gnm 2016-17.pdf
TRANSCRIPT
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PROSPECTUS FOR
ADMISSION INTO GENERAL NURSING & MIDWIFERY
(G.N.M) COURSE IN GOVERNMENT
&
INC RECOGNISED PRIVATE
TRAINING CENTERS OF ODISHA
FOR THE ACADEMIC SESSION 2016–17
Approved by Govt. in Health & Family Welfare
Department Letter No: ME-II-M-10/2016-
12855/H, Dtd. 18.06.2016
Cost of Application Form & Prospectus: Rs.500/- (Rupees Five Hundred) only
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Application form & Prospectus for admission into GNM training course for the academic session 2016-17 are available in the official website of Directorate of Nursing, Odisha“www.nursingodisha.nic.in” . Intending male and female candidates can apply online by depositing prescribed fee Rs. 500/-(Rupees Five Hundred only) in shape of SBI Challan attached to the prospectus (annexure-II).The candidate can avail the facility for submission of On-line application which are available at the nearest centers i.e. CSC (Common Service Centre) at Gram panchayat level/Community Health Centre (CHC) at block level/CDMO office at District level.
For any query contact:- 0674-2393840.
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PREFACE
Nursing is a rewarding career that offers a bright and satisfying future for young persons
who have a desire to serve people with a caring attitude. As members of a modern health care
team, nurses render a significant service in the care of the sick and in the prevention of illness and
injury. Increasing numbers of trained nurses are needed to fill the responsible positions as experts
in bedside nursing services, and as researchers seeking new and better ways of meeting the
nursing needs of patients. Salary and conditions of service of nurses are attractive compared to
those in other fields of employment with similar educational requirements. Nursing offers a
challenge and opportunity to serve a fellow being. If you have the zeal and desire for nursing, you
are invited to choose this noble profession.
In order to facilitate the admission at door step in remote areas and to bring clarity in the
selection process, Govt. of Odisha have introduced submission of online application, selection &
admission for GNMcourse which is praiseworthy.
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INDEX
Sl.no Content
Page no
I Tentative Admission Calendar 5
II General Information & Eligibility 6-7
III Admission Procedure 7-8
Online registration 9-11
Online Choice Filling 11
Publication of Applicant List, Document
Verification & Choice Locking
11-13
Publication of merit list &Provisional Seat Allotment
(Round 1)
13-14
Deposition of Course Fees 14-15
Final Seat Allotment (Round 2) 15
List of Left Out Candidate 16
IV Post Admission 17-18
V Selection Committee 19
Annexure –I Procedure for password reset by OTP. 20
Annexure –II SBI challan for Application Fee 21
Annexure –III List of Nodal Centers 22
Annexure –IV Caste Certificate Proforma 23
Annexure –V Residence/Nativity Certificate Proforma 24
Annexure –VI Proforma of Certificate of Sainik Board 25
Annexure –VII Proforma for undertaking by guardian 26
Annexure –VIII Proforma of physical fitness certificate. 27
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I. TENTATIVE ADMISSION CALENDAR
Availability of Online Application form and Prospectus in official
website: www.nursingodisha.nic.in
27.06.2016 to 23.07.2016
Last date for submission of online application form
23.07.2016 by 5.00 PM
Date of Publication of candidate list in the official website:
www.nursingodisha.nic.in
27.07.2016
Date of Document Verification and choice locking at Nodal
Centers.
01.08.2016 to 09.08.2016 by 5 PM
,excluding Govt. holidays
Medical board for the verification of PH Candidates
11.08.2016 / 12.08.2016
Publication of merit list and Provisional seat allotment of the
selected candidate for 1st Round.
18.08.2016
Date of Reporting at nodal centers with course fees. 25.08.2016 to 30.08.2016 by 5 PM,
excluding Govt. holidays.
Publication of final seat allotment for the selected candidates for
the 2nd Round.
