BANARAS HINDU UNIVERSITY SCHOOL OF NURSING SIR SUNDERLAL HOSPITAL VARANASI

Date of Receipt of Application Form: Form No.: Cost : General Category = Rs.500/- only SC/ST Categories= Rs.400/- only BANARAS HINDU UNIVERSITY SCHOOL OF NURSING SIR SUNDERLAL HOSPITAL VARANASI - 221 005 APPLICATION FORM AND INFORMATION BOOKLET FOR ADMISSION TO "THREE & HALF YEAR DIPLOMA IN GENERAL NURSING & MIDWIFERY COURSE-2006" Last date for Receipt of completed Application Form in M.S. Office, S.S.Hospital, BHU: 31 st MAY 2006 (Wednesday) till 5.00 PM (For Office use only) Comments of Screening Committee Category Provisional Roll No. allotted Provisionally Qualified: PQ* / PQ** / PQ*** Unqualified with Reason: PQ General SC ST Details of Bank Draft/Bankers Cheque Name of the Bank Branch & Place of issue Draft No. Date Amount IMPORTANT INFORMATION/INSTRUCTIONS 1. This contains Application Form from Page 1 to 5, Registration Card, Provisional Admit Card and Information Booklet from Page No. 1 to 4. 2. Please read the Information Booklet carefully before filling-up the Application Form. 3. The course is open only to female candidates who are Indian Nationals and are either Unmarried or Divorcee/Widow without children and are 17 to 35 years of age as on 1 st September 2006 (INC Norms). 4. The Application Form must be filled in by the candidate in her own handwriting. 5. While submitting the Photocopies of the Certificates, Mark Sheets or any other document the printed matter on both sides of the aforesaid documents, if any, is required to be Xeroxed on both sides, attested and be sent along with the Application Form. Incomplete Photocopies of the Certificates, Mark Sheets or any other documents will not be considered. 6. The Application Form submitted incomplete shall be rejected without any communication whatsoever. No communication will be made for the Candidates who have not qualified for appearing in the Written Entrance Examination. 7. The date of Written Entrance Examination is 15 th July, 2006 (Saturday) at Banaras Hindu University only. The exact venue will be informed through Provisional Admit Card only to those Candidates who will be called for the above-mentioned Examination. Contd.... 2

2 PARTICULARS TO BE FILLED IN BY THE CANDIDATE IN HER OWN HANDWRITING (Strike out whichever is not applicable) 1. Name in Full: (in block letters) 2. Date of Birth: 3. Age as on 1 st September, 2006: 4. Father's Name in full (in block letters): 5. Mother's Name in full (in block letters): 6. Father's Occupation: Service / Business / Retired / any other 7. Father's/Guardian s full Postal Address: (Phone Number) Paste a self-attested Passport size recent front view photograph 8. Name and Address of Local Guardian (if any): 9. Permanent Home Address: 10. Address for Correspondence: (Phone Number) 11. Nationality: State to which belong: 12. Religion: Caste: 13. Marital Status: (Married / Unmarried / Divorcee / Widow) (In case of Divorcee Candidate, an Affidavit to this effect is to be submitted) 14. Encumbrance if any in case of Divorcee and Widowed Candidates: YES / NO (If no, an affidavit is to be submitted stating that there is no Children liability) 15. Category of Candidate: General / SC / ST (In case of SC / ST Candidate, a Certificate to this effect from the competent authority MUST be submitted along with the Application Form) Contd.... 3

3 16. Educational Qualification: Examination Passed with Board/ University Year of Passing Subjects of Study Marks obtained / Maximum Marks Total Marks obtained with % High School/ SSLC,... Intermediate/ Pre-degree/ 10+2/any other Equivalent... Any Other, specify...... Note: Please attach attested Photocopies of all the Academic Certificates & Mark Sheets of each Examination passed. The overleaf printed matter in the Certificates & Mark Sheets, if any, is also required to be Xeroxed on both sides, attested and to be attached with the Application Form. 17. Name and Full Address of the College last attended: Date: SIGNATURE OF THE CANDIDATE IN FULL Place: Contd.... 4

