PROSPECTUS FOR ADMISSION INTO GENERAL NURSING & MIDWIFERY (G.N.M) COURSE IN GOVERNMENT & PRIVATEINC RECOGNISED TRAINING SCHOOLS OF ODISHA

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1 PROSPECTUS FOR ADMISSION INTO GENERAL NURSING & MIDWIFERY (G.N.M) COURSE IN GOVERNMENT & PRIVATEINC RECOGNISED TRAINING SCHOOLS OF ODISHA DURING THE ACADEMIC SESSION Cost of Application Form & Prospectus: Rs.500/- (Rupees Three Hundred) only 1

2 Application form & Prospectus for admission into GNM training course for the academic session are available in the official website of Directorate of Nursing, Odisha& DMET,Odisha & Intending male and female candidates may apply online by depositing prescribed fee Rs. 500/-(Rupees Five Hundred only) in shape of SBI Challan attached in the prospectus (annexure-3).the candidate may avail the facility for submission of On-line application which are available at the nearest center i.e. CSC (Common Service Centre), at Gram panchayat level/community Health Centre at block level/cdmo office at District level. For any query contact:

3 Index Sl.no Content Pa ge no I II III Admission Calendar General Information & Eligibility Admission Procedure Online registration Online Choice Filling Provisional Merit List, Document Verification & Choice Locking Provisional Seat Allotment (Round 1) Deposition of Course Fees Final Seat Allotment (Round 2) List of Left Out Candidate IV Post Admission V Selection Committee 18 Annexure I List of Institution participating in Counseling Annexure II SBI challan for Application Fee 24 Annexure III List of Nodal Centers 25 Annexure IV Cast Certificate Proforma 26 Annexure V Residence/Nativity Certificate Proforma 27 Annexure VI Proforma of Certificate of Sainik Board 28 Annexure VII Proforma for undertaking by guardian 29 Annexure VIII Proforma of physical fitness certificate. 3

4 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 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 into GNM course at G.P level which is praiseworthy. 4

5 ADMISSION CALENDAR Publication of Advertisement Availability of Online Application form and Prospectus in official website Last date for submission of application Expected date of Publication of provisional merit list in the official website: Expected date of Document Verification and choice locking at Nodal Centres Expected date of Reporting at nodal centers with course fees to ( The Mock registration process starts from to till 2.00 PM after that AM) onwards the final registration process will start.) by P.M to to Final seat allotment Reporting at nodal center With fees for 2 nd round counseling to Publication of list of left out Candidate

6 I. GENERAL INFORMATION - Applications are invited for admission in General Nursing & Midwifery (GNM) 1 training course in all Government & INC approved Private G.N.M training centers for the year (detail list of institutions can be found in annexure 1). - 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 will adopt their own procedure for filling up 15% seats under management quota. - All the institutions (Govt. & Private) having INC recognition as on will be allowed for the e-counseling process. III. ELIGIBILITY - Candidate must be 17 years of age or above as on There is no age bar for registered ANM/LHV candidate. - The candidates must have passed 10+2 with % marks from CHSE Odisha or equivalent thereof however science is preferable. Or 10 +2/12 th with % marks from state open schools recognized by state Govt. and National Institute of Open School recognized by Central Govt vocational ANM course with % marks from the school recognized by Indian Nursing School. Or Or 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 the candidate seeking admission in Govt. School of Nursing & against 85% Govt. quota of Private School of recognized by INC. - Must be a domicile / permanent resident / native of Odisha but currently residing outside Odisha. 6

7 - Both female / male candidates (10% reservation for male candidates out of total seats) are eligible to apply. - Physically Handicapped having locomotor disability of lower limbs between % to 50% will be taken in to consideration. Candidates are advised to obtain their physical handicap certificate from the competent medical authority of their district on last week of july 2015 or first week of august 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: on or before by PM. 7

8 The e-counseling and admission Process involves the following steps: Step 1 Payment of application fee & online form fill up by the candidate and registration for User id and Password. Step 2 Choice Filling by the Registered Candidates Step 3 Provisional Merit List. Document Verification at Nodal Centres. The copy of the Candidate Details, Document Details and Choice list will be generated and signed by both Nodal Officer and Candidate. Step 4 Round 1: Provisional Seat Allotment & publication on 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 within stipulated time period her/his allotted seat will be cancelled and such candidates will be deleted from the merit list. Step 6 Round 2: Seats not filled up in Round 1, will be filled up in the Round 2 as per the merit list. Step 7 Left out candidate list is prepared, verified and displayed on the website. 8