03.09.2016
Reporting at nodal center with course Fees for second round
counseling
07.09.2016 to 09.09.2016 by 5 PM
Reporting at the institution for admission
14.09.2016 to 16.09.2016 by 5 PM
N.B.: Initial Date of Submission of Online Application Form : Dt: 27.06.2016
Last Date of Submission of Online Application Form : Dt: 23.07.2016 by 5.00 PM
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I. GENERAL INFORMATION
Applications are invited for admission in General Nursing & Midwifery (GNM) training course in
all INC recognized Government & Private G.N.M training centers for the year 2016-17.
The duration of the training course is 3 years which includes theory and practical as per
prescribed syllabus of Indian Nursing Council.
Admission for all seats in government institutions & 85% of seats in private institutions
will be filled up through common merit list.
Private Institutes shall fill up 15% seats under management quota as per the eligibility
criteria of INC.
All the institutions (Govt. & Private) having INC recognition as on dt: 31.07.2016 will be
allowed for the e-counseling process.
II. ELIGIBILITY
Candidate must be 17 years of age or above as on dt: 31. 12. 2016.
The candidates must have passed
- 10+2 with 40% marks from CHSE Odisha or equivalent thereof, However science is
preferable. Or
- 10 +2/12th
with 40% marks from state open schools recognized by state Govt. and National Institute of Open School recognized by Central Govt.
Or
- 10+2 vocational ANM course with 40% marks from the school recognized by Indian Nursing School.
Or
- 10 +2 Health Science vocational stream from a recognized CBSE Board/ State/
Center. 5% of total mark is relaxed for SC/ ST candidates.
Must have passed Odia up to M.E. standard for all Govt. school of Nursing and 85% Govt
seats in private nursing institutions recognized by INC. Must be a domicile / permanent resident / native of Odisha but currently residing
outside Odisha.( for all Govt. school of Nursing and 85% Govt seats in private nursing institutions recognized by INC)
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Both female / male candidates (only 10% reservation for male candidates out of total
seats) are eligible to apply.
Physically handicapped having locomotor disability of lower limbs between 40% to 50%
only will be taken in to consideration. Candidates are advised to obtain their handicapped
certificate from the competent authority of the concerned district. Shall be medically fit for the course (Medical certificate format in annexure -VIII)
III. ADMISSION PROCEDURE
- Candidates can apply for the GNM Course online by applying in the appropriate application form available at website: www.nursingodisha.nic.in on or before dt: 23.07.2016 by 05.00 PM.
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The e-counseling and admission Process involves the following steps:
Step 1
Payment of application fees & online form fill up by the candidates and registration for User id and Password.
Step 2
Choice Filling by the Registered Candidates
Step 3
Publication of Applicant List. Document Verification (Candidate Details, Document
Details) and final Choice locking at Nodal Centres. The copy of these lists will be
generated and signed by both Nodal Officer and Candidate.
Step 4
Round – 1: Publication of merit list.
Publication of provisional Seat Allotment list in the website.
Step 5
The Candidates who have been allotted seats will come to the Nodal Centre and
deposit course fees. The candidate who does not deposit course fee / part
course fee within the stipulated time period, her/his allotted seat will be cancelled
and her/his name will be deleted from the merit list.
Step 6
Round – 2: The unfilled seats after Round -1, shall be allotted from the auto
up graded merit list.
Step 7
The List of Left out candidates will be displayed in the official website.
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Step 1:Online Registration
ASSISTANCE:
The candidates finding difficult to register online can get the assistance of the Govt. facilities like CDMO(DPMU Office), Community Health Centre(CHC) & Common Service Center (CSC) at Gram Panchayat level .Service charges of Rs. 25/-only is to be paid towards filling up form at Common Service Center.
Procedure for online Registration
Payment of Non-refundable Application fees Rs. 500 only through S.B.I.Challan.
(Given in the annexure II)
Open the website www.nursingodishanic.in
Click on "New Registration for ANM and GNM courses”.
