Application _ann. B_of Scheme. - Department of AYUSH

Annexure-BAPPLICATION FOR CONTINUING MEDICAL EDUCATION (CME)PROGRAMME FOR AYUSH DOCTORS1. Name of the Institution/ Organisation2. Address/ Tele No./Fax No./ E Mail3. Nature of the Institution Government / Governmentaided / private4. Documents to be enclosed with theapplication (for all colleges): A certificateto this effect that the organization has notobtained or applied for grants for the samepurpose or activity from any other Ministryor Department of the Government of Indiaor the State Government or any other nongovernmentalorganisation.5. Additional Documents to be enclosed withthe application (for private collegesestablished under societies Act): Copiesof Articles of association bye-laws, auditedstatement of accounts, sources andpattern of income and expenditure, etc.6. Year of Establishment7. Previous experience of organizing suchprogrammes (details may be given)8. Details about the previous grants, if any,under this Scheme (ROTP & CME)9. Whether Utilisation Certificates in theprescribed proforma/ audited accountsreflecting itemwise expenditure/Achievement cum performance report/statement showing name & address of thetrainees certified by the institute that allthe trainees are registered AYUSHpractitioners etc. are sent or not. If yes,date of sending the same.

10. Whether any other grants under anyscheme were received from thisDepartment at earlier occasions. If yes,the details thereof. Whether UtilisationCertificate and other requisite documentsis pending/due for such grants, or sent.11. Number of programmes applied for12. Names of Experts/ Resource persons forconducting the programme with theircurrent posting, date of birth andqualifications & experience in the subjectfor which they are invited, Tel no., E-mail,Mobile etcSignature of the Head of theInstitution/ Association/ OrganisationName:___________________________Designation_______________________Postal address_________________________Tel/Fax No._________________________E-mail: ……………………………………..