9 Step 1: Online Registration ASSISTANCE: Note: Candidate may practise with the mock application form available in the official website (link) before filling up the actual application form. 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 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. The amount is payable through SBI Challan ( given in the annexure II) Open the website 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. 9

10 Filling up online Application form After login, 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 10

11 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 datas and the consequences thereafter.. In case of discrepancies if any, 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 Important Note: Before choice filling in the final application form candidate may practise the mock format available in the official website (link). - Candidate must verify the name of the list of the institutions & total no. of seats available (Annexure- I) & 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 own wish. The candidates are advised to see the updated list of institutions till for choice filling up for the institutions. - The candidates are permitted, if they so desire, to change or re-order (through move/swap options) their choices, delete earlier choices and add new choices as many times til they lock their final choices at the nodal center during document verification. Step 3: Provisional Merit List, Document verification & Final Choice Locking a. Provisional Merit List - Merit list shall be prepared on the basis of career marks. - For calculating career marks, 50% of the percentage of marks secured in HSC (10 th 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 as follows: Science with Biology Science without Biology and other equivalent examination. 11

12 - 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 c. Seniority in date of birth. b. Reporting at Nodal Centre for Document Verification - Provisionally selected candidates are required to attend the designated nodal center (annexure III) for verification of original relevant documents, payment of course fees and 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). The nodal center has to return back the original documents 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 10 th (HSC) pass certificate issued by BSE Odisha or equivalent thereof pass certificate 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 Odiya as a subject at M.E/HSC issued by Board of secondary education (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) 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 % to 50% 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) 12

13 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). In case of any discrepancy(from HSC /equivalent certificate) in the green card the candidate shall have to submit an affidavit duly sworn before the executive magistrate failing which the Green Card reservation quota will not be taken in to consideration 14. The original Medical Fitness certificate issued by the Govt. medical officer. If a candidate fails to submit the original College leaving certificate (C.L.C/ T.C) or character /conduct certificate at the time of document verification, he/she may be admitted with an undertaking to submit the same before the Principal Tutor of the concerned GNMTC. 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 have to handover a print out of final locked choices signed both by the candidate and officer in charge of the nodal center. Step 4: Provisional Seat Allotment (Round 1) - During this step, the seats will be allotted in the order of final merit list prepared after the document verification and choice locking at the nodal center. - The provisional allotment of seats will be available on the official website and SMS alert regarding allotment will be sent to candidates. Steps 5: Deposition of Course Fees at Nodal Centre Candidate has to deposit the following fees at the nodal centre towards course fees in shape of DD in favour of the Convener GNM selection committee payable at Bhubaneswar 13

14 Fees for Government institutions Sr.No Title of the fees 1 st Year 2 nd Year s3 rd Year 1 Admission Fees Rs.2250/- Rs.2250/- Rs.2250/- 2 Tuition Fees Rs.2250/- Rs.2250/- Rs.2250/- 3 Hostel Fees Rs.1800/- Rs.1800/- Rs.1800/- 4 Electricity Charges Rs.900/- Rs.900/- Rs.900/- 5 Transportation charges training for field 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/- Besides the above the messing charge may be charged extra. Fees for 85% Govt. quota seats under Private institutions 1 Tuition Fees (including fees towards hospital for Clinical Training) Total Rs.36,000/- per annum Rs.36,000/- NB:- Charges for Lodging, Boarding, Transportation, etc. shall be paid separately. If the candidate fails to deposit the requisite fees at the nodal centre on the notified date the name of the candidate will be deleted from the counseling process. Step 6: Final Seat Allotment (Round 2) - The final allotment of seats after auto up gradation will be available on the official website and SMS alert regarding allotment will be sent to candidates. - Candidate has to verify the reporting date for admission from the web-side - 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-side. - In addition to the documents already submitted at nodal center, an undertaking from a Local Guardian as per Annexure VII, should be signed by the Parent / Guardian of the candidate. - Any candidate who had previously got a seat in private institution in provisional seat allotment and after auto up-gradation get a seat in the Govt. Institution then, the balance course fee will be refunded. 14

