PROSPECTUSFOR ADMISSION INTO GENERALNURSING &MIDWIFERY (G.N.M)COURSE IN GOVERNMENT & INC RECOGNISED PRIVATE TRAINING CENTERS OF ODISHA DURING THE ACADEMIC SESSION 2015–16 Cost of Application Form & Prospectus: Rs.500/- (Rupees Five Hundred) only 1 Application form & Prospectus for admission into GNM training course for the academic session 2015-16 are available in the official website of Directorate of Nursing, Odisha& DMET ,Odisha “www.nursingodisha.nic.in” & “www.dmetodisha.gov.in”. 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-II).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:- 0674-2393840 2 Index Sl.no Content Page no I Admission Calendar II General Information & Eligibility III Admission Procedure 5 6 7-15 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 Annexure I List of Institution participating in Counseling Annexure II SBI challan for Application Fee Annexure III List of Nodal Centers Annexure IV Cast Certificate Proforma Annexure V Residence/Nativity Certificate Proforma Annexure VI Proforma of Certificate of Sainik Board Annexure VII Proforma for undertaking by guardian 16-17 18 19- 23 24 25 26 Annexure VIII Proforma of physical fitness certificate. 3 27 28 29 30 of Odisha have introduced submission of online application. nurses render a significant service in the care of the sick and in the prevention of illness and injury. Nursing offers a challenge and opportunity to serve a fellow being.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. Govt. If you have the zeal and desire for nursing. and as researchers seeking new and better ways of meeting the nursing needs of patients. In order to facilitate the admission at door step in remote areas and to bring clarity in the selection process. 4 . selection & admission into GNM course at G. Salary and conditions of service of nurses are attractive compared to those in other fields of employment with similar educational requirements. Increasing numbers of trained nurses are needed to fill responsible positions as experts in bedside nursing services.P level which is praiseworthy. As members of a modern health care team. you are invited to choose this noble profession. nic.gov.) Last date for submission of application 12.09.in/ www.nrhmorissa.2015 Availability of Online Application form and Prospectus in official website 14.nursingodisha.2015 till 2.2015 by 05.07.2015 www. 02.gov.in/ Expected date of Document Verification and choice locking at Nodal Centres 25.09.2015 to 27.00 PM after that 17.ADMISSION CALENDAR Publication of Advertisement 13.in/odisha.09.09.in/www.in/ Mock registration process starts from 14.09.in/odisha.00 P.08.2015 Final seat allotment 10.2015 Publication of list of left out Candidate 21.in/www.nic.08.2015 Reporting at nodal center With fees for 2nd round counseling 15.2015 5 to 16.2015 Expected date of Reporting at nodal centers with course fees.dmetorrisa.nrhmorissa.07.nursingodisha.gov.2015 to 16.2015.M Expected date of Publication of provisional merit list in the official website: 20.gov.08.07.00 AM) onwards the final registration process will start.dmetorrisa.07.gov. ( The www.2015 .07.08.2015 to 12.08.gov.2015 to 04.15 11.in/ www.09. E. III. 12.N.M training centers for the year 2015-16 (detail list of institutions can be found in annexure 1). - The candidates must have passed 10+2 with 40% marks from CHSE Odisha or equivalent thereof however science is preferable. & Private) having INC recognition as on 31. - All the institutions (Govt. 2015. - Must be a domicile / permanent resident / native of Odisha but currently residing outside Odisha. Or 10 +2 Health Science vocational stream from a recognized CBSE Board/ State/ Center.2015 will be allowed for the e-counseling process. GENERAL INFORMATION - Applications are invited for admission in General Nursing & Midwifery (GNM) 1training course in all Government & INC approved Private G. - The duration of the training course is 3 years which includes theory and practical as per prescribed syllabus of Indian Nursing Council. and National Institute of Open School recognized by Central Govt. - Must have passed Odia up to M. - Admission for all seats in government institutions & 85% of seats in private institutions will be filled up through common merit list. ELIGIBILITY - Candidate must be 17 years of age or above as on 31.( for all Govt school of Nursing and 85% Govt seats in private nursing institutions recognized by INC) 6 . Or 10 +2/12th with 40% marks from state open schools recognized by state Govt.I.07. Or 10+2 vocational ANM course with 40% marks from the school recognized by Indian Nursing School. school of Nursing and 85% Govt seats in private nursing institutions recognized by INC. - Private Institutes will adopt their own procedure for filling up 15% seats under management quota by observing minimum eligibility criteria. standard for all Govt. - 5% of total mark is relaxed for SC/ ST candidates. 