Application form for teacher for stage wise promotion under CAS of UGC
as per 4th Amendment

PART A : GENERAL INFORMATION

1)	Name (in Block Letters) :		

2)	
Father's Name/Mother's Name :		

3)	
Cast :	
Category :	

4)	
Department / College :		

5)	
Current Designation & Grade Pay :		

6)	
Date of Last Promotion :		

7)      Address for correspondence (with Pin code)

8)      Permanent Address ( with Pin code)

9)      Mobile No.:                                       Resi. No.

10)    Whether acquired any degree or fresh academic qualifications during the year :

11)    Academic staff college Orientation / Refresher Course attended during the year :

Name of the Course
Summer School	Place	Duration	Sponsoring
Agency	

				

Name of Candidate  :             	

Applied for the Post  of                                                                  Stage (               to                )

College :

Academic Year

Note : Candidate need to submit Category-I for each academic year separately for whole assessment period.

CATEGORY-I
TEACHING, LEARNING AND EVALUATION RELATED ACTIVITIES

Nature of Activity	Assistant
Professor	Associate Professor	Professor	API Score	API Score (for office use)	Encl. No.	
	Max. Score	Actual Score	Max. Score	Actual Score	Max. Score	Actual Score				
a. Direct Teaching	
70	Actual hours spent per	
60	Actual hours spent per	
60	Actual hours spent per				
		academic year ÷7.5		academic year
÷7.75		academic year
÷7.75				
b.            Examination
duties           (question paper              setting, Invigilation, evaluation  of  answer scripts)       as       per allotment	

20	Actual
hours spent per academic year ÷10	

20	Actual
hours spent per academic year
÷10	

10	Actual hours
spent per academic year
÷10				
c.               Innovative
Teaching   - learning methodologies, updating   of   subject contents/courses, mentoring etc.	

10	Actual hours spent per academic year ÷10	

15	Actual hours spent per academic year
÷10	

20	Actual hours spent per academic year
÷10				

Total (a+b+c )				

Note :

1.   Direct   Teaching   16/14/14   hours   per   week   include   the   Lectures/Tutorials/Practicals/Project
Supervision/Field Work. .
2.  University may prescribe minimum cut-off, say 75%, below which no scores may be assigned in these sub-categories.
3.  In consonance with established academic and teaching traditions, and with a view to reinforcing a student-centric and caring approach the teachers are encouraged to work with students, beyond the structure of classroom teaching. Indicatively, this could entail mentoring, guiding and counseling students. In particular teachers would be the best placed to identify and address the needs of students who may be differently abled, or require assistance to improve their academic performance, or to overcome a disadvantage. There are no prescribed hours for such efforts, measured either in weeks or months, or in the context and calculation of the API scores, these are nevertheless important and significant activities that could be carried out by teachers.

Name of Candidate  :             	

Applied for the Post  of                                                                  Stage (               to                )

College :

Academic Year

Note : Candidate need to submit Category-II for each academic year separately for whole assessment period.

CATEGORY-II
PROFESSIONAL DEVELOPMENT,  CO-CURRICULAR  AND EXTENSION ACTIVITIES

Cate- gory II	
Nature of Activity	
Maximum
API Score	
Actual score	API Score	API Score (for office use)	Encl. No.	

a.	Student related co-curricular, extension and field based activities.
(i)  Discipline related co-curricular activities (e.g. remedial classes, career counselling, study visit, student seminar and other events.)
(ii) Other co-curricular activities (Cultural, Sports, NSS, NCC etc.) (iii) Extension and dissemination activities (public /popular
lectures/talks/seminars etc.)	

