Intake Capacity

 

:

 

 

 

 

 

 

 

 

Date :

 

 

 

Sr.

Name of the

 

 

Qualifica-

Date of

Date of

Date of

Phone No.

 

 

Experience

 

 

No. & Date

Designa-

M/F

Subject Category Appoint-

Retire-

(R) & (M)

E-mail Prof.

A.P.

 

 

 

of letter of

No

Teacher

tion

Birth

Lect.

Tutor

ment

 

tion

 

ment

 

 

 

 

Approval

 

 

 

 

 

 

 

 

 

 

 

 

1

2

3

4

5

6

7

8

9

10

11

12

13

14

Seal & Signature Dean / Principal

Appendix ‘G’

Faculty : Allied Health Sciences

Proforma regarding Information of Hospital

Courses : Occupational Therapy, Physiotherapy, Prosthetics & Orthotics & B.A.S.L.P.

1.

Own MCI recognized hospital / affiliated hospital

 

Medical College

: Yes / No

2.

Bed Strength

: ……………………...

3.

Whether minimum 300 bedded Allopathic

: Yes / No

4.

Daily OPD

: ………… IPD : …………

5.

Annual occupancy

: ……………………...

6.

ICCU Bed Strength

: ……………………...

7.

Laboratory

: ……………………...

8.

Casualty Department

: ……………………...

9.

Equipments

: Adequate / Inadequate

10. Paramedical Staff

: Adequate / Inadequate

11. Total Built up area of Hospital

: Sufficient / Insufficient

12. Student Patient Ratio

: ……………………….

13. Bed occupancy

: ……………………….

14. Other, if any

:………………………..

Date :

Signature of Dean / Principal

Appendix ‘H’

Faculty : Allied Health Sciences

Proforma regarding information of College infrastructure, Library & Hostel etc.

Courses : Occupational Therapy, Physiotherapy, Prosthetics & Orthotics & B.A.S.L.P.

A) College infrastructure :

i. Own land (enclosed 7/12 extract / property card) : …… Acres

ii. Own College Building

: Yes / No.

iii. Built-up area

: ..………………. Sq. Ft.

B) Library :

 

i. No. of Books available

: ……………………….

ii. No. of Journals available

: ………………………..

iii. Reading room for staff

: Available / Not available

iv. Reading room for students

: Available / Not available

C) Hostel :

 

i. Girls Hostel

: Own / Rented, Capacity : …..

ii. Boys Hostel

: Own / Rented, Capacity : …..

D) Number of Lecture Hall

: ……………………..

Capacity of each Hall

: ……………………..

E) Gymkhana Facility

: Yes / No.

Date :

Signature of Dean / Principal

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3. This third section should also be quite straightforward, Payment details, i Name of the drawee Bank, ii DD No Dated, iii Amount Rs, iv University Receipt No Date, a Date and Number of First, Attach Xerox Copy, b Date and Number o First, Attach Xerox Copy, Request for Extension by Natural, ie from, First Year to Second Year, Second Year to Third Year, Internship Training, and Date and Number of First - every one of these empty fields must be completed here.

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