2015 by 05. - Shall be medically fit for the course (Medical certificate format in annexure -VIII) III.in/ www.gov.in on or before 12. 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 2015.dmetorissa.in/ www. 7 .nursingodisha.08.gov. - Physically Handicapped having locomotor disability of lower limbs between 40% to 50% will be taken in to consideration.gov.in/ www.odisha. - ADMISSION PROCEDURE Candidates can apply for the GNM Course online by applying in the appropriate application form available at website: www.- Both female / male candidates (10% reservation for male candidates out of total seats) are eligible to apply.00 PM.nic.nrhmorissa. will be filled up in the Round 2 as per the merit list. The copy of the Candidate Details. Step 4 •Round – 1: Provisional Seat Allotment & publication on the website. 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 7 •Left out candidate list is prepared.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. Step 5 •The Candidates who have been allotted seats will come to the Nodal Centre and deposit course fees. Document Details and Choice list will be generated and signed by both Nodal Officer and Candidate. Step 6 •Round – 2: Seats not filled up in Round 1. Document Verification at Nodal Centres. 8 . verified and displayed on the website. 25/only is to be paid towards filling up form at Common Service Center.I. 500 only through S.. The candidates finding difficult to register online can get the assistance of the Govt. Click "apply online" and then click on "GNM".nic.......Service charges Rs. The amount is payable through SBI Challan ( given in the annexure II) Open the website www.in Click on "New Registration for ANM and GNM courses” and andand aaaandannanand AAANMANM.Step 1: Online Registration ASSISTANCE: Note: Candidate may practise with the mock application form available in the official website www...The online application form will be displayed.. Fill the details on the application form and click on save and continue... facilities like CDMO(DPMU Office).in (link) before filling up the actual application form. Community Health Centre(CHC) & Common Service Center (CSC) at Gram Panchayat level . Procedure for online Registration Payment of Non-refundable Application fees Rs.....Challan.. Then the candidate will be directed to generate his /her own password. 9 .B.nursingodisha..nursingodishanic.. Personal Details.Filling up online Application form After login. the candidate has to fill up the following details in the form. Colour Photo (20. Address Details. Challan details.50 KB in jpg/jpeg) & Signature (10-20 KB in jpg/jpeg) Snapshot of the online form given below 10 . Academic details. 2nd 10+2 Science without Biology. . 11 .) will be taken into consideration. CHC. Document verification & Final Choice Locking a. Provisional Merit List - Merit list shall be prepared on the basis of career marks.nursingodisha. 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.Important Note: .nic. In case of discrepancies if any. - Candidate must verify the name of the list of the institutions & total no. The candidates are advised to see the updated list of institutions till 31. The candidate is required to verify his/her personal details before submission of application as per documentary evidence. - The candidate can give his/her choices judiciously in order of preference from the list of available institutions as per own wish. . Help centers like (CSC. of seats available (AnnexureI) & fill up the choices for institutions. - Preferences will be given in the following order:1st 10+2 Science with Biology.in (link).2015 for choice filling up for the institutions. . 3rd 10+2 and other equivalent examination. if they so desire. - The candidates are permitted. Step 3: Provisional Merit List. to change or re-order (through move/swap options) their choices. 50% of the percentage of marks secured in HSC (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. - For calculating career marks. delete earlier choices and add new choices as many times til they lock their final choices at the nodal center during document verification. 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 www. The selection committee is not responsible for any omission & commission in the submitted datas and the consequences thereafter. the candidate may bring it to the notice of the Principal Tutor of the Concerned Nodal Centre during the time of document verification.07. Institutions & 85% of Govt. Qualifying stream . 