15 Reservation of Seats (from total seats) as per Orissa Reservation of Vacancies Act: i) 22.5% for ST, ii) 16.25% for SC. iii) 3% for Physically challenged iv) 3% for Ex-servicemen v) 5% for Green card - 10% s eat s o f (tot al no. of seat s availabl e in Go vt. & IN C recognized P ri v at e institutions) wi ll be res erved fo r m al e candidat e. - In case of non-availability of candidates belonging to Scheduled Caste community, Scheduled Tribe, candidates can be selected in their place and vice versa subject to other eligibility criteria. - In case of non-availability of candidates in any of the reserved category, the seats will be filled up from the candidate of unreserved category. - If any seats out the 85% govt. quota seats of the private institution remains vacant, then the private institutions may be allowed to fill up those seats from the common merit list. Step 7: List of Left out Candidates - In this step list of candidates, who has not been allotted the seat even after completion of seat allotment process will be prepared. - List will be verified and displayed on the website: - The process of counseling of the left out candidates will be notified in the official website. 15

16 IV. POST ADMISSION A Hostel Accommodation - There is provision for accommodation in the G.N.M. Training Centre only for female candidates. No provision of hostel accommodation for male candidates. - Candidate may reside outside the hostel if permitted by the Director Nursing Odisha, only in exceptional circumstances. - The candidates are to abide by the Rules and Regulations of the concerned Institutions and Hostel, during the period of study. - If any of them will be found to be involved in immoral activities, unruly and undisciplined conduct, she/he will be 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 a stipend of Rs. 1000/- per month. - 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. 16

17 - S.C./S.T. candidates admitted into G.N.M Course in INC recognized Private Institutions, scholarship will be borne by NHM, under Swasthya Sebika Nijukti Yojana (SSNY) Scholarship Scheme as follows: o Partial Scholarship as Tution Fees to SC/ST students belonging to Non-KBK Rs.15,000/- per annum. o Full scholarship as Tution Fees to SC/ST students belonging to KBK & KBK+ 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 E. Discipline i. Annual Vacation- Days (which can be divided) ii. Sick Leave (10 days) iii. Preparatory Leave (7 days) - Absence of a student beyond 15 days in addition to the prescribed leave will not be allowed to rejoin again except in case of candidate admitted on health ground subject to production of medical certificate from competent authority. - 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 in one installment. - If any incident of ragging comes to the notice of the authority, the concerned student shall be given liberty to explain and if her/his explanation is not found satisfactory, the authority would expel her from the institution. - No application for change of Training Institution during the training period will be entertained. 17

18 V. 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 Secretary, ON&MEB, Bhubaneswar Member 7 Registrar, ONMC, Bhubaneswar Member The Nodal Selection Committee shall consist of:- 1 CDMO/Director Capital Hospital Chair Person 2 Principal Tutor Convener 3 Senior Tutor Member 4 Senior Tutor Member 5 District Public Health Nurse Convener 6 Matron / Asst.Marton /Nursing Sister Member (Nominated by CDMO) Selection of GNM Training Course will be under the supervision of Chair-person & Convener of the State Selection Committee. All disputes pertaining to the selection and admission shall fall within the jurisdiction of Bhubaneswar only. The convener of the selection committee shall be the legal person in whose name the selection committee may sue or may be sued. 18

19 Annexure - I List of Institution participating Online Counseling & Admission Process List of Government Institutions Sr.No Name of the institutions as per dt: No.of Seats available 1 GNM School Of Nursing Government, Hospital Dhenkanal, Orissa 2 GNM School Of Nursing Government Hospital Kalahandi, Orissa 3 GNM School Of Nursing Government, Hospital, Kandhamal, Orissa 4 GNM School Of Nursing Government, Hospital, Sundargarh, Orissa 5 SCB Medical College Hospital Sch. Of Nsg. PO / M - Cuttack, 7507,Orissa 6 V S S Medical College Hospital School Of Nursing, Burla, Sambalpur ,Orissa

20 List of the Private Institutions Sl.No Name of the institutions as per dt: No.of Seats 1 Anjaali College Of Nursing Studies At-Uttara Chaka, P.O- KousalyagangaBhubaneswar, Distt- Khurda, Orissa ,Orissa 2 Ashwini School Of Nursing At - AshwiniHospital Sector -1, Cda Cuttack,Orissa 3 Bhagabati School Of Nursing At/Po -Padmapur, Saragan Via: Sunhat Balasore756002,Orissa 4 Bhava Institute Of Medical Science &Research Plot -1480, I R C Village, NayapalliBhubaneswar , Orissa,Orissa 5 Bhubaneswar School Of Nursing At 94,Dharmavihar, Po/Via - KhandagiriDist - Khurda, Odisha ,Orissa 6 Biswanath Institute Of Medical TechnologyPlot No 360/2692, Mahadev Nagar, Lane No1, Jharapada Bhubaneswar, Dist - Khurda,Odisha ,Orissa 7 Blue Wheel Institute Of Nursing Sciences At-- Chandpur, Po - Chandpur Via - Ranpur, Ps - RanpurNayagarh,Orissa 8 D R I E M S School Of Nursing At -Kairapari, Po - KotsahiTangi Cuttack7522,Orissa 9 General Nursing & Midwifery TrainingSchool Central Hospital, B Valley, MahanadiCoalfiields Ltd At Po BrajrajNagar,Jharsuguda, Odisha ,Orissa 10 General Nursing And Midwifery TrainingSchool, N S Ch., Talcher, At/ P O - Dera,Talcher, Pin ,Orissa 11 Gopabandhu Institute Of Medical Sci. &Research Vill - Madhabpur, Po -Mahakalabasta Via - Athgarh Cuttack7529,Orissa 12 Hitech School Of Nursing Health Park,Pandara Po - G. G. P. Bhubaneswar751025,Orissa 13 I I M T School Of Nursing S 3 M 4, ChhendColony, KalingaSundergarh Rourkela769015,Orissa 14 JharsugudaGNM Training College At/Po- JharsugudaJharsuguda,Orissa