1. I have read the information leaflet carefully. 4 DECLARATION FORM (To be signed by the Candidate herself) 2. I am an Indian citizen and have not taken part in any activity subversive to law. 3. The Application Form has been duly filled and signed by me in my own handwriting. All the information furnished herein is true and complete and nothing has been concealed or distorted. If any time it is found that the entries made in my Application Form are incorrect or any of the information has been concealed or distorted, my admission to the Diploma in Nursing Course at the School of Nursing, Sir Sunderlal Hospital, Banaras Hindu University, shall be liable to be summarily cancelled without any notice whatsoever by the Head of the Institution. 4. I shall abide by the decision of the Head of the Institution in all matters of admission, discipline, examination, residence, attendance in the classes and shall abide by the Rules & Regulations of the School of Nursing and Banaras Hindu University. 5. I shall reside in the Student Nurses Hostel without any member of my family for the entire period of my training and shall abide by the Rules and Regulations of the Student Nurses Hostel for the entire period of my training. 6. I promise to submit/show original copies of all my Educational Qualification Certificates, Mark Sheets as well as other relevant Certificates at the time of my admission to the Admission Committee. In the event of failure to do so my admission to School of Nursing, S.S. Hospital, BHU, shall stand cancelled. Date : SIGNATURE OF THE CANDIDATE IN FULL Place : UNDERTAKING BY THE FATHER/GUARDIAN In the event of my Daughter/Ward being admitted to Three & a Half Year Diploma in General Nursing & Midwifery, I hereby give an undertaking that I shall be responsible for the behavior and conduct of my Daughter/Ward during the entire Course of her studies and shall make payments for any dues to the University. I also give an undertaking that in all matters of Admission, Discipline, Examination, Residence, Attendance in Class and other related matters my Daughter/Ward shall abide by the decision of the Head of the Institution. Date: Place : SIGNATURE OF THE FATHER/ HEAD OF THE FAMILY & RELATIONSHIP WITH THE CANDIDATE (in case father is not alive) NAME IN FULL Contd...5

-5- CHECK-LIST FOR ENCLOSURES (All Photocopies of Certificates submitted are to be self attested by the Candidate and to be enclosed in the Order mentioned below) Sl. No. Particulars of Certificates/Documents 1. High School/SSLC Passing Certificate (for DOB) 2. High School/SSLC Marks Sheet 3. Intermediate / Pre-degree /10+2 /Any other Equivalent Examination Passing out Certificate 4. Intermediate / Pre-degree /10+2 /Any other Equivalent Examination Marks Sheet 5. SC/ST Certificate (Attested Photocopy) from a competent authority* 6. The relevant Affidavit in Original in case of Divorcee. 7. Any other relevant Certificate 8. A self addressed envelop of the size 25 cm x 10 cm and a D.D. of Rs. 50/- drawn in favour of the Medical Superintendent, SSH and payable at Bank of Baroda BHU Branch. 9. One 8 cm. x 4 cm. size slip mentioning the name and address of the Applicant in Block Letters YES/NO (Please Specify) Enclosure No Date : SIGNATURE OF THE CANDIDATE IN FULL * Competent Authorities for Issuing the SC/ST Certificate:- The District Magistrate, Addl. District Magistrate, Collector, Dy. Commissioner, Addl. Dy. Commissioner, Dy. Collector, 1st Class Stipendary Magistrate, City Magistrate, Sub-Divisional Magistrate, Taluk Magistrate, Executive Magistrate, Extra- Asstt. Commissioner, Chief Presidency Magistrate, Revenue Officer, Tahsildar, Administrator, Development Officer (Lakshadweep Island)

REGISTRATION CARD (SESSION-2006) To be submitted alongwith the Application Form after completion Date of Examination: 15.07.2006 (Saturday) Roll No. Examination Centre: (TO BE FILLED IN BY THE CANDIDATE IN HER OWN HANDWRITING WHILE APPLYING) Name of the Candidate in full :_ Father's Name : Date of Birth : Category : General / SC / ST Paste a self attested pass port size recent front view photograph Address for : Correspondence Specimen Signature of the Candidate at the time of applying TO BE SIGNED IN THE EXAMINATION HALL AT THE TIME OF EXAMINATION Signature of the Candidate at the Examination Hall Signature of the Invigilator attesting the Signature of the Candidate

BANARAS HINDU UNIVERSITY SCHOOL OF NURSING, SIR SUNDERLAL HOSPITAL PROVISIONAL ADMIT CARD (For the Written Entrance Examination relating to admission to Three & A Half Year Diploma in General Nursing & Midwifery 2006) To be submitted alongwith the Application Form after completion Date of Examination: 15.07.2006 (Saturday) Examination Centre: Roll No. (TO BE FILLED IN BY THE CANDIDATE IN HER OWN HANDWRITING WHILE APPLYING) Admit Provisionally: (Write your Name in Full and in Block Letters) Daughter/Ward of: (Write Name of your Father/Guardian in Full and in Block Letters) Paste self attested Passport size recent front view photograph. Address for Correspondence: SIGNATURE OF THE CANDIDATE IN FULL SIGNATURE WITH SEAL OF PRINCIPAL, SCHOOL OF NURSING, S.S.HOSPITAL