15	
Actual hours spent per academic year ÷10				

b.	Contribution   to  corporate   life  and
management   of  the  department   and
institution  through  participation  in academic and administrative  committees and responsibilities.
i). Administrative responsibility (including as Dean / Principal / Chairperson / Convener / Teacher-in-charge/similar other duties that require regular office hrs for its discharge)
(ii). Participation in Board of Studies, Academic and Administrative
Committees	

15	

Actual hours spent per academic year ÷ 10				
c.	Professional   Development   activities   (such   as
participation   in  seminars,
conferences, short term training courses, industrial experience, talks, lectures	

15	Actual
hours spent per				
	in refresher / faculty development courses,
dissemination  and general articles
and any other contribution)		Academic
year ÷ 10				

Total  (a+b+c)				

Name of Candidate  :             	

Applied for the Post  of                                                                  Stage (               to                )

College :

Academic Year

Note : Candidate need to submit Category-III for each assessment year separately for whole assessment period. It may not be as per academic year.

CATEGORY-III
RESEARCH AND ACADEMIC CONTRIBUTIONS

A      Details of Research Papers Published

A.1     Refereed Journals as notified by the UGC

Sr.
No.	Title of the Article	Author	Co-
Authors	Name of the
Journal Vol. No. & pp with UGC Sr No.#	International
/ National	Impact
factor as it published	API
Score	API Score
(for office use)	Encl.
No.	

										
#Candidate has to mention serial number of Journal as per UGC notification

A.2   Other Reputed Journals as notified by the UGC

Sr. No.	Title of the Article	Author	Co- Authors	Name of the Journal Vol. No. & pp with
UGC Sr No.#	International
/ National	Impact factor as it published	API Score	API Score (for office use)	Encl. No.	

										
#Candidate has to mention serial number of Journal as per UGC notification

Categ ory
III	Activity	Faculty of Sciences /
Engineering / Agriculture /
Medical / Veterinary
Sciences	Faculties of Languages /
Humanities / Arts /
Social Sciences / Library
/ Physical education / Management	Maximum score for
University / College teacher*	API Score	API Score (for office use)	Encl. No.	

(A)	Research
Papers published in	Refereed Journals as
notified by the UGC#	Refereed Journals as notified by the UGC#	
25 per Publication				
		Other Reputed Journals
as notified by the UGC#	Other Reputed Journals as
notified by the UGC #	
10 per Publication				

Total		

B      Details of Publications other than journal articles (books, chapters in books)

B.1	Details of Text / Reference Books, published by International Publishers, with ISBN/ISSN number as approved by the University and posted on its website. The List will be intimated to UGC.

Sr.
No.	Title of the Book	Author	Co-Author(s)	Name of the
Publisher, Month, Year	ISBN /
ISSN	API
Score	API Score
(for office use)	Encl.
No.	

									

									

B.2     Details of  Subject  Books,  published  National  level  publishers,  with  ISBN/ISSN  number  or  State  Central  Govt.
Publications a approved by the University an posted on its website. The list will be intimated to UGC.

Sr.
No.	Title of the Book	Author	Co-Author(s)	Name of the
Publisher, Month, Year	ISBN /
ISSN	API
Score	API Score
(for office use)	Encl.
No.	

									

B.3     Details of Subject Books, published by other local publishers, with ISBN/ISSN number as approved by the
University and posted on its website. The List will be intimated to UGC.

Sr. No.	Title of the Book	Author	Co-Author(s)	Name of the
Publisher, Month, Year	ISBN / ISSN	API Score	API Score (for office use)	Encl. No.	

									

B.4     Details of Chapters in Books, published by National and International level publishers, with ISBN/ISSN
number as approved by the University and posted on its website. The List will be intimated to UGC.

Sr.
No.	Title of the
Book	Name of
the Editor	Chapter
contributed	Author  / Co- Author(s)	Name of
the
Publisher	ISBN /
ISSN	API
Score	API Score
(for office use)	Encl.
No.	

