RENEWAL FORM FOR STUDY CENTRE - Jrnrvu

RENEWAL FORM FOR STUDY CENTRE
1. Name of the Institution/ Society
Directorate Of Distance Education
Rajasthan Vidyapeeth (Deemed) University
Pratap Nagar,Udaipur, Rajasthan
(for office use only)
www.rvduniversity.com
Name of the Study Centre :________________________________________
Code Number of S.C :____________________________________________
Place :____________________________________________________________
District : _________________________________________________________
State : ____________________________________________________________
Date of Selection : ________________________________________________
Courses Offered : _________________________________________________
Space for Photograph
Paste one recent
passport size
photograph
prefarably colour
of the head of
Institution/ Society
Please do not Pin or Staple
2. Name of the study centre Incharge
3. Complete Address for Correspondence(Do not repeat name) :
State : Pin code :
E-mail Address
Website, if any, then URL
Location : URBAN , SEMI-URBAN , RURAL , BACKWARD
4. Telephone Number : STD Code
(O) :
(R) :
(Mobile) :
(FAX) :
5. Status of the Institution : -
A. Society/ Govt./ University Dept./ Pvt Aided/ Pvt Unaided________________
b. Date of Incorporation/ Commencement of business_______________
c. Nature of Business_________________________________________________
6. Affiliated to / recognized by university/ any body/ any other body(specify)
a. Name of the affiliating body
b. Postal address(with district & pin code)
c. Phone/ fax/ e-mail/ Telex(with appropriate codes)
7. a. Details of Educational Qualification of Head of Organization(From X standard onwards) :
Name of the Qualifying
Examination
Year of
passing
School/College University/Board Percentage

. Work experience of the study centre Incharge
Duration Name of the Organisation Designation Responsibilty
8. Your Survey
a. Population of city/ town :
b. No. of schools and colleges in the area :
9.Faculty (on date of proposal)
Sr.no Name Designation Qualification Teaching Date of Total Status
experience appointment emoulments full/ part time
10.Laboratory Facilities
a.
Sr.No. Name of the Laboratory Available area Maximum Batch size
b. Major equipment/ machine available (details may be enclosed)
11.Library Facilities( details may be enclosed)
No of text/ subject books
No of reference books
No of encyclopedia
No of periodicals
No of Journals
others

12.Infrastructure Facilities (Give a layout of the building, if possible)
Particulars Available Area (sq.ft) No. of Rooms
Staff room
Class room
Laboratory
Library
Reception
Rest/ Guest rooms
Toilets
Any Other
13. .Rajasthan Vidyapeeth Courses which shall be conducted at your centre
Sr.no Course Title Duration Intake Capacity Batches Full/ Part Course fee
per batch per day time
1.
2.
3.
4.
5.
6.
7.
1. Track record of your institute
a. Details of courses conducted during previous year (if any)
b. Is there any placement assistance in your institute?
c. Any other activity carried out?
SEAL OF THE INSTITUTE
Complete application forms for study centres are to be Submitted to : The Co - Ordinator
Regional Service Division
Koteshwar Plaza, Nehru Road
Mulund (W), Mumbai - 400080
Maharashtra, India.
PH : (022)25921598, 25922602, 25922603
Fax : (022)25921598
Website: www.rvduniversity.com
SIGNATURE
HEAD OF THE INSTITUTE
Renewal Forms without following annexures will be considered incomplete and will be liable to be rejected :
1. Self Declaration Form on Stamp Paper of Rs.100/- (Annexure I)
2. Declaration for Training Facilities ( Annexure II)
3. Address Declaration on Letterhead of Study Centre (Annexure III )

On Stamp Paper of Rs.100/-
[Annexure - I]
SELF DECLARATION FORM
I/We hereby apply for the renewal of my/our Study Centre for session 2007-08. I/We
hereby undertake as under :
1. To pay all the outstanding dues.
2. To pay all the fees as per the University Norms.
3. Not to charge any extra fees from the students apart from the fees prescribed
in the prospectus.
4. To have the format of my/our advertisement approved by the University before
I/We release it to the media.
5. To submit all the forms to the University within the prescribed time limit.
6. To deliver minimum number of counselling hours as per the norms of the
University.
7. To individually verify all the documents enclosed with the student forms with
the originals.
8. To take full responsibility of all the documents/correspondences signed by my
staff on my behalf.
9. To abide by all the rules and regulations of the University as promulgated from
time to time.
10. Not to indulge into any sort of criminal/immoral/illegal activity.
I/We further acknowledge that if at any point of time the University finds any
deficiency in my/our infrastructure or in the support services to the students or if
I/we am/are found involved in any sort of unlawful activities, then the university will
have the full right to terminate my/our study centre authorization without seeking
my/our clarification.
For _____________________
Signature of the Study Centre Head
(With Seal/Stamp)

ON THE LETTER HEAD OF THE INCHARGE OF THE TRAINING CENTRE
[Annexure - II]
To,
The Director,
Directorate of Distance Education
J.R. N. Rajasthan Vidyapeeth University
Pratap Nagar, Udaipur-313003 (Rajasthan)
DECLARATION FOR TRAINING FACILITIES
(for the faculty of Engineering Program)
Dear Sir/Madam,
After careful analysis of University minimum norms, I assure you that we have all
facilities as per the requirement of the course
________________________________________ for the students enrolled in Directorate
of Distance Education Janardan Rai Nagar Rajasthan Vidyapeeth University, Udaipur
(Raj.).
We have no objection for the premises being used by the University Program Study
Centre. The University inspection team can visit/inspect the premises at any time.
Name of the Training Centre __________________________________________
__________________________________________
Address
__________________________________________
__________________________________________
__________________________________________
__________________________________________
Phone ________________ Fax _______________
Duration of Agreement from __________ to _____________ (at least for 3 years)
Authorized Signatory of Training Centre
(With Seal/Stamp)
Signature of Study Centre Head
(With Seal/Stamp)

ON THE LETTER HEAD OF THE STUDY CENTRE
[Annexure - III]
ADDRESS DECLARATION
In Case the Study Centre Premises is owned
I, do hereby declare that I own the under mentioned premises which complies with the
University requirement and wherein I intend to run the Study Centre of Rajasthan
Vidyapeeth University.
Address of the Premises
_______________________________________
_______________________________________
_______________________________________
_______________________________________
I submit to you the following documents as address proof of the proposed Study Centre
Premises :
1. Copy of Purchase Agreement.
2. Latest Electricity Bill of the Premises.
For _____________________
Signature of the Study Centre Head
(With Seal/Stamp)
In case the Study Centre Premises is rented
I, do hereby declare that I have acquired the under mentioned premises on
rent/hire/leave& licence which complies with the University requirement and wherein
I intend to run the Study Centre of Rajasthan Vidyapeeth University.
Address of the Premises _______________________________________
_______________________________________
_______________________________________
_______________________________________
I submit to you the following documents as address proof of the proposed Study Centre
Premises :
1. Leave & License Agreement OR NOC from owner.
2. Latest Electricity Bill of the Premises.
For _____________________
Signature of the Study Centre Head
(With Seal/Stamp)