Application Letter for the establishment of Commerce and Management Study Centre of
Yashwantrao Chavan Maharashtra Open University, Nashik
This Application should be forwarded through
District/Regional Centre Only
Date:
Place:
To
The Director,
School of Commerce & Management,
Yashwantrao Chavan Maharashtra Open University,
Nashik- 422 222.
Subject : Application for the establishment of a Study Centre of Yashwantrao Chavan
Maharashtra Open University for Bachelor of Fire and Health Safety
Environment (HSE) Management (P 97) Programme.
Sir,
This College/Institution is keenly interested in establishing a Commerce and Management
Study Centre of Yashwantrao Chavan Maharashtra Open University for Bachelor of Fire and Health Safety Environment (HSE) Management (P 97) Programme.
I am sending herewith the detailed information of our College / Institution in the prescribed format.
I am also enclosing a crossed Demand Draft of a nationalized bank of Rs.15, 000/- towards
Non refundable Processing Fees drawn in favour of Finance Officer, Yashwantrao Chavan
Maharashtra Open University, Nashik, payable at Nashik and a memorandum of understanding duly signed by concerned authorities of our institute/college.
I request the University authorities to consider our application sympathetically and grant us a
Study Centre for Bachelor of Fire and Health Safety Environment (HSE) Management
(P 97) Programme.
Thanking you and hope for early favourable reply.
Yours sincerely
(Principal/Chairman/ Secretary/Head of the Institution)
Forwarded through - Regional District /Regional Centre:…………………………..
Enclosed : 1. Information Report, Application Form & MOU
2. D.D. No.:……………………. Rs.15, 000/-
Date:………………………… Bank Name:…………..
Page 1 of 26

YASHWANTRAO CHAVAN MAHARASHTRA OPEN UNIVERSITY
Dnyangangotri, Near Gangapur Dam, Nashik 422 222
Bachelor of Fire and Health Safety Environment (HSE) Management
D
.D. No.:……………………. Rs.15, 000/-
Date:………………………… Bank Name:…………..
1.
Date of Application Received at District Centre:
Application to be Accepted / Rejected
If Rejected: Reason:
Signature of District Centre Head/Co-ordinator:
2.
Date of Application Received on Regional Centre:
Application to be Accepted / Rejected
If Rejected: Reason:
Signature of Regional Centre Head/Co-ordinator:
3.
Date of Application Received at Head Quarters Nashik
Application to be Accepted / Rejected
If Rejected: Reason:
Signature of Director
/
Programme Co-ordinator:
Page 2 of 26

CHECK LIST: Please Tick ( √) if submitted
Sr.No Particulars Applicant
1
District/
Regional
Centre
2
3
4
5
6
7
8
9
Demand Draft-
Amount : Rs 15,000/-
Validity:_________
Educational Campus
Affiliated to University
Bachelors Degree programme Offered
Application Form
Appendix-I
Reading Material in
Library
Appendix-II Head/
Counsellors’/
Coordinators Bio data
Attached
Appendix-III
Resolution as per format on Letter Head
Appendix-IV
MOU on Rs. 100 Non-
Judicial Bond Paper
True of copies of
Layout, rent etc mentioned in the form
Sign:
Date:
Name:
Head
Quarters
Inspection
Committee
Page 3 of 26

Instructions for filling up the form:
1.
Use capital Letters only.
2.
Do not overwrite.
3.
Enclose relevant document in the sequence mentioned.
IMPORTANT NOTE:
1.
Recognition will be given for Three years only and for renewal study centres need to apply in prescribe format by paying requisite fee as per the university rules.
2.
Applications sent directly to the School/HQ, will not be considered for approval.
MINIMUM REQUIEREMENTS FOR ESTABLISHMENT OF NEW STUDY
CENTRE
Applicant fulfilling the following criteria will be eligible for the recognition to start programs in Fire and Safety Programme
1.
Applicant/ Applicant body must possess qualification in Fire and Safety Field with minimum of 5 years Practical Field Experience in Active Fire and Safety Services.
2.
Possess qualification in Fire and Safety Field with minimum of 5 years Teaching and
Training Experience in Fire and Safety Field in recognized Institution.
3.
Applicant has to apply in prescribed format with application and Detailed Project
Report along with the Presentation.
4.
Applicant has to fulfil the necessary Approval/ Processing Fees decided by the university in Demand Draft only which is non refundable.
5.
Applicant/ Trust/ Institution must have separate Fixed Deposits in the name of
Institution/trust which will run the new study centre in Nationalized Banks for the development of the Study Centre (Minimum amount of 5 lacs.). The amount of deposits is according to the status of the program proposed to be started.
6.
Applicant must have satisfactory/enough infrastructure to run the schedule program efficiently. Like-