BANARAS HINDU UNIVERSITY SCHOOL OF NURSING SIR SUNDERLAL HOSPITAL ADMISSION TO FIRST YEAR OF "THREE AND A HALF YEAR GENERAL NURSING & MIDWIFERY" IMPORTANT NOTE: INFORMATION & INSTRUCTION BOOKLET (This Booklet be retained by the Candidate and need not be sent with the Application Form) 1. Please read carefully the information and instructions mentioned in this booklet before filling up the Application Form. 2. The Application Form not filled properly or incomplete in any respect will be rejected summarily without any intimation to the Candidate. 3. Any concealment of facts or giving wrong information in the Application Form or submission of forged documents shall make the candidature liable to be rejected and the admission to the Course shall be terminated at any time during the Course of training. 4. Banaras Hindu University shall not be bound by any means to provide employment to the candidates after their passing out Diploma Course in General Nursing from the School of Nursing, Sir Sunderlal Hospital, Banaras Hi ndu University, Varanasi. The School of Nursing, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi offers "Three and a half year Diploma in General Nursing & Midwifery " to the eligible candidates from all over the country. This training is as per the syllabus of the Indian Nursing Council, New Delhi. 1. ELIGIBILITY CRITERIA: 1.1) Only the female candidates who are Indian citizens and are Unmarried, Divorcee/Widow without any children liability and who are medically fit in all respects i.e. physic ally and mentally, are eligible to apply for admission to the above -mentioned Course. 1.2) AGE: The candidates should be 17 to 35 years of age as on 1 st September of the year of admission (INC Norms). 1.3) QUALIFICATIONS: 1.3.1) Intermediate/10+2 or equivalent with subjects such as Physics, Chemistry, Biology from a recognized Board/University having 45% marks in aggregate for the General Category (35% in case of SC/ST candidates). Those who have appeared for the Intermediate or equivalent examination but the results are not declared shall be permitted to appear in the Written Entrance Test for admission to the Nursing Course, but they will be required to submit attested photocopy of the Intermediate or equivalent examination marks -sheet latest by 16 th August of the year of Nursing Written Entrance Test without which their candidature for admission will not be considered. Contd.... 2

2. AVAILABILITY OF APPLICATION FORMS: 2 2.1) The prescribed Application Form can be obtained either in person or by post during the period as mentioned in the Advertisement published each year in News Papers on any working day between 11.30 AM to 3 PM from the Office of the Medical Superintendent, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi-221005 on payment of Rs.500/- only for the General Candidates and Rs.400/- only in case of SC/ST candidates through a Demand Draft / Bankers Cheque preferably of Bank of B aroda) payable at BOB, BHU Branch (Code BHUVAR) in favour of the Medical Superintendent, Sir Sunderlal Hospital, Banaras Hindu University. The Application Forms shall not be available on cash payment. 2.2) Application Form will also be available from BHU website www.bhu.ac.in which can be downloaded and sent to the above-mentioned office duly completed and accompanied by required DD and other documents as mentioned above. 2.3) Last date for receipt of the completed Application Form in the office of the Medical Superintendent, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi either by post or by hand will be as per the Advertisement published in Newspapers each year. 3. CRITERIA FOR REJECTION OF APPLICATION FORM: 3.1) Incomplete Applications and Applications received after last date shall be rejected. 3.2) If the candidate does not fulfill the eligibility criteria No communication will be made to the candidates who have not qualified for appearing in the Written Entrance Examination for Admission to the Nursing Course. 4. DATE OF COMMENCEMENT OF THE COURSE:: 1 st September each year: 5. NUMBER OF SEATS: There are 24 seats of which 15% seats (4 seats) are reserved for Scheduled Caste and 7.5% seats (2 seats) are reserved for the Scheduled Tribes candidates. The remaining 77.5% seats (18 Seats) are for the General Category. 6. METHOD OF SELECTION: THE NURSING ADMISSION WRITTEN ENTRANCE EXAMINATION SHALL BE HELD AT THE EXAMINATION CENTRE, B ANARAS HINDU UNIVERSITY ON DATE AND MONTH AS PUBLISHED IN THE ADVERTISEMENT IN NEWSPAPERS. 6.1) The candidates will be selected on the basis of their merit in the Written Entrance Competitive Examination conducted for the purpose. The question paper will have 100 Multiple Choice Questions (each carrying 4 marks from Physics, Chemistry, Botony & Zoology (25 questions each) having maximum marks 400 with time duration of 2 hours. There will be negative marking also ie 1 mark will be deducted for one wrong answer. 6.2) The qualifying marks in the Competitive Written Entrance Examination for admission shall be 45% for General Category and 35% for SC/ST Categories. Contd.... 3