11.- In case of more than one candidate having equal career marks. Authentic proof of passing Odiya as a subject at M. 12.) 8. The nodal center has to return back the original documents to the candidate after due verification. Original SBI Challan deposit slip. Original certificate of Ex-Serviceman from Rajya Sainik Board (Annexure vi) 12 . Two copy of self-attested recent passport size Colour photograph. b. payment of course fees and choice locking on the scheduled date and time notified on the official web-site. 3. 10+2 pass certificate and mark sheet issued by CHSE Odisha or equivalent thereof. Original caste certificate (SC/ST candidate) issued by the competent authority. Original character /conduct certificate from the Head of the Institution last attended 6.E/HSC issued by Board of secondary education (for candidates applying for Govt. 4. Original Physically Handicapped certificate issued by the competent medical authority of the Dist. (Annexure iv) 9. Copy of the submitted application form duly signed by the candidate or a copy received from the help center. 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. 10. Locomotor disability of lower limbs between 40% to 50% will be taken into consideration. Domicile/ Residential / Nativity Certificate from competent authority as per Annexure-v 7. other set self-attested photo copy). Original College Leaving Certificate / Transfer Certificate 5. Documents required for verification are as follows: 1.500/-(Rupees Five Hundred) only towards application fees. quota seats of Private Institutions. Seniority in date of birth. Rs. - During document verification at the nodal centers the candidates are required to submit two sets of the following documents (one set original. a. b. English marks in 10+2. inter-se merit shall be taken into consideration as below in order of preference. Original 10th (HSC) pass certificate and mark sheet issued by BSE Odisha or equivalent thereof. c. 2. (in case of Physically Handicapped candidates only). nic.C/ T. medical officer.in and SMS alert regarding allotment will be sent to candidates. Final Locking of Choices . . • 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. Original Green Card (with all pages) issued by the Chief District Medical Officer. - The provisional allotment of seats will be available on the official website www.Candidate has to lock the choice as per her/his own preference at the nodal centers immediately after verification of original documents and testimonials.L.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. (In case of candidate claiming for the seat under green card quota). C. he/she may be admitted with an undertaking to submit the same before the Principal Tutor of the concerned GNMTC.nursingodisha. Note: In case the candidate fails to produce any original document as per the prospectus.Candidates are advised to give maximum numbers of choices in order of preference. The original Medical Fitness certificate issued by the Govt. the seats will be allotted in the order of final merit list prepared after the document verification and choice locking at the nodal center. . his/her name will be deleted from the list. 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 . If a candidate fails to submit the original College leaving certificate (C.13.C) or character /conduct certificate at the time of document verification. Step 4: Provisional Seat Allotment (Round 1) - During this step. 8000/- Besides the above the messing charge may be charged extra.nursingodisha.000/- NB:.150/-(once) Caution Money (Refundable) Rs. Boarding.in and SMS alert regarding allotment will be sent to candidates. - 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. 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.Charges for Lodging.000/.1000/TOTAL Rs.2250/Rs. Transportation. the balance course fee will be refunded.2250/Rs.1800/Electricity Charges Rs. an undertaking from a Local Guardian as per Annexure –VII.per annum Rs.800/_ Rs.2250/Rs. - 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.No 1 2 3 4 5 6 7 2nd Year Rs.36.Fees for Government institutions 1st Year Title of the fees Admission Fees Rs. - In addition to the documents already submitted at nodal center.36.900/Rs. Institution then. Fees for 85% Govt.9000/- Sr. etc. quota seats under Private institutions 1 Tuition Fees (including fees towards hospital for Clinical Training) Total Rs.nic.1800/Rs.800/_ Rs.900/Rs.650/training Identity Card Rs.1800/Rs.2250/Tuition