eoNDufANJl uNIVEg,snY, e.*.DcHIgoIJ NAT:ONAL SERVICE
Transcription
eoNDufANJl uNIVEg,snY, e.*.DcHIgoIJ NAT:ONAL SERVICE
eoNDufANJl uNIVEg,snY, e.*.DcHIgoIJ (Established by Government of Maharashtra Notification No. MISC -2007t(322tOU UNl4 Dated2Th Sept. 2011 Staie University Governed by Maharashtra University Act, 1994 ) NAT:ONAL SERVICE SCHEME Dr.l.S. Mohurley Programme Coordinator Mobilet 777 4027 661, 9422893555 MIDC Road, Complex,GADCHlROL|- 442 605 (M.S) web: qondwana.diqitaluniversitv.acl Email : A onlz-zztlzz director.studentwelfarequs@qmail-com Fat t}7t32-223322 Avhan-2015/44 Date: The Principal of conceming colleges Affi liated to Gondwana University, Gadchiroli. Subject:- Selection ofNSS Volunteers for Avhan: the disaster management training camp-2015. Respected Sir, As per the directions by the Secretary to the Govemor, the AYHAN State Level Disaster Management Training Camp has been decided to be given to the NSS volunteers in Maharashtra. For Academic yeat 2014-15 the Training camp of AVIIAN will be organized at Shreemati Nathibai Damodar Thakarsi Womin University Mumbai between 256 May, 20lS & 3.d June 2015. The travelling expenses to attend this training camp will be provided from Disaster Management funds of Univenity. Railway Reservation of all the students and team leaders from Nagpur to Mumbai and Mumbai to Nagpur is already done. Every student and team leader must haye to reach al Nagpur Railway Station before 2.00 pm positively on 23 May 2015. Every participant as a volunteers or program Officer must bring following items/articles with them while attending the training camp, such as two sets of white Pants and full shirts, Spoon, Bed sheet, Battery, Note Book, Pen, Shoes (Any one of Hunter/Canvas/Sports). They must bring College Identity card, Enrolment form duly signed, certified documents with then. The NSS volunteers/ the Programme officer from your college selected as per the attached list to participate in the said training camp. You are kindly requested to send the required certificates to the NSS Office sharply on or before 20 May 2015 and make the necessary arrangements. Thanking yoq Regards Gondwana University, Gadchiroli Enclosures: I ) 2) List of volunteers Gadchiroli District and Chandrapur District Necessary Certificates to fill and send to Univelsity Programme Coordinator NSS for uploading the data of participants online. GONDW.*Nfi. UNIVf,.BSITY, GJIDCHIROLI LIST OF CON丁 :NGENttFOR AVHAN‐ 2015 ゝ 、 _=二 ´ f DrSTR′ Cr ιFyfι ハyHArV― cHArvcfι ι rV6 ORも BR′ 6Д Dffrvssし ν′ District : Contingent Leaders : Gadchiro‖ 1)prOf.Saniav M Mahalan(9049757160) 2)Prof.5mt Lokhande(9420511560} LIST OF FEMALE CONT:NGENT Name of Volu nteers Adarsh Kumud Bangare Ada rsh College, Wadsa Resh ma Suresh Sh rad ha Waman Kove Vaishali loghenttam ina f r.rnt-ota rirtuyyu Shedmek kka surayya 8 Co llege, Wadsa M. G. Co llege, Armori M. G. Co lle8e, Armori ― 下 163 34 159 30 I 1625 1 1 30 33 Mobile No. 一一 8485814772 g rsarazozg 9404225063 1 9420061509 「 Kusuma Ma noha r Ratnam 1 Chest Height Cla ss ― Shweta Subod h Meshram Ka t College Add ress 1 ::∬ S B Co‖ ege,Aheri Krush i Ma havidya laya, Gadchiroli BhaBwantrao Arts ColleBe, Sironcha BhaBwa ntrao Arts College, Sironcha Rina Sudhakar Tekam I Rama Sonu sami ヽ Иahi a Mahavidyalava, Gadch ro i Mahila Ma havidya laya, I Gadchiroli BA‖ Agri. ll BAH BAH 11 159 1 「 ]「 ::lfI::4 1-卜七 蓋 テ 薫 156 31 7588807047 156 31 9403447315 9552143162 BA BA H 7588495363 158 WAITING LiST OF FEMALE CONTINGENT ● 0 S N Name of Volunteers 1 Dipa Mangesh Weladi 2 Paya I Karme Komal Kamble (n College Address 5. B. Co llege, Aheri Bhagwantrao College, Eta pa lli Bhagwa ntrao College, Etapalli sl^L.