Click "apply online" and then click on "GNM". The online application form will be displayed.
Fill the details on the application form and click on save and continue.
Then the candidate will be directed to generate his /her own password.
Important Note:
Candidates are required to note or remember their password to login in future. To maintain
confidentiality of the password is the sole responsibility of the candidate and all care must be
taken to protect its security. If due to any reason the password is forgotten or misplaced, then there is
provision of “OTP” (One Time Password) which will be sent to the registered Mobile no. to reset the
password. “Procedure for Password RESET by the candidate using OTP is available on“ Annexure-I” .
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Filling up online Application form
After logging in , the candidate has to fill up the following details in the form. Personal Details,
Address Details, Academic details, Challan details, Colour Photo (20- 50 KB in jpg/jpeg) &
Signature (10-20 KB in jpg/jpeg) .
Snapshot of the online form given below:
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Important Note:
The candidate is required to verify his/her personal details before submission of application as per documentary evidence.
The selection committee is not responsible for any omission & commission in the submitted data and the consequences thereafter.
In case of discrepancies, the candidate may bring it to the notice of the Principal Tutor of the Concerned Nodal Centre during the time of document verification.
Help centers like (CSC, CHC, CDMO) Office will hand over a copy of the submitted application form (duly signed both by the candidate & officer in-charge of the center) to the candidate & retain the second copy for the official record.
Step 2: Online Choice Filling
Candidate must verify the name of the list of the institutions & total no. of seats available from the official website of INC (www.indiannursingcouncil.org )& fill up the choices for institutions.
The candidate can give his/her choices judiciously in order of preference from the list of available institutions as per her/his own choice. The candidates are advised to see the updated list of institutions for choice filling.
The candidates are permitted, if they so desire, to change / re-order (through move/swap
options) their choices, delete earlier choices and add new choices as many times till they
locktheir final choices at the nodal center during document verification.
Step 3: Publication of Applicant List, Document verification & Final
Choice Locking
a. Publication of Applicant List
Merit list shall be prepared on the basis of career marks.
For calculating career marks, 50% of the percentage of marks secured in HSCE (10th
or equivalent examination without extra optional) and 50% of the percentage of marks secured in CHSE (10+2 or equivalent examination without extra optional.) will be taken into consideration.
Preferences will be given in the following order :-
- 1st
10+2 Science with Biology.
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- 2nd
10+2 Science without Biology.
- 3rd
10+2 and other equivalent examination.
In case of more than one candidate having equal career marks, inter-se merit shall be
taken into consideration as below in order of preference.
a. Qualifying stream.
b. English marks in 10+2 exam.
c. Seniority in date of birth.
b Reporting at Nodal Centre for Document Verification
Applicants are required to attend the designated Nodal Center (Annexure III) for verification of original relevant documents and final choice locking on the scheduled date and time notified on the official web-site.
During document verification at the Nodal Centers the candidates are required to submit
two sets of the following documents (one set original, other set self-attested photo copy)
and original bank challan towards application fee . The Nodal Center has to return back
the original documents except bank challan to the candidate after due verification.
Documents required for verification are as follows:
1. Copy of the submitted application form duly signed by the candidate or a copy
received from the help center.
2. Original 10th
(HSCE) pass certificate and mark sheet issued by BSE Odisha or equivalent thereof.
3. Original 10+2 pass certificate and mark sheet issued by CHSE Odisha or equivalent
thereof.
4. Original College Leaving Certificate / Transfer Certificate
5. Original character /conduct certificate from the Head of the Institution last attended.
6. Domicile/ Residential / Nativity Certificate from competent authority as per Annexure-V.
7. Authentic proof of passing Odia as a subject at M.E / HSCE issued by Board of
secondary education or other equivalent board (for candidates applying for Govt. Institutions & 85% of Govt. quota seats of Private Institutions.