21 15 Kalinga Institute Of Industrial Technology (Deemed University Campus- V),A T/ P O: KI I T Bhubaneswar , Orissa 16 Kalinga Nursing School, Kalinga HospitalLimited, Chandrasekharpur,Bhubaneswar ,Orissa 17 KoshalaGNM Training School Dhanupali,SambalpurDistSambalpur , Orissa 18 Kuntala Devi School Of Nursing At/Po-Debatra Colony, SamantaMargDist -Nayagarh, Orissa ,Orissa 19 Kuntala Devi School Of Nursing New BusStand Road, Po KhurdaKhurda, Orissa752055,Orissa 20 Lord Jagannath Mission's School OfNursing Plot No. 228/237, Sector - A, Zone -B MancheswarIndl Estate, P O - RasulgarhBhubaneswar ,Orissa 21 Maa Annapurna School Of Nursing Plot No.2764/4805, NageswarTangiBhubaneswarKhurda ,Orissa 22 Mahima School Of Nursing At- GopalsagarP.O- JagatsinghpurJagatsinghpur ,Orissa 23 Manjari Devi School Of Nursing, 208,Kharavela Nagar, Unit-3,Bhubaneswar , KhurdahDistt.,Orissa 24 Mothers Nursing School Plot No 120 B,Kaling Nagar, K - 1, GhatikiaBhubaneswar,Khurda, Odisha751003,Orissa 25 National Institute Of Medical &Management Studies 392-A/B, BaramundaKhurda, Bhubaneswar ,Orissa 26 Neelachal Institute Of Nursing School Co- Housing Complex, Unit Iii KharvelNagar,Janpath - KhordhaKhordha ,,Orissa 27 Netaji School Of Nursing Plot No. 262 (B),District Centre ChandrasekharpurKhurdaBhubaneswar ,Orissa 28 Nurses Training Institute IspatGeneralHospital Rourkela, Sector-19 Sundergarh769005,Orissa 29 Orissa Nursing Training Institute PensionLane, Buxi Bazar Dist Cuttack- 7501,Orissa,Orissa

22 Pallichandan School Of Nursing At/PoNimapara (Women's College Road) Dist -Puri, Orissa ,Orissa 31 PathaniSamanta Nursing Centre At- OldTown, KaransahiDistNayagarh, Orissa 32 Prativa Devi School Of Nursing Plot No 79,Kharvel Nagar, Unit - Iii Bhubaneswar,Orissa ,Orissa 33 Ramadevi School Of Nursing Pattamundai (By Pass Chak) Kendrapara DistrictKendrapara , Orissa,Orissa 34 S I E M S School Of Nursing Plot No 467,Madhusudan Nagar, Side Of New A GColonyDist Bhubaneswar , Orissa 35 Sabarmati School Of Nursing At MahanadiVihar, Po NayabazarDist Cuttack- 7504,Orissa,Orissa 36 Sahayoga Institute Of GNM Training CollegeAt - Kasturi Nagar, 5th Lane, Po/Dist - RayagadaRayagada ,Orissa 37 Sailabala School Of Nursing AtSailashrinibas, Narendrakona, Po PuriTownPuri, Odisha ,Orissa 38 Salandi School Of Nursing Nh - 5, MotelSquare Tehsil - BhadrakBhadrak ,Orissa 39 Sambalpur Nursing School At- Govindtola,Po- Dhanupali, Sambalpur ,Orissa Sarada Devi Institute Of Medical Science #1525, Mahanadi Vihar Cuttack 7504,Orissa 41 School Of Nursing & Health Sciences, HillPatna, Behrampur ,Orissa 42 Seva School Of Nursing At - IndrahaniNagar Po - Turanga, Angul , Orissa, 43 Shaikh School Of Nursing BaghraRoad,NearPrativa Nursing Home Ward No-16,Baripada, Mayurbhanj, Orissa, Pin ,Orissa 44 Shree Mahavir School Of Nursing,Gopalpur, Cuttack ,Orissa 45 SmtSusila Devi Institute Of NursingEducationSaiPriya Nagar, Near NyrSchoolRayagadaRayagada ,Orissa 46 Sri Jagannath School Of Nursing C/O MrMukesh Kumar Vasani, At Post KhariarRoadNuapada, Odisha ,Orissa 20 22