Availability of minimum land required for Field Training purpose like – P.T. and Parade / Fire Drills and Other related Demonstration and Assembly.

Availability of – Minimum 6 classrooms, Administrative office, Library,
Reading room, Computer room, Internet facility, Equipment room, Store room

Availability of adequate Co-ordinator and Teaching Faculty and other staff

Availability Hostel facility, Mess facility, Medical Ads according to the requirement for starting a new academic program.

Availability of conveyance facility in emergency and in general for students and parents
7.
Applicant must possess his own Practical Equipment according to the program curriculum, which are sufficient for field training, demonstrations and applications.
8.
Applicant must have tie up with corporation Fire and Emergency Services, Local
Bodies, Emergency Medical Services for practical field training and demonstrations necessary for trainee students during their academic year.
9.
Applicant must possess list of different nature of industries and disciplinary coordination for industrial visit, project work, and practical attachments necessary for the trainee students during their academic year.
10.
Applicant must have different types of books, journals, magazines, periodicals according to the academic programs rather than the books provided by the university.
11.
Applicant must follow all rules and regulation for admission procedures, registration procedures, regular training and teaching schedule, examination and evaluation
Page 4 of 26

procedures and co ordination/ communication procedures with university and students.
12.
Applicant must up date / keep all documentary records of students attendance, staff attendance, assignments, internal examinations, internal marks, external marks, final result, repeaters (Journal submission, assignment submission, project submission, internal practical/ project marks, industrial visit marks etc.) and be produced or keep available in front of university committee when required or time to time.
13.
Applicant must maintain economic records related to academics and new developments of running financial year and produced in front of university if required.
14.
Centre In-charge will be a regular/ permanent employee preferably the head of the existing institute or college.
15.
Administrative Staff ( one each)
a. Programme Co-ordinator: Full Time faculty member of the existing institute or college possessing Post Graduate Degree.
b. Assistant
c. Peon.
Page 5 of 26

Information of the College/ Institute Applying for Study Centre
Please Note: All fields mentioned under are mandatory.
A: General Information about the Applicant
Name of the College/
Institute
1
Address
2
3
4
5
6
7
8
9
10
11
12
City/Town
Tahsil/ Taluka
District
State
PIN Code
Telephone with STD
Code Office:
FAX Details
Email Address
Affiliated
University/Board to
Approval Number and
Date of Approved
University a. Approval Number b Date:
13
14
Type of Affiliation
Temporary / Permanent of Expiry Date
Affiliation (if any)
Page 6 of 26

15
16
17
18
19
20
21
Type of College/Institute
: Private / Government
Timing of
College/Institute the
The College/ Institute has: (Please give details) a.
Schools
(Primary/ Secondary) b. Jr. College
(Arts/Com/Sci/Voc etc) c. Sr. College
(Arts/Com/Sci/Voc etc) d. Any Other
Is your college /Institute already a Study Centre of YCMOU for any other Programme? a.
If Yes Study Centre
Code b.
If Yes Please specify programmes
Number of teaching staff (fulfilling
YCMOU criteria)
Number of non-teaching staff
Name and distance of the nearest active
YCMOU Fire and Safety
Engineering Management
Study Centre (in km)
Page 7 of 26