8. Original caste certificate (SC/ST candidate) issued by the competent authority.
(Annexure- IV)
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9. Original Physically Handicapped certificate issued by the competent medical
authority of the Dist. (in case of Physically Handicapped candidates only). Locomotor
disability of lower limbs between 40% to 50% only will be taken into consideration. 10. Original SBI Challan deposit slip, Rs.500/- (Rupees Five Hundred) only towards
application fees.
11. Two copy of self-attested recent passport size Colour photograph.
12. Original certificate of Ex-Serviceman from Rajya Sainik Board (Annexure- VI).
13. Original Green Card (with all pages) issued by the Chief District Medical Officer, (In case of candidate claiming for the seat under green card quota). The name and Date of birth in green card should match with the name and Date of birth mentioned in the HSCE/equivalent certificate. Any difference regarding this should be supported by an affidavit duly sworn in before the executive magistrate.
14. The original Medical Fitness certificate issued by the Govt. Allopathic medical
officer. Note: In case the candidate fails to produce any original document as per the prospectus, his/her name will be deleted from the list.
C. Final Locking of Choices
Candidate has to lock the choice as per her/his own preference at the Nodal Centers
immediately after verification of original documents and testimonials.
Candidates are advised to give maximum numbers of choices in order of preference.
The Nodal Centers will handover a print out of final locked choices signed both by the
candidate and officer in charge of the Nodal Center to the candidate.
Step 4: Publication of merit list &Provisional Seat Allotment
(Round 1)
During this step, the seats will be allotted in the order of merit from the list prepared after
the document verification and choice locking at the nodal center.
The provisional allotment of seats will be available on the official
websitewww.nursingodisha.nic.inand SMS alertregardingallotment of seat will be sent to
the Mobile No. of the candidates.
The candidates are requested to download the intimation letter of provisional seat allotment
by logging in to their “Applicant Login” and report at the Nodal Centre for Depositing
Course fee/Part course fee.
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The candidates are requested to report at the institutions for admission only after the final
seat allotment done in the 2nd
Round of counseling.
Steps 5:Depositing Course Fees /Part course fee
The candidate shall deposit the prescribed fees at SBI by system generated SBI challan.
The course fee/part course fee once deposited shall not be refunded under any
circumstances.
The counter foil of the above deposit shall be deposited at the Nodal Centre on the
scheduled date.
Course Fees for Government institutions
Sr. No Unit 1
st Year 2
nd Year 3
rd Year
1 Tuition fees Rs.2250/- Rs.2250/- Rs.2250/-
2 Admission Fee Rs.2250/- Rs.2250/- Rs.2250/-
3 Hostel Charges Rs.1800/- Rs.1800/- Rs.1800/-
4 Electricity Charges Rs.900/- Rs.900/- Rs.900/-
5 Transportation Charges for field
training / Clinical training.
Rs.650/- Rs.800/- Rs.800/-
6 Identity Card Rs.150/-
(once)
_ _
7 Caution Money (Refundable) Rs.1000/- _ _
Total Rs.9000/- Rs.8000/- Rs.8000/-
N.B. : - The mess charges will be paid separately by the candidate.
Course Fees for 85% Govt. quota seats under Private institutions
1. Tuition Fees (including fees towards
hospital for Clinical Training)
Rs.36,000/- per
annum
Total Rs.36,000/-
Charges for Lodging, Boarding, Transportation, etc. shall be paid separately by the candidate.
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NB:- If the candidate fails to deposit the requisite fees( course fee / part course fee) at the
nodal centre on the notified date, the name of the candidate will be deleted from the counselling
process.
Step 6:Final Seat Allotment (Round 2)
The final allotment of seats after auto up gradation will be available on the official website www.nursingodisha.nic.in and SMS alert regarding allotment will be sent to candidates.
`
The candidates are requested to download the intimation letter of Final seat allotment by
logging in to their “Applicant Login” and report at the Nodal Centre for Depositing Course
fee/Part course fee (if not deposited in Round -1).
Candidate has to verify the reporting date for admission from the web-site.