-' etu-zl Class Height Chcst Mobilo No BTm 1 165 1 36 1 9403438413 BA BA 164 ││ 164 35 35 8275790622 8275790622 College Address Ada rsh College, Desaiga nj Class Height B Com 174 Chest Mobile No 84/81 8806790155 11 Minal Vitthalrao lDhore I Dipak Vishweshwar Parteke Milind Honaji Pradhan Krishi Mahavidya laya, Gadchiroli G. M.College, Kurkheda Rajesh Chinnamma Bhagwantrao Arts College, Siro ncha Mahindra Pochelu 18 9 │ Kunal Keshav 6urnule Homkant Falgun Raut 10 Pankaj Nago hasaokar Ashutosh Narayan 166 I Agril‖ Bhagwantrao Arts College, Sironcha M. G. College, Armori 82/78 B Sc l1 171 94/89 8412907648 I a.a.rr j rzs 95/89 9405960845 BA‖ 175 B Sc‖ 175 │ Ψ S B Co‖ ege,Aheri 彎 Ambedkar Co‖ ege of 167 Sudarshan S. la na ki Shrikruksha n Tulshiram Tormalwar Karan Chandravilas | ,u I Ashvin suresh 1フ Ku ld 18 Sh ip Porte rika nt Naitam le-Am bed ka r College of Gadchiro R.D. College, M ulchera Kisa nrao Khobragade College, Kisa nrao Khobragade College, Sh市 aji Maha宙 dyalaya′ Gadchiroli Bhagwa ntrao Arts College, Etapa‖ oSW‖ 2 ー ヒ 11iII:arat Yashwant Va ibhav Sangewa r 7588771828 Gadchiroli hagwa ntrao Arts College, Adv. Vittha lrao Banpurkar Malewada 83087377s6 93/86 8928732347ss 83/80 8275842913 1 175 に生 ぱ 型 Щ 81/78 t-----940513684 i 5 84/7CJ BA‖ 1 167 79/75 9427993997 86/80 9420845675 87/84 9420510223 B.A. il | BA ‖ 1 762 aossr roso, 7588703499 164 BSc H 169 89/87 8275528953 175 93/86 8657575882 168 87/82 8275814356 170 89/85 9405723721 Shivaji Mahavidyalaya, Gadchiroli. 趙 騎 J i Govt. Science College, B 1 165 Gadchiroli 巴 87/82 BA 1 Govt. Science College, Shubham Ramakant Naitam 1 9405355006 コ 175 Social Work,Gadchiro i Fu 8928764022 」 BA H Fule― 81/77 83/80 S. B. College, Aheri Da 1 ―‐ Hitkarini Mahavidyalaya, Armori 1 175 G. 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O oO●〓∽日詢商. o∽ ● om 〓∽ 0日●“ ●一 口く ゴV ︼ 〓﹁ く m ∞い︻ 〇 い ∞ 〇∞ ∞い 0い 一い ヽト い〇.い寸 め ヾ 〇∞ ]ヨくヌ面﹂ ぼつ ら D パ 2 賓 〓 o い曽 ∩ トロ ロ ZO︼ 卜0ロロ国∽ いH〇一Z ≦ 〓>く H 口o“日 o∩く0 ^ ´い︼ ∽“口>り負︺くZくをF ∩ZOO / い 寸 い つ い ヽ い い ヾ い い 寸 ∞ つ 0 〇 ∞ い ∞ い ∞ ト ヽ C0 Cヾ い 〇 ∞ lr い OO 〇 ●O / AVHAN― CHANCELLOR BRIGADE TRAINING PROGRAM ON DI〔 PREPAREDNESS REGISTRAT10N FORM AND COMMITMENT CERTIFICATES PERSONAL INFORMAT10N Name: Class― ―――――――――――――― Div― ――――――――― Roll Residential Address-----.---Taluka― ― ――――― ―― ― District Pin Code― ―――…… ― Contact dctail STD Code― ――― ―― ――Rcsidence Teト ー ーーーーMObile Emaill D ― ― ― ― ― ― ― Datc ofBirth― ―― ―― Age― ……………― Spectacles:Ycs/ Hei ght-:=-----Wei ght-------Blood Group--- PARENTSINFORMAT10N --Hbyo-- --------- - - - - -- - - ー Name: Office Address-― ――………Taluka― ――――――_Distict Pin Codc――――――………― Contact detail STD Code― ―………― ――Residcncc Tel― ―¨― Mobilc― ― EmaiH D NSTITUTIONAL INFORNIAT10N Name OF College: onEcial Addrcss ― ― ― ― ― ― ― ― ― ― ― ― ――― Taluka― ― ――____District― ― ―― ―――Pin Codc― Contact detail STD COde Tel― ――――__― ――― Fax _____ No― ―……― Emaill D Name of Residcntial Addrcss― ――――――――……………――――――――――――――――……… ―――――― Taluka― ―――____― ―DistHct― ―――――――Pin Code_________¨ Contact dctail STD Code― ――………―Tel― ――――――― ― MObilc No― ――_― ――― ‐ Ema‖ ID― ――――¨――――― ――― Name of Program Rcsidential