										

Categ
ory
III	Activity	Faculty of Sciences /
Engineering / Agriculture
/ Medical / Veterinary
Sciences	Faculties of Languages /
Humanities / Arts / Social Sciences / Library / Physical education / Management	Maximum score
for
University / College teacher*	API Score	API Score (for office use)	Encl. No.	
(B)	

Publications other than
journal articles (books, chapters in
books)	Text/Reference,  Books
published by International Publishers, with ISBN/ISSN number as approved by the University and posted on its website. The List will be intimated to UGC.	
Text/Reference Books, published by International Publishers, with ISBN/ISSN number as approved  by the University and posted on its website. The List will be intimated to UGC.	

30 per Book for
Single Author				
		Subject       Books,      published
by
National level publishers, with ISBN/ISSN number or State / Central  Govt. Publications  as approved   by  the   University and posted   on   its   website. The   List will be intimated to UGC.	Subject      Books,
published     National     level publishers,     wit
ISBN/ISSN     number    or State Central      Govt. Publications      a approved by   the   University    an posted  on its website.  The List  wil be intimated to UGC.	

20 per Book for Single Author Author				
		Subject Books, published by
Other local publishers, with ISBN/ISSN number as approved by the University and posted on its website. The List will be intimated to UGC.	Subject   Books,   published
by Other
local publishers, with ISBN/ISSN number as approved  by the University and  posted  on  its website. The  List  will  be  intimated to UGC.	

15 per Book for
Single Author				
		Chapters in Books, published
by
National and International level publishers, with ISBN/ISSN number as approved by the University and posted on its website. The List will be intimated to UGC.	Chapters in Books,
published by
National and International level publishers, with ISBN/ISSN number as approved by the University and posted on its website. The List will be intimated to UGC.	

International –10 per Chapter
National – 5 per
Chapter				

Total				

C       Details of Research Projects

C.1      Sponsored Projects

Sr.
No.	Title of the
Project	Funding
Agency	Grant
Sanctioned	Duration	Project
Status
Completed
/ on- going	Project
Type Research/ Consult	Policy
Document	API
Score	API
Score (for office use)	Encl.
No.	
				From	To							

												

												

C.2      Consultancy Projects

Sr.
No.	Title of
the
Project	Funding
Agency	Grant
Sanctioned	Duration	Project
Status
Completed
/ on- going	Project
Type Research/ Consult	Policy
Document	API
Score	API
Score (for office use)	Encl.
No.	
				From	To							

												

C.3      Research Projects Outcome / Outputs

Sr.
No.	Title of
the
Project	Funding
Agency	Grant
Sanctioned	Duration	Project
Status
Completed
/ on- going	Project
Type Research/ Consult	Policy
Document	API
Score	API
Score (for office use)	Encl.
No.	
				From	To							

												

(C)	
RESEARCH PROJECTS	
Categor
y  III	Activity	Faculty of Sciences /
Engineering / Agriculture /
Medical / Veterinary
Sciences	Faculties of Languages /
Humanities / Arts / Social Sciences / Library / Physical education / Management	Maximum score for
University / College teacher*	API Score	API Score (for office use)	Encl. No.	
(C)(i)	Sponsored
Projects	(a)   Major Projects
with grants above Rs.
30 lakhs	Major Projects with grants
above Rs. 5 lakhs	20 per Project				
		(b)    Major Projects
with grants above Rs.
5 lakhs up to Rs. 30 lakhs	Major Projects with grants
above Rs. 3 lakhs up to
Rs. 5 lakhs	15 per Project				
		(c)   Minor Projects
with grants above  Rs.
1  lakh  up  to  Rs.  5 lakhs	Minor Projects with grants
above Rs. 1 lakh up to
Rs. 3 lakhs	10 per Project				
(C)(ii)	Consultancy
Projects	Amount mobilized with
a minimum of Rs.10 lakhs	Amount mobilized with a
minimum of Rs. 2 lakhs	10 for every Rs.10 lakhs and Rs.2 lakhs, respectively				

(C) (iii)	

Projects
Outcome / Outputs	

Patent / Technology transfer / Product / Process	Major Policy document
prepared for international bodies like WHO/UNO/UNESCO/UNICEF etc. Central  / State Govt./Local Bodies	30 for each International /
20 for each  national level output or patent.
Major policy document of International bodies – 30, Central Govt. – 20, State Govt.-10
Local bodies – 5				
				Total				

D        Research Guidance

D.1      Details of M.Phil Awarded

Sr.
No.	Name of the
Scholar	Title of the
Thesis	Submitted	Awarded	University	Month
and
Year	API
Score	API
Score (for office use)	Encl.
No.	