Candidate has to report at the institution along with a copy of final seat allotment on the
scheduled date and time notified on the web-site.
In addition to the documents already submitted at Nodal Center, an undertaking as per Annexure –VII signed by the Parent / Local Guardian of the candidate has to be submitted at the respective institution after admission.
NB: - Candidate has to report at the institution for admission only as per final seat allotment,
on the scheduled date notified on the website.
Reservation of Seats (from total seats) as per Orissa Reservation of Vacancies Act:
- 22.5% for ST
- 16.25% for SC
- 3% for Physically challenged
- 3% for Ex-servicemen
- 5% for Green card holder
10% seats of (total no. of seats available in Govt. & INC recognized private institutions)
will be reserved for Male candidates.
In case of non-availability of eligible Scheduled Caste candidates, Scheduled Tribe candidates can be selected in their place and vice versa subject to other eligibility criteria.
In case of non-availability of eligible candidates from reserved categories, the seats will be
filled up by the unreserved (UR) category candidates.
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Step 7:List of Left out Candidates
List of candidates, who have not been allotted seats in Round 1 & Round 2, will be
prepared.
List will be verified and displayed on the website: www.nursingodisha.nic.in .
The process of counseling of the left out candidates will be notified in the official website.
If any seat out of the 85% govt. quota seats of the private institution remains vacant, those
seats will be filled up by the private institutions from the common merit list.
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IV. POST ADMISSION
A. Hostel Accommodation
There is provision for hostel accommodation in the G.N.M. Training Centre only for female candidates butfor male candidates there is no such provision at Govt. institutions.
Candidate may reside outside the hostel if permitted by the Director Nursing Odisha ,
only in exceptional circumstances (for Govt. institutions). The candidates shall abide by the Rules and Regulations of the concerned
Institutions and Hostel, during the period of study. Candidates involved in unruly, undisciplined activities are liable for due punishment, by
the concerned Principal Tutor under intimation to the Director of Nursing, Odisha, Bhubaneswar.
B. Uniform
Selected candidates after admission have to wear uniform:
Female candidate during clinical duty - white salwar kameez with white apron with black shoes and during field practice - Green saree / salwar kameez.
For male candidates, white shirt and white full pant with white apron and white socks
with black shoes during ward duty and green shirt and black pant during field duty.
C. Stipend
As per decision of Government the students those who will get admission into
Government GNM Training Schools will get stipend as per Govt. norm. On admission in the Training Centre N.T.I., SAIL, Rourkela, School of Nursing, NSC Hospital, MCL, Talcher, SON IB Jharsuguda, stipend will be paid to students in each month during the training period as per existing rules of the Government of Odisha, But the same will be paid only on successful completion of a preliminary examination after three months of admission and after +2 Council & H.S.C Certificate/Mark list are found genuine on verification and also after submission of necessary agreement by their Parents/ Guardians in a Cartridge paper to refund the stipend paid to her/him if she/he will discontinue the training.
In case a candidate fails to qualify herself / himself in the 1st preliminary examination,
she / he may be given maximum two more chances failing which her/his admission will be cancelled and she/he will be debarred from training. In case of discontinuance from study on any ground the stipend already received, will be recovered in full as per the provisions of the Agreement.
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S.C./S.T. candidates admitted into G.N.M Course in INC recognized Private Institutions, scholarship will be borne by NHM, under “SwasthyaSebikaNijuktiYojana” (SSNY) Scholarship Scheme as follows:
o Partial Scholarship as Tution Fees to SC/ST students belonging to Non-KBKdistricts
@ Rs.15,000/- per annum.
o Full scholarship as Tution Fees to SC/ST students belonging to KBK & KBK+ districts @ Rs.50,000/- per annum.
o Sponsored SC/ST students have to execute a bond with Government which will be
provided during admission subject to provision of funds by the appropriate authority.
