CENTRE FOR DISTANCE EDUCATION
ACHARYA NAGARJUNA UNIVERSITY::NAGARJUNA NAGAR-522510
Proforma Application Form For Sanctioning
New Learner Support Centre (LSC)
Name of the College and Postal Address
1
with Pin-code
Name of the Educational Society and
2 Registration No. and Date (Enclose copy of
Bylaws)
Name and Address of the Secretary &
Correspondent (Enclose copy of
3 Resolution)
Mobile No
Name of the Principal
4 (Enclose copy of the Appointment order)
Mobile No
Name of the LSC Co-Ordinator
(Qualification Equivalent to Assistant
Professor) (Enclose Copy of the order
issued by the Principal)
Qualifications
Year of Appointment
5
Assistant Professor / Associate
Designation
Professor / Professor
Mobile No (Permanent Number for CDE
Programme - not personal number)
e-mail id (Permanent e-mail id for CDE
Programme - not personal e-mail id)
Name of the Office Assistant identified for
CDE Programme (Enclose Copy of the
6 order issued by the Principal)
Mobile No
Name of Affiliating University and Courses
sanctioned
7 (Enclose copies of affiliation orders)
Year of Establishment of the College
Details of Accommodation
Available (Enclose Building GPS Map Photo)
Building Area
8 No. of Class Rooms
No. of Labs and details
No. of Books in the Library
Availability of Internet facility YES / NO
9 Name of the Website
e-mail id
Information required for fixing of
examination centre:
a. Particulars of Govt. Colleges
located in the same place:
b. Particulars of Aided Colleges located
10
in the same place
c. Particulars of un-aided Degree
Colleges affiliated to local university
d. Particulars of Junior Colleges located
in the same place
e. Govt. High Schools located in the
same place
Note : If suitable colleges are not available
in the same place for fixing of examination
centres, the University will allot examination
Centre in the nearby place or district head-
quarters.
M.Sc. BOTANY
M.Sc. ZOOLOGY
M.Sc. PHYSICS
M.Sc. CHEMISTRY
M.Sc. MICROBIOLOGY
M.Sc. MATHEMATICS
M.Sc. STATISTICS
M.Sc FOOD & NUTRITION SCIENCE
M.Sc. COMPUTER SCIENCE
M.Sc. PSYCHOLOGY
MCA
MBA
M.COM - ACCOUNTANCY
M.COM – BANKING
M.A. ENGLISH
M.A. TELUGU
M.A. SANSKRIT
M.A. HINDI
M.A. ECONOMICS
M.A. HISTORY
List of Programmes for which permission is M.A. POLITICAL SCIENCE
requested for LSC M.A. SOCIOLOGY
11 MSW MASTER OF SOCIAL
(Put the Tick Mark “✓”against the WORK
programmes you want to apply) M.A. JOURNALISM & MASS
COMMUNICATION
M.A. HUMAN RESOURCES
MANAGEMENT
M.L.I.Sc
B.L.I.Sc
B.COM (COMPUTER
APPLICATIONS)
B.COM (GENERAL)
B.B.A. (BACHELOR OF
BUSINESS ADMINISTRATION)
ALL BA
DIPLOMA IN FOOD
PRODUCTION
DIPLOMA IN
PSYCHOLOGICAL GUIDANCE
AND COUNSELLING
CERTIFICATE COURSE IN
HOTEL & HOSPITAL
MANAGEMENT
CERTIFICATE COURSE IN HIV
/ AIDS COUNSELLING
For each programme applied, enclose the
list of minimum three (03) faculty members
identified for Teaching weekend classes.
You are also requested to submit the Bio-
data of individual faculty member as given
12 in Annexure-II along with the certificates of
Qualifications for considering your request.
Without the Bio-data and certificates
along with the Annexure-I list of programme
wise faculty members your application will
be rejected.
For each Science programme applied,
enclose the Programme wise Laboratories
identified for weekend practical classes per
each Science programme. You are also
requested to submit the GPS Map camera
13 Photograph of each Lab identified along with
Annexure-III Programme wise Laboratories
identified for considering your request.
Without the GPS Map camera
Photograph of each Laboratory identified
your application will be rejected.
14 If Any
UNDERTAKING
I hereby declare that we shall conduct weekend classes as per the
norms laid down by the Centre for Distance Education and shall abide by
the rules and regulations of Acharya Nagarjuna University in extending
student support services and we agree to the conditions that the University
reserves the right to withdraw the permission given for offering Programmes
in the event of any deviations or violation of terms and conditions specified in
the MOU.
Signature of the Secretary & Correspondent with Seal
Annexure-I
LIST OF PROGRAMME WISE FACULTY MEMBERS
(use separate sheet for each Programme and enclose the Bio-data and
certificates along with the list of Programme wise faculty members)
PROGRAMME NAME:
S.No. Name of Mobile Email Id Highest Year of Teaching Designation
the Number Educational Appointment Experience (Lecturer /
Academic Qualification (in No of Assistant
Counsellor Years) Professor /
Associate
Professor /
Professor)
1
2
3
Signature of the Principal with Seal
Affix latest
Annexure-II Photograph
BIO-DATA FOR INDIVIDUAL FACULTY MEMBER
(use separate sheet for each Faculty Member)
Name of the Faculty Member
1
& Address
2 Name of the Father
3 Date of Birth
4 Mobile No
5 e-mail id
Educational Qualifications
6
(Enclose Xerox copies of Certificates)
Technical/Professional Qualifications
7
(Enclose Xerox copies of Certificates)
8 Nature of Appointment Full-Time / Part-Time
9 Date of Appointment
10 Previous Experience
Name of the programme being taught
(mention UG / PG Programme name)
11
Presently Teaching Subjects/Courses
Earlier Taught Subjects/Courses
UNDERTAKING
I hereby declare that I am willing to teach the students of CDE,
ANU as per the syllabus prescribed with focus on examination pattern.
Signature of the Faculty Member
Annexure-III
PROGRAMME WISE LABORATORIES
(use separate sheet for each Programme Laboratories and enclose the
GPS Map camera Photograph of each Laboratory identified)
PROGRAMME NAME:
Details of Laboratory No. of Rooms Furniture Equipment
Signature of the Principal with Seal
Date:
From
To
The Director,
Centre for Distance Education,
Acharya Nagarjuna University,
Nagarjuna Nagar-522510.
Respected Sir,
Sub : I furnish the following information as per UGC-DEB Guidelines
2020.
Table A:
Learner Support Type of Staff Full-Time Part-Time
Centre (LSC)
(Give full address)
Academic
Administrative
Technical / Professional
Any other
Total
Table B:
Details No. of Rooms Furniture Equipment
Help Desk cum Pre-
Admission Counselling
Office
Teleconferencing
Library
ICT facility
(with Projector)
Science Labs
Week End
(for Practical)
Week End
Teaching/Counseling
(for Classes)
Any other : Specify
Thanking You,
Yours Sincerely,
Signature of the Principal with Seal