										

D.2      Details of Ph.D. awarded  / Thesis submitted

Sr. No.	Name of the
Scholar	Title of the Thesis	Name of the
University	Month
and Year	API
Score	API Score
(for office use)	Encl.
No.	

								

(D)	
RESEARCH GUIDANCE	
Categ
ory
III	Activity	Faculty of Sciences /
Engineering / Agriculture / Medical / Veterinary Sciences	Faculties of
Languages /
Humanities / Arts / Social Sciences / Library / Physical education / Management	Maximum score for
University / College teacher*	API Score	API Score (for office use)	Encl. No.	
(D) (i)	M.Phil.	Degree awarded	Degree awarded	5 per candidate				
(D)
(ii)	
Ph.D.	Degree awarded / Thesis submitted	Degree awarded / Thesis submitted	
15/10 per candidate				

E       Details of Fellowships, Awards and Invited lectures delivered in conferences / seminars
E.1    Details of Fellowships/ Awards

Sr.
No.	Name of the
Fellowship / Awards	Organizer	International /
National / State / University level	Awarded	Date	API
Score	API
Score (for office
use)	Encl.
No.	

									

E.2    Details of Invited  lectures / papers

Sr. No.	Title of the
Article	Author	Co- Author(s)	Name of the Programme	Organiser	Date	International
/ National / State / University level	API Score	API Score (for office use)	Encl. No.	

E	Fellowships, Awards and Invited lectures delivered in conferences / seminars	
Categ
ory
III	Activity	Faculty of Sciences /
Engineering / Agriculture / Medical / Veterinary Sciences	Faculties of Languages /
Humanities / Arts / Social Sciences / Library / Physical education / Management	Maximum score for
University / College teacher*	API Score	API Score (for office use)	Encl. No.	

(E) (i)	

Fellowships/ Awards	International
Award/Fellowship from academic bodies	
International Award / Fellowship from academic bodies/associations	
15 per Award / 15 per
Fellowship				
		National
Award/Fellowship
from academic bodies	National Award/Fellowship
from academic bodies/associations	10 per Award / 10
per Fellowship				
		State/University level
Award from academic bodies	State/University level Award
from academic bodies /
associations	
5 Per Award				
(E)
(ii)	Invited
lectures /
papers	International	International	7 per lecture /
5 per paper presented				
		National level	National level	5 per lecture /
3 per paper presented				
		State/University level	State/University level	3 per lecture /
2 per paper presented				
	The score under this sub-category shall be restricted to 20% of the minimum fixed for Category III for any assessment period				

F        Development of e-learning delivery process/material

Sr.
No.	Name of the
Fellowship / Awards	Organizer	International /
National / State / University level	Date	API
Score	API Score
(for office use)	Encl.
No.	

								

(F)	Development of e-learning delivery process/material	10 per module	API
Score	API Score
(for office use)	Encl.
No.	

Total API Score (A+B+C+D+E+F)

API Score             API Score (for Office Use)

I certify that the information provided is correct and best of my knowledge.

Place & Date:                                                                                               Signature of Candidate

Note :       Each proof submitted shall be in proper sequence with enclosure number. If candidate submits a proof for Research Paper for Category III.A.1. Referred Journal then enclosure number should be A1.1 for 1st  paper, for 2nd  paper, A1.2, for 1st  paper of category III.A.2. enclosure number A2.1 for
2nd  paper A2.2 and so on for each category. Such enclosure number should be mentioned on proof
enclosed with same numbers. Date of research papers should be highlighted.