B: Information about Parent Organization of the Applicant
1
Name of the Parent
Organization
2 Address
3 City/Town
4 Tahsil/Taluka
5 District
6 PIN Code
7
Telephone with STD Code
Office
8 FAX Details
C: Constitution of Parent Organization
Legal status of Organization (Public Trust Act 1950/ Societies Registration Act 1860/
Government Body)
1 Status:
2
Registered Under: (Give name of the governing authority)
3 Registration No:
4 Date of Registration:
5 Name of the Chairman
6 Address of the Chairman
7 Contact Number of the Chairman a Office Phone No. With STD Code: b
Residence Phone No. With STD
Code:
10 Mobile No:
Page 8 of 26

D:Information of the Centre Head( Principal of the existing College/
Institute)
Affix passport size latest photograph
1 Name
2 Residential Address
Phone with STD Code
3 Office:
4 Residence:
5 Mobile No
6 E-Mail Address
7 Date of Birth
8
Date of joining the Present
College/ Institute
9
10
Educational Qualification
(Enclose necessary true copies of certificates)
Experience (Enclose necessary true copies of certificates)
Teaching (years)
Professional( years)
Total( years)
Page 9 of 26

E: Information of the Coordinator
1
2
3
4
5
6
7
8
9
Name of the person who will work as coordinator
Residential Address
Office Phone No. with STD Code:
Residence Phone No. with STD
Code:
Mobile No
E-Mail Address
Date of Birth
Date of joining the College
Educational Qualification (Enclose necessary true copies of certificates)
Experience (Enclose necessary true copies of certificates)
10
Teaching (years)
Professional( years)
Total (years)
Affix passport size latest photograph
Page 10 of 26

F: INFRASTRUCTURAL FACILITIES
Please Give the details and enclose the true copies of the layout of the space in the college, which will be utilized as the Study Centre purpose with dimensions. Also enclose Ownership/lease/rent documents.
Lecture Halls/ Rooms Available of Counselling Sessions
1
2
Name of the building in the campus
Number of Rooms in the Building
3
Number of Rooms available for YCMOU
Counselling Sessions in the Building
F-1: Details of Lecture Halls/ Rooms available for YCMOU Counselling Sessions in the Building
Sr.
No
Existing
Name/
Number of the
Lecture
Halls/
Rooms Dimensions
Area in sq. ft
Student Capacity
For
Classes Exam
No in each Classroom
Tables Chairs Benches Board Fans
Tube lights
1
2
3
4
5
6
7
8
9
Windows
10
Page 11 of 26

F: 2Details of Computers available for YCMOU Counselling Sessions/ practical’s in the
Building
Total Number of Computer -:
Existing
Name/
Number
Lab
Sr.
No.
1
2
3
4
Machine Type
Desktop /
Laptop RAM
Hard Disk
Capacity
Monitor
Type
CD /
DVD
Drive
Version of
Operating
System
5
F:3: Computer Lab available for YCMOU Counselling Sessions/ practical’s in the Building
Student Capacity
For No in each Lab
Sr.
No
1
2
3
4
5
Dimensions
Area in sq. ft Classes Exam Tables Chairs Benches Board Fans
Number of
Computers
Tube lights Windows
Page 12 of 26

G: Library Details
N o Particulars Dimensions
1
Library
Reading
Room
2
G: Other Library Details
Sr.No Particulars
Area in sq. ft.
1
2
3
4
No. Of
Tables
No.
Of
Chairs
No.
Of
Racks Boards
Seating Capacity
No of Books available (Titles)
No of Books available (Total
Copies)
No of Journals
Details
5 No. of News paper
H: Teaching Aids Available
Sr.No Particulars
Television/ DVD Player
1
2
3
4
LCD Projector
Slide/ OHP/ Projector
Recorder
Yes/ No Quantity
No. of fans
No. of
Tube lights
No. of windows
Page 13 of 26

I: Other Facilities in the same Building where Counselling Sessions are proposed
Yes/ No
Details(eg
Room No) Dimension
Area in
Sq.mt
Sr.
No Particulars
1
Reception Room
2
3
Staff Room
Stores
4
5
6
7
8
9
Drinking water
First Aid
Ladies Room
Ladies Toilet
Gents Toilet
Other
Page 14 of 26