D. Vacation& Holidays ( as per INC guideline from time to time)
Out of 52 weeks in one calendar year 6 weeks are deducted in first year and second year.
o 4 weeks vacation
o 1 week preparation leave
o 1 week of Examination.
Third year: First six months = 24 weeks
2 weeks vacation
Second six months= 24 weeks
1 week preparation
1 week Examination E. Discipline
Students remaining absent beyond 15 days in addition to the prescribed leave will
not be allowed to re-join, except on health ground and also in exceptional circumstances . Re-joining the course will be decided by the Director Nursing Odisha.
The student should not indulge herself/himself in criminal offences. If found involved in
such activities, she/he will be removed from the Training and the stipend received by her during training period will be recovered.
As per direction of Hon’ble Supreme Court of India passed in slp (c) no.24295/2004, slp
no.14356/2005, wpc no.173/2006 and slp (c) no.24296 – 24299/2004.if any incident of
ragging comes to the notice of the authority, the concerned candidate shall be given
liberty to explain and if her / his explanation is not found satisfactory, the authority
would expel her / him from the institution.
Affidavit (1) by the candidate (2) by the parent shall be taken as per the circularNo.22-1
O(Web)-INC (Part) dated 14th May 2013. No request for change of training institution after admission will be entertained.
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III. SELECTION COMMITTEE
The State Selection Committee shall consist of:-
1. Director Nursing, Odisha : Chairperson
2. Joint Director, Nursing, Education : Vice - Chairman
3. Joint Director, Nursing, Clinical : Member
4. Deputy Director Nursing , Odisha : Member
5. Asst. Director Nursing, Education : Convener
6. Asst. Director Nursing, Com. Health : Member
7. Secretary, ON&MEB, Bhubaneswar : Member
8. Registrar, ONMC, Bhubaneswar : Member
The Nodal Selection Committee at District level shall consist of:-
1. CDMO/Director Capital Hospital : Chair Person
2. Principal Tutor : Convener
3. Senior Tutor (2 No.s) : Member
4. District Public Health Nurse : Member
5. Matron / Asst. Matron/ Nursing Sister : Member nominated by
CDMO.
Selection process of GNM Training Course will be under the supervision of the Chairperson & Convener of State selection committee.
In case of any dispute in respect of the stipulation in this prospectus and admission of
the students the interpretation and decision of the GNM selection committee of shall be
final & binding.
In case of legal disputes the counter / P.W(C) will be filed by the convener of GNM
selection committee on behalf of Selection committee/Govt.
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Annexure-I
Procedure for Password RESET by students using OTP:
1. Click on Applicant Login.
2. Click on Forgot Password link.
3. Choose the Course name (GNM).
4. Enter the Application Number.
5. Enter Applicant Name.
6. Enter D.O.B (DD/MM/YYYY).
7. Enter the Security Code.
8. Click on SUBMIT button.
9. After clicking on SUBMIT button, if all the details entered are found correct, OTP
number will be sent to the registered mobile number and the OTP Entry screen will
appear.
10. Enter the OTP and click on SUBMIT button.
11. If OTP not delivered to the registered mobile number, then click on Click Here to
Resend link.
12. If correct OTP entered by the candidate, then Password Reset screen will appear.
13. Enter the New Password and Confirm New Password.
14. Then Click on SUBMIT button.
15. If New Password and Confirm New Password entered are same, then the message
“Password Reset Successful” will appear.