23 47 Sum Nursing School, C-51, B D A H I GDuplex, Baramunda, Bhubaneshwar ,Orissa 48 SundergarhGNM Training College AtSankaraSundargarh ,Orissa 49 Surya School Of Nursing At/Po - Hatadihi,Dist - Kenojhar Kenojhar , Orissa 50 Sushree Institute Of Technical Education ASchool Of Nursing, PallishreeVihar, At/ Po-Sadaipali, DistBalangir, Orissa Susila Devi Batakrishna Nursing School,Door No- 866/1379, Street: Rajpur,Nuapada, At/ Po/ Dist- Nuapada ,Orissa,Orissa 52 Tulasi G N M Training Centre, Gopa, P O - Keshpura, Near T V Centre Kendrapara,Orissa 53 Vivekananda Institute Of Social Work &Social Science ( V I S W A S S ) School OfNursing, P No. 474, Pitapalli Square N H-5,P O KumarbastKhurda ,Orissa

24 24 Annexure II SBI CHALLAN BANK S SLIP STATE BANK OF INDIA (POWER JYOTI ACCOUNT) CANDIDATE S SLIP STATE BANK OF INDIA (POWER JYOTIACCOUNT) DEPARTMENT S SLIP STATE BANK OF INDIA (POWER JYOTIACCOUNT) GNM SELECTION COMMITTEE-CUM- DIR,NURSING,ODISHA ACCOUNT No Name of candidate GNM SELECTION COMMITTEE-CUM- DIR,NURSING,ODISHA ACCOUNT No Name of candidate-: GNM SELECTION COMMITTEE-CUM- DIR,NURSING,ODISHA ACCOUNT NO Name of candidate-: Branch Name Branch Code Amount. Rs.500/- In words (Rupees Five Hundred) only Journal No... (To be filled by Bank) Branch Name Branch Code Amount. Rs.500/- In words (Rupees Five Hundred) only Journal No... (To be filled by Bank) Branch Name Branch Code Amount. Rs.500/- In words (Rupees Five Hundred) only Journal No... (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.

25 List of Nodal Center Sl. No. Nodal Centre Tagging District 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 Annexure III 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 25

26 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 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) 26

27 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 Odisha Full Signature of the applicant Signature of the competent authority Date Round seal of the Office Designation (with seal of officer) 27

28 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 Exserviceman/ Identify Card bearing Machine No._. 2. Shri/Kumari is the dependent son/daughter of the above named Ex-serviceman/widew 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 Srl. No. He/She is eligible for admission in Education/ Technical Institutions in seats reserved for the children of Defence Serviceman/ Exserviceman personnel/ Defence personnel killed in action. (*Strike out those are not applicable) Place: Date: (Office Seal) Secretary Odisha Sainik Board/ Razya Sainik/ Zilla Sainik Board 28

29 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... Under take to act as the Local Guardian of Miss / Smt.. Daughter / Wife of Sri..during her period of study in the H.W.(F) Training Centre,... I also undertake to act on behalf of the parents / husband of the said student during the period of study in the G.N.M. Training Centre,... 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 -.. Date - Signature in full of the Local 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 G.N.M.Training Centre,... Place: Date : Signature in full of the Parent/Guardian/Husband Signature in full of the Student 29

30 Annexure-VIII CERTIFICATE OF PHYSICAL FITNESS IN RESPECT OF SELECTED CANDIDATES FOR ADMISSION INTO THE GENERAL NURSING & MIDWIFERY TRAINING COURSE Name of the Candidate in full Age Sex Height Weight Heart Eye Teeth Liver Lungs Spleen Blood Pressure Blood Group Please indicate if Pregnant of L.M.P. Previous Medical History, if any Remarks of Identification (In case of female candidate) Date (In case of female candidate) Personal 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 -

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