G: Separate Office for YCMOU Centre
Sr.No Particulars
Existing Room No
1
Dimension
2
3
Area in Sq mt
4
5
6
7
No of Tables
No. of Chair
No. of Cupboards
No. of Racks
8
9
10
11
12
White/ Black Board
Notice Boards( 1-Office and 1 -Lobby )
No. of Tube lights
No. of Fans
No. of Windows
Details
Page 15 of 26

H:Counsellors Details: Please note 50 per Cent of the counsellors should be existing regular teaching staff of the college/ Institute
( Enclose the Faculty Bio-data of each Counsellor in prescribed format given in Appendix I along with the true copies of the mark sheets and certificates)
Regular/
Visiting
Staff
Approved by
Convention al
University
(Yes/ No)
Experience (in Years)
Approval
No. &
Date
Educational
Qualification Teaching Professional Total
Sr.
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Name counsellor of
Subject
Page 16 of 26

I:Non Teaching Staff Details:
Sr.
No Name
1
Designation Age
2
3
4
5
6
7
8
9
10
Educational
Qualification
Regular/
Temporary
Staff
Experience ( in
Years)
Page 17 of 26

UNDERTAKING
The Principal/ head is willing to co-operate for the following functions to be performed by him and the staff working under him for effective functioning of the proposed study centre: a.
Participate and supervise work of the study centre. b.
Make teaching staff available for counselling. c.
Make teaching and non teaching staff available for Co-ordinating the programme. d.
Make teaching and non teaching staff available for exam related work. e.
Make available Non- Teaching staff to work part –time for the study centre. f.
Library facility will be made available on Saturday, Sunday and whenever counselling sessions are scheduled. g.
Computer lab facility will be made available on Saturday, Sunday and whenever counselling sessions are scheduled. h.
Drinking water, first aid etc. and other necessary amenities will be made available on Saturday, Sunday and whenever counselling sessions are scheduled.
The information filled in the Application Form is true to the best of our knowledge.
The Principal/Head and the College/ Institute Authorities do hereby undertake to give all necessary co-operations for efficient and effective functioning of the
Study Centre of the Yashwantrao Chavan Maharashtra Open University, if granted to our College/ Institute
Date: Seal of the College /Institute Name and Signature of
Principal/ Head
Place:
Name and Signature of
Chairman of the Organization
Page 18 of 26

Sr.
No.
APPENDIX: I
READING MATERIAL AVAILABLE IN LIBRARY
1.
BOOKS: Please Note
Minimum 500 books and 25 Titles per course/ subject should be available for reference (Commerce & Management subjects).
ACCESSION
No.
SUBJECT TITLE
OF THE
BOOK
PUBLISHER YEAR
OF
PUBLI
CATIO
N
NAME
OF
AUTH
OR
Marathi/
English
2.
LIST OF MAGAZINES AND JOURNALS
Please mention latest available
Sr.
No.
ACCESSION
No.
Name National/
Internatio nal
Frequency PUBLI
SHER
YEAR
/
Month
OF
PUBLI
CATI
ON
Marathi/
English
3.
List of Newspapers :
Sr.
No.
Name National/
Local
Frequency Marathi/
English/
Hindi
4.
Online subscriptions if any mention all the details.
5.
CDs’/ DVDs’ available mention all the details
Page 19 of 26

APPENDIX: II
YASHWANTRAO CHAVAN MAHARASHTRA OPEN UNIVERSITY, NASHIK
SCHOOL OF COMMERCE AND MANAGEMENT
BIODATA FORMAT OF HEAD/COUNSELLORS’/CO-ORDINATOR
THE TRUE COPIES OF THE MARK SHEETS AND CERTIFICATES )
(PLEASE USE CAPITAL LETTERS ONLY)
(
PLEASE ATTACH
1. NAME:_____________________________________________________
2. DESIGNATION:________________________________________________
Affix passport
___________________________________________________________
5. MOBILE NO: ___________________ LANDLINE NO :__________________
6. EMAIL ID: ______________________________________________
7. DATE OF BIRTH: ___________ (DD/MM/YY) AGE: __________ YEARS
8. EDUCATIONAL QUALIFICATION:
DEGREE SUBJECT CLASS YEAR
OF
PASSING
MARKS
OBTAINED
(PERCENTAGE)
SSC
HSC
UG
PG
M.PHIL
PHD
NET/SET
OTHERS
9. M.PHIL/ PH.D RESEARCH TITLE :
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Page 20 of 26