16. Click on OK button.
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Annexure –II
SBI CHALLAN:
BANK’S SLIP
CANDIDATE’S SLIP
DEPARTMENT’S SLIP
STATE BANK OF INDIA
STATE BANK OF INDIA
STATE BANK OF INDIA
( POWER JYOTI ACCOUNT )
( POWER JYOTI ACCOUNT )
( POWER JYOTI ACCOUNT )
GNM SELECTION COMMITTEE-CUM-DIR,NURSING,ODISHA
GNM SELECTION COMMITTEE-CUM-DIR,NURSING,ODISHA
GNM SELECTION COMMITTEE-CUM-DIR,NURSING,ODISHA
ACCOUNT No: 30760830432
ACCOUNT No: 30760830432 ACCOUNT No: 30760830432
Name of the Candidate:
Name of the Candidate: Name of the Candidate:
Branch Name:
Branch Name: Branch Name:
Branch Code:
Branch Code: Branch Code:
Amount .Rs.500/- Amount .Rs.500/- Amount .Rs.500/- In words ( Rupees Five Hundred )only In words ( Rupees Five Hundred )only In words ( Rupees Five Hundred )only Journal No:
Journal No: Journal No:
(To be filled by Bank) (To be filled by Bank)
(To be filled by Bank)
Signature of Candidate :
Signature of Candidate :
Signature of Candidate :
Signature of Bank Officer :
Signature of Bank Officer :
Signature of Bank Officer :
Fees remitting Branch may collect Rs.50/- (Rupees Fifty) only towards non-home charges from the remitter SEPARATELY.
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Annexure – III
List of Nodal Center
Sl. Nodal Centre
Tagging District
No.
1 ANM TC, Balasore Balasore, Bhadrak
2 ANM TC, Bolangir Bolangir
3 ANM TC, Baripada Baripada, Mayurbhanj
4 ANM TC, Bhawanipatna Kalahandi, Nuapada
5 ANM TC, Berhampur Gajapati
6 GNM TC, Berhampur Ganjam
7 ANM TC, Daspalla Nayagarh
8 ANM TC, Deogarh Deogarh
9 ANM TC, Dhenkanal Dhenkanal, Angul
10 ANM TC, Jaypore Koraput, Malkangiri, Nabarangapur, Rayagada
11 ANM TC, Kendrapara Kendrapara, Jajpur
12 GNM TC, Cuttack Cuttack, Jagatsinghpur
13 ANM TC, Keonjhar Keonjhar
14 ANM TC, Phulbani Kandhamal
15 ANM TC, Puri Puri
16 ANM TC, Sambalpur Baragarh
17 GNM TC, Sambalpur Sambalpur
18 ANM TC, Sundergarh Sundergarh, Jharsuguda
19 ANM TC, Boudh Boudh
20 ANM TC, Sonpur Subarnapur
21 ANM TC, Bhubaneswar Khurda
22 ANM TC, Bhubaneswar Khurda
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Annexure – IV
CASTE CERTIFICATE
Miscellaneous Certificate No.--------------------------------------------------------------------------------
This is to certify that Sri / Smt. / Miss-----------------------------------------------------------------------
Son / Daughter / Wife of Sri.-------------------------------------------------------------------------------------
of Village / Town--------------------------------------------------- P.S -------------------------------------
Tahasil--------------------------------- in the District of ……………………………… in the State of
Odisha belongs to the ……………………………………. Caste / Tribe which is recognised as
Scheduled Caste / Tribe under Constitution (Scheduled Caste / Tribe) order 1950 as amended by
the Scheduled Castes and Scheduled Tribes (Amendment) orders Act 1976.
Sri / Smt. / Miss --------------------------------------------------------------------------------------------
and ------------------------------------------------------------------------ family are ordinarily reside in
Village / Town -------------------------------------------- P.S.-----------------------------------------------
Tahasil --------------------------------- in the District of -------------------------------- of the State of
Odisha
Full Signature of the applicant Signature of the competent
authority
Date –
Round seal of Office
Designation (with seal of officer)
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Annexure –V
FORM No. III
Office of the ------------------------------------------------------------- Date ---------------------------
Miscellaneous Certificate Case No ---------------------------------------------------------------------- .
RESIDENT / NATIVITY CERTIFICATE
This is to certify that Sri / Smt. / Miss -------------------------------------------------------------------
Son / Daughter / Wife of Sri. ----------------------------------------------------------------------------
is a native of the district of -------------------------------------------------------------------------------- in the State of Orissa and he / she belongs to P.S.-----------------------------------------------------
Tahasil-------------------------------------- in the District of------------------------------------------
since ------------------------- years.The certificate is being granted only for the purpose of G.N.M.