3 6.3) In case of candidates obtaining equal marks in the Written Entrance Examina tion, their inter se merit shall be decided in the following order : - 6.3.1) Candidates securing higher aggregate marks in Science subjects i.e. Physics, Chemistry, & Biology in the qualifying examination will rank higher. 6.3.2) If this also happens to be the same, candidate having higher marks in aggregate at the qualifying examination would rank higher. 6.3.3) If this also happens to be same, the candidate senior in age would rank higher. 7. ADMISSION: 7.1) The admission of the candidates selected on the basis of merit of the Written Entrance Examination shall be subject to their medical fitness by the Medical Board so appointed for the purpose. 7.2) Candidates who are less than 18 years of age would be required to submit consent of their Father / Guardian to join the Course. 7.3) Candidates would be required to submit NO OBJECTION CERTIFICATE from the Employer if employed 7.4) At the time of admission, a sum of Rs.500/- will be charged as Nursing School Development Charges from every candi date admitted into the School of Nursing, SSH, BHU. 7.5) The Admission to the Nursing Course shall be subject to fulfilling the eligibility criteria as defined above. The Candidates who are called for Admission on merit must bring with them all the original certificates, mark sheets, etc. for verification by the Admission Committee. 7.6) In the event of availability of vacant seats, candidates from the waiting list, if any, will be asked to join the Nursing Course on call latest by 30 th September of the calendar year and thereafter no candidate will be admitted even if the seats are vacant in any of the categories. This is because the Nursing Course starts on 1 st September and it will not be possible to compensate for teaching lagging behind beyond 30 th September. 8. SUBMISSION OF BOND: The candidates after joining the Course shall be free to leave the Course within 7 days of their admission without any monitory precondition. However, the candidates who join the Course will be required to sign a Bond on a Non-Judicial stamp paper of Rs.15/- duly signed by the Candidate, her Father/Guardian, two Witnesses & Notary stating that she would pay a sum of Rs.5000/- only to the Banaras Hindu University along with the stipend money in full pay to the candidates during the training course as well as other miscellaneous charges such as laboratory, library, etc. in case she leaves the Course after 7 days of joining and only then her original certificates shall be released. A copy of the exact Format for the Bond containing a few other clauses shall be issued to the selected Candidates at the time of their joining the above-mentioned Course for the purpose of submitting the Bond. Contd.... 4

4 9. SECURITY MONEY: The Candidates admitted to the School of Nursing, Sir Sunderlal Hospital, BHU will deposit a sum of Rs.2100/- as Security Money payable as monthly installment of Rs.50/ - to be deducted from their stipend money over a period of 3 ½ years. This Security Money shall be refunded to the Nurses after completion of the Diploma Course, in case they are not employed in Sir Sunderlal Hospital, BHU. 10. PROBATION PERIOD (PRELIMINARY PERIOD): (As per the guidelines of the Indian Nursing Council) 10.1) The candidates once admitted to First year of "Three and a Half Year Diploma in General Nursing & Midwifery" shall be on probation for a period of 12 weeks from the date of admission during which they would attend the wards for observation & supervision practice period not exceeding 16 hours per week. During the probation period they will not be allowed to wear the prescribed uniform. 10.2) At the 11 th or 12 th week, the Probationary Nursing Students will be subjected to a preliminary examination to assess their ability t o continue the Course. The successful candidates will be allowed to continue as confirmed Nursing Students. 10.3) Those who do not qualify the preliminary examination mentioned above will be re - examined after a month and only those who qualify will be t reated as confirmed Nursing Students. 10.4) Those who fail in the second attempt also, their names will be struck off from the rolls of the School of Nursing and they will not be allowed to continue the Diploma Course. 10.5) The Admission Committee after a period of 12 weeks will, however have the right to discontinue training and terminate any Student Nurse from School of Nursing without assigning any reason even if she has qualified the examinations. 11. EXAMINATIONS: 11.1) Various tests are held during the Training Course at the School of Nursing, S.S. Hospital, BHU, and the students will have to appear for the three annual examinations conducted by the U.P. Medical Faculty, Lucknow, one each at the end of every year. 11.2) A Student Nurse who fails in the First Year Examination is permitted one more chance on full stipend provided the work and conduct of the student is satisfactory. No stipend will be given for the subsequent attempts till she passes the first year examination. Stipend will be paid for the entire period of Course. If the training is discontinued at any stage, necessary penalty may be imposed according to the terms of Agreement Bond. (PROF. S. CHOORAMANI GOPAL) MEDICAL SUPERINTENDENT