10. EXPERIENCE IN YEARS :
TEACHING INDUSTRIAL TOTAL
RESEARCH EXPERIENCE: ___________________ YEARS
11. TEACHING/PROFESSIONAL/WORK EXPERIENCE
NO.
NAME OF THE POSITION NATURE OF
INSTITUTION HELD WORK
PERIOD OF
EXPERIENCE
FROM TO
12. RESEARCH GUIDANCE
A) M. PHIL. STUDENTS - DEGREE AWARDED : ____________
B) PH.D. STUDENTS - DEGREE AWARDED : ____________
13. NO .OF RESEARCH PUBLICATIONS IN JOURNALS / PERIODICALS /
CONFERENCE PROCEEDINGS:_____
25. SUBJECTS WHERE YOU CAN CONTRIBUTE AS AN EXPERT FOR COUNSELLING/
PAPER SETTING/CHECKING/ :
1._________________________________________________
2._________________________________________________
3._________________________________________________
4._________________________________________________
5._________________________________________________
I HEREBY DECLARE THE INFORMATION MENTIONED ABOVE IS TRUE TO THE BEST OF
MY KNOWLEDGE
DATE: SIGNATURE:
PLACE:
Page 21 of 26

APPENDIX-III
RESOLUTION OF THE SOCIETY (To be submitted duly filled on the letterhead of the
Institution)
It is resolved unanimously in the meeting of the Governing body of…………………………..
…………………..………………………………………………. held on ……………………. under the Chairmanship of Shri ……………………………………………………………….. that the Bachelor of Fire and Health Safety Environment (HSE) Management (P 97)
Programme Study Centre of Yashwantrao Chavan Maharashtra Open University, Nashik be established in …………………………………………………… College /Institute
/Foundation /Trust.
If the University permits the College /Institute/Foundation/Trust to establish the centre, we undertake to provide all the necessary academic and infrastructural facilities and co-operate for the smooth and efficient functioning of the Study Centre. We shall extend full cooperation and support for the smooth conduct of these academic programmes (including end exam and central assessment programme), as per the approved rules of the university. We shall abide by the rules and regulations of the Yashwantrao Chavan Maharashtra Open University, Nashik prescribed and revised from time to time.
If the study centre is closed down for any reason, equipments, furniture, books supplied by the University shall be returned to the University through the…………………………………
Regional Centre.
We shall have no objection if the University ceases the services of Counsellors, Co-ordinator and Office Staff appointed at the Study Centre.
Proposed by………………….
Seconded by………………….
Place: (Seal of Signature Signature
Date: the Institution) (Name: ) (Name: )
Secretary Chairman
Institution/Foundation/Trust Institution/Foundation/Trust
Page 22 of 26

Appendix-IV
Memorandum of Undertaking (MOU) for YCMOU Study Centre, Nashik
(To be submitted by the Management on Rs. 100 Non-Judicial Bond Paper)
We,
Mr./Mrs/Ms._____________________________________________________________
Chairman of (Organization Name) ___________________________________________
Mr. / Mrs /Ms____________________________________________________________
Secretary of (Organization Name)___________________________________________
Mr. / Mrs./Ms____________________________________________________________
Principal/Director of the (College/Institution Name)______________________________
Have been given to understand about the various Academic Programs under the School of
Commerce and Management, Yashwantrao Chavan Maharashtra Open University ( herein after referred to as YCMOU) , Nashik.
We hereby agree to offer the services of our organization for the establishment of Study
Centre of YCMOU for Bachelor of Fire and Health Safety Environment (HSE)
Management (P 97) programme under the School of Commerce and Management, YCMOU, Nashik.
1.
We hereby agree to spare the accommodation, computing facilities, equipments, tools and other infrastructure facilities for implementation of the programme as prescribed by YCMOU from time to time.
2.
We hereby agree to ensure security and record of learning material provided by
YCMOU with necessary documents.
3.
We hereby agree to provide a separate and easily accessible office space for YCMOU
Study Centre. Moreover, we agree to put up sign board bearing the Name of
YCMOU Study Centre at the prominent location.
Page 23 of 26