Training Course 2016- 17 Odisha .
Full Signature of the applicant Signature of the competent authority
Date –
Round seal of the Office Designation (with seal of officer)
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Annexure - VI
GOVERNMENT OF ODISHAOFFICE OF THE ORISSA SAINIK BOARD,
BONAFIDE CERTIFICATE
1. Certificate That No.
____________________________Rank_______________________ _______ Name_______________________________Vill___________________________ P.O__________________________________P.S__________________________ Dist.____________________ (Odisha) is a bonafide Serviceman/ Ex-serviceman of the Indian
Army/Air force/Navy/CRPF/BSF. ( In case of widow: (Name)
Smt._________________________________ date of death of husband
__________________________, Cause of death: Battle Casualty killed in action/death on duty
attributable to Military Service/death after discharge from Armed Forces*). He/ She been issued
with Ex-serviceman/ Identify Card bearing Machine No._________________________. 2. Shri/Kumari ___________________________________is the dependent son/daughter of the
above named Ex-serviceman/widow of serviceman/ Ex-serviceman. His/her date of birth
is_____________________ as per his/her Birth Certificate/ SLC/Mark-sheet/ Exam. Admit
Card/ Board Certificate/ Military Discharge Book/issued by the
_____________________________bearing Sr. No._____________________. He/She is eligible
for admission in Education/ Technical Institutions in seats reserved for the children of Defence
Serviceman/ Ex-serviceman personnel/ Defence personnel killed in action. (*Strike out those are not applicable)
Place:
Date:
Secretary
OdishaSainik Board/RazyaSainik/
ZillaSainik Board
(Office Seal)
26
Annexure-VII
U N D E R T A K I N G (To be submitted by the selected candidates after admission in the respective Training Centre) I Sri/ Smt. (Name of the Local Guardian)---------------------------------------------------------------,
Address: -------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------, undertake to act as the Local Guardian of Miss / Smt. Daughter / Wife of Sri----------------------
…………………………………………………………………. during her period of study in the GNM Training School.
I also undertake to act on behalf of the parents / husband of the said student during the period of study in the GNM Training School --------------------------------------- for which I have been empowered by the parent / guardian / husband of the said student.
I further undertake to take custody of the above student as and when required by the
school authorities and to ensure that she maintains the academic discipline and good conduct during the period of study in the aforesaid institution.
Place: Signature in full of the Local
Date: Guardian
ATTESTATION BY PARENT / HUSBAND / GUARDIAN
The above undertaking has been signed in my presence, I empower Sri/Smt.----------------------
------------------------------------- to act as Local Guardian of my daughter / wife Miss / Smt.--------
-------------------------------------------during the period of her studentship in the GNM
Training School ----------------------.
Place: Signature in full of the
Parent/Guardian/Husband Date :
Signature in full of the Student
27
Annexure-VIII
CERTIFICATE OF PHYSICAL FITNESS IN RESPECT OF SELECTED CANDIDATES FOR ADMISSION INTO THE GENERAL NURSING &
MIDWIFERY TRAINING COURSE-2016.
Name of the Candidate in full
Age Sex Height Weight
Heart Eye Teeth Liver
Lungs Spleen Blood Pressure Blood
Group
Please indicate if Pregnant (In case of female candidate) Date
of L.M.P. (In case of female candidate)
Previous Medical History, if any
Personal Remarks of
1.
2.
I certify that I have examined the above named candidate and cannot discover that she /he has any
diseases, constitutional weakness or bodily infirmity and I consider that the candidate is physically and mentally fit to undergo General Nursing and Midwifery Training Course under Health & F.W. Department.
SIGNATURE OF THE CANDIDATE
Signature & Seal of authorized Medical Officer (Govt. of Odisha)
Designation –
Date -