Address Contact detail STD Codc ―― ――――¨― Tcl― ―――――___― Mobile No一 ―__― ―― EmalH D Name of University: OIIice Address-Contact dctail STD Code― ― ‐ ―― ―_― ―Tel― ― ―― ―― ―………― Fax No Emaill D 沈 STER Name of Program Residential Address ― ………―― Tel― ――――――――Moblc Contact detal STD Codc― ― No Emaill D Other Information Enrollment Year ofNSS: Skills known: DH宙 T MIIImmg l COOkng 下 戸 gra"y 「 kponWiJng E"nghthg 而 Wish to particiPate Swimming will l di宙 ng Any Other Fire Fighting First Aid training like to know Procedure in police statior/Legal knowledge Anv other additional information: 1)COMⅣ ΠT` CNT CERTIFICATES (Jointly Singc NSS Voluntcer/Parents/Programmcr offlcer&Ceni″ by Prindpal) UNDERTAKING BY THE PARTICIPATING STUDENT A) at -------I undertake to state that I shall be attending the training program ofAVHAN to be held V In consideration ofmy being nominated at my request to undergo all t)'pes of training and also participating in any NSS training activities in/outside NSS and traveling. I undertake and agree that neither I nor my executor/administrator will make any claim against any officer of NSS/Principal /Program Coordinator/State Liaison Officer/ Youth Officer/Assistant Program Adviser/Deputy Program adviser in respect of any loss or injury to the property or person (including injury resulting in death.) which may suffer while or inconsequence of my being in training/participating in AVHAN I further undertake to state that I shall be abiding by all rules & regulation ofthe camp and shall be liable for strict disciplinary action for violation ofthe same= Signature of the Student Date: B) I RESPONSIBILITY CERTIFICATE agree as a responsible person that my Son/DaughterAMard is being allowed to participate in the above mentioned camp to be held at ___-_- University at my own risk. Ifany accident or death occurs during this camp/program, I or any ofmy relation of legal heir will not demand any claim from State Govt./ University/College an account Si ofmy Son/Daughter /Ward being NSS uni! a part this camp. gnature of the parent/Guardian Date: C) VOLUNTEERSHIP CERTIFICATE It is certificate that the vorunteer is a confide student he/she is a regular NSS Volunteer from one year of of the coregernstitution and the year _-_-____-_and has completed his/her volunteer ship and he/she is neither a member ofNCC nor a member of Scouts and Guides/Rovers/Rangers. Signature of NSS program Officer Signature of the principal College Seal 2) CERTIFIcATE oF MEDIcAL/PHYSIcAL FITNESs Signature of the candidate: I do hereby certiry that I have examined the vorunteer and found him,rer fit for undergoing rigorous training for AVHAN_ sisnature given above,.,", .,#l?.u"ff:Iffi,",:'""r1T.,fr"il:,:,:", may cause any hindrance due to training program. Signarure of the Medical Officer Address with Contact No 3) VERIFICATION CERTIFICATE This is to certifr that Mr/JvIs__-__- _-___ ;::; his/her participation in the above mentioned rigorous Seal Date---------_-_--_____- NSS Volunteers of _--_______- College is a bonafide student and NSS Volunteers of___-_--____---__ --------------University. The information provided in the registration form by the vorunteer and a' the certificates signed by him/her. parents program officer, hincipar and medicar Officer are endorsed by me as a program Coordinator ofthe University. Signature of the program Coordinator University Seal Date: _--