4.
We hereby agree to provide willing faculty members of our institute to work as designated Study Centre Head, Co-ordinator, Teacher Counsellors, Accountants and
Assistant as prescribed by the YCMOU from time to time.
5.
We hereby agree to make available the necessary training materials, consumables, electricity and water facilities to the students undergoing training programs of the university without demanding any financial compensation from the university.
6.
We hereby agree to maintain record of Financial Accounts, Receipts & Expenditure as prescribed by YCMOU from time to time and funds received on account of admission/block grants shall be used for centre Operation and Development only. We understand that the study centre share of programme fees includes expenditure towards running of study centre which includes components like salaries of staff, honorarium to counsellors, honorarium given to supervisors for theory examination, examiners for practical examinations, assessors of assignments, payment towards advertisements TA/DA for travel to attend various events organized by the university, cost of computing and other facilities at the study centre etc. Hence, we will not demand any financial compensation from YCMOU for such kind of expenditure.
7.
We hereby agree to maintain all records in respect of the programmes and submit the same to the university authorities as and when asked for.
8.
We hereby agree to pay honorarium through crossed cheque to Centre Head, Coordinator, Accountant, Assistant, Peon and Teacher Counsellor as prescribed by the
YCMOU from time to time.
9.
We hereby agree to implement the programs of the YCMOU with due dignity, quality and sincerity and maintain the high standard of education values as prescribed by the
YCMOU from time to time.
10.
We hereby agree to follow procedures regarding programme promotion, admission, examination and other procedures specified by YCMOU.
11.
We hereby agree to take every care to scrutinize Admission Forms of students and verify eligibility of students to various programmes.
Page 24 of 26

12.
We hereby agree to collect the study centre fee from students as prescribed by
YCMOU and issue the receipt of payment to the respective student. In any case we will NOT charge fees more than what YCMOU has prescribed.
13.
We hereby agree to submit student admission forms to YCMOU and collect study material from YCMOU or as prescribed by YCMOU and distribute to the students without demanding any financial compensation.
14.
We hereby agree to inform to the students all instructions received from the
University regarding the course, contact of sessions, conduct of examination etc.
15.
We hereby agree to extend full cooperation and support for the smooth conduct of these academic programmes (including end exam) as per the approved rules of the university.
16.
We hereby agree to send our counsellors and experts for paper setting, question bank development and other activities carried by YCMOU.
17.
We hereby agree that the examination of our students may not necessarily be conducted at our study centre.
18.
We hereby agree to provide computing and other facilities for conduct of examination in case YCMOU decides to organize examination of our students or students of other study centres at our study centre.
19.
We hereby agree that
Recognition will be given for three years only and for renewal we need to apply in prescribe format by paying requisite fee as per the
YCMOU rules
20.
We hereby agree that YCMOU shall have full power to close down our Study Centre in consistent with YCMOU rules, regulations, policies and powers without assigning any reason and without any reimbursement for loss from YCMOU to our organization.
Page 25 of 26

21.
We hereby agree that all legal disputes regarding study centre and enrolled students shall be subject to Nashik jurisdiction only
22.
We hereby agree that any dispute with regards to the opening or closing of study centre shall be sorted out with the mutual discussion and the Director of the
Concerned School/Division of YCMOU Nashik shall be the final authority to pass an order to that respect which shall be binding on the institute running the YCMOU study centre.
23.
We have read all the Rules and Regulations given by the authority of YCMOU and we hereby agree to abide by the Rules and Regulations to that effect. Failing of which our study centre shall be closed.
1) Chairman of the Organization
2) Secretary of the Organization
3) Principal/Director of the College/ Institution
Date:
Place:
Name and Signature
Name and Signature
Name and Signature
MOU Accepted/Rejected/
Signed Director
& Send Back for Record School of Commerce & Management,
YCMOU
Date:
Place:
Page 26 of 26