PART C : OTHER RELEVANT INFORMATION

Please give details of any other credential, significant contributions, awards received etc. not mentioned earlier.

S. No.	Details (Mention Year, value etc. where relevant)	

		

		

		

		

I certify that the information provided is correct as per records available with the university /
department and/or documents enclosed along with the duly filled PBAS proforma.

Signature of the faculty with
Designation, Place & Date

I certify that the information provided is correct as per records available with the university/
department  and/or documents enclosed along with the duly filled PBAS proforma.

Signature of Principal with seal

PART – D : SUMMARY OF API SCORE

Name of Candidate:                                                                          Stage (       to         )

Academic
Year	Category - I	Category - II	
	A	B	C	Total
API Score	A	B	C	Total
API Score	
2009-2010									
2010-2011									
2011-2012									
2012-2013									
2013-2014									
2014-2015									
2015-2016									
2016-2017									
Total									

Summary of Total API Score obtained for Category III  (A+B+C+D+E+F) Assessment Period from                             to  		
Year	API Score	Total
API Score	
Entire Assessment Period	A	B	C	D	E	F		
from                           to  									
from                           to  									
from                           to  									
from                           to  									
from                           to  									
from                           to  									
from                           to  									
from                           to  									
from                           to  									

Category	Criteria	Total-API Score for Assessment Period	Annual Average API Score for Assessment Period	
I	Teaching, Learning and Evaluation related activities			
II	Professional Development,  Co-Curricular
And Extension Activities			
III	Research And Academic Contributions			
	Total ( Category II & III)			

PART E : MAJOR PUBLICATIONS FOR ASSESSMENT BY THE EXPERTS

Name of Candidate :             	 Applied for the Post of                                                                  Stage (               to                )
College :

Sr. No.	Title of the Paper/ Book	Publisher	Edition	Date of
Publication	Name of
Co-Authors	
1						
2						
3						
4						
5						

Date of placement in Assistant Professor Stage-II / Lecturer (Senior Scale):  	

N

Note :

1.    5 best major publications for assessment in case of  Professor.
3 best major publications for assessment in case of Associate Professor.
2.	For the post of Professor, an applicant shall submit the publications from which he/she was placed in the Assistant Professor stage-II (AGP Rs.7,000/-) or Lecturer (Senior Scale).
3.	An Associate Professor who wishes to be considered for Professor is requested to submit only such research papers/publications which he/she had  not submitted earlier for promotion of Reader/ Associate Professor for assessment by subject experts.
4.    Candidate needs to submit proof of availing Assistant Professor Stage-II/Lecturer (Senior Scale).
5.     Candidate needs to submit copy of publications in four sets.

Signature of Candidate

VEER NARMAD SOUTH GUJARAT UNIVERSITY
University Campus, Udhna-Magdalla Road, SURAT –7

PART F : SYNOPSIS OF APPLICATION

Name :

Applied for the Post of                                 Stage (       to        ) College :

Sr.
No	Age with
D.O.B.	Present post
& Date	Qualifications	Specializations	Project if
Any	Teaching
Experience	No.  of
years	Research
Experience	
Publications	Remarks if any	
			  B.Sc., B.Com., B.A.,			Lecturer			Books  	

Articles 	 published, Research 	 Papers, Journal  			
			  M.Sc., M.Com., M.A.,			Reader					
			  M.Phil.					          Ph.D. students have completed &        students are working under my guidance
          M.Phil students have completed &          students are working under my guidance.
  Attended                  Conference                         level /         Seminar
                      level  /              Refresher Course           Orientation Course.
   Any :  		
			  Ph.D.				
			  Other :				

Note: Qualification Example      B.Sc. 65%, 1st Class, South Gujarat University, Surat.                  M.Sc.70% 1st (Dist) Class,                         University,

M.Phil  Month-Year-

University,

Ph.D.  Month-Year

University,

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