Fees Rs.2250/Hostel Fees Rs. should be signed by the Parent / Guardian of the candidate. shall be paid separately.2250/Rs.900/Transportation charges for field Rs.8000/- s3rd Year Rs. 14 . Step 6: Final Seat Allotment (Round 2) - The final allotment of seats after auto up gradation will be available on the official website www. the seats will be filled up from the candidate of unreserved category. o f s e a t s a v a i l a b l e i n G o v t . - In case of non-availability of candidates in any of the reserved category.in - The process of counseling of the left out candidates will be notified in the official website. Step 7: List of Left out Candidates - In this step list of candidates. & I N C r e c o g n i z e d Private institutions) will be reserved for male candidate. Scheduled Tribe. then the private institutions may be allowed to fill up those seats from the common merit list.Reservation of Seats (from total seats) as per Orissa Reservation of Vacancies Act: i) 22. 15 .nic. candidates can be selected in their place and vice versa subject to other eligibility criteria. iii) 3% for Physically challenged iv) 3% for Ex-servicemen v) 5% for Green card - 10% s e a t s o f ( t o t a l n o . - List will be verified and displayed on the website: www. - If any seats out the 85% govt. quota seats of the private institution remains vacant.25% for SC. - In case of non-availability of candidates belonging to Scheduled Caste community. ii) 16. who has not been allotted the seat even after completion of seat allotment process will be prepared.nursingodisha.5% for ST. B. she/he will be liable for due punishment by the concerned Principal Tutor under intimation to the Director of Nursing. stipend will be paid to students in each month during the training period as per existing rules of the Government of Odisha. POST ADMISSION A Hostel Accommodation - There is provision for accommodation in the G. In case of discontinuance from study on any ground the stipend already received. only in exceptional circumstances for govt institutions. SON IB Jharsuguda. NSC Hospital.S. Talcher. In case a candidate fails to qualify herself / himself in the 1st preliminary examination. will be recovered in full as per the provisions of the Agreement.white salwar kameez with white apron with black shoes and during field practice . institution. unruly and undisciplined conduct. MCL. Bhubaneswar. - If any of them will be found to be involved in immoral activities.per month.. SAIL. 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. Odisha .IV. during the period of study. No provision of hostel accommodation for male candidates at Govt. C. Uniform Selected candidates after admission have to wear uniform: - Female candidate during clinical duty . Rourkela. - But the same will be paid only on successful completion of a preliminary examination after three months of admission and after +2 Council & H.I. - On admission in the Training Centre N. - Candidate may reside outside the hostel if permitted by the Director Nursing Odisha .M.T. 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. School of Nursing. Training Centre only for female candidates.N. 16 .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. 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/. - For male candidates. - The candidates are to abide by the Rules and Regulations of the concerned Institutions and Hostel.Green saree / salwar kameez. the concerned student shall be given liberty to explain and if her/his explanation is not found satisfactory.15.N. D.C./S. the authority would expel her from the institution. under “Swasthya Sebika Nijukti Yojana” (SSNY) Scholarship Scheme as follows: o Partial Scholarship as Tution Fees to SC/ST students belonging to Non-KBK districts @ Rs. - The student should not indulge herself/himself in criminal offences. 17 . *Third year: First six months = 24 weeks * 2 weeks vacation Second six months= 24 weeks *1 week preparation *1 week Examination E. 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.per annum.per annum. she/he will be removed from the Training and the stipend received by her during training period will be recovered in one installment.M Course in INC recognized Private Institutions . - If any incident of ragging comes to the notice of the authority.000/. candidates admitted into G.000/. scholarship will be borne by NHM. If found involved in such activities. 4 weeks vacation 1 week preparation leave 1 week of Examination. - No application for change of Training Institution during the training period will be entertained.T. o Full scholarship as Tution Fees to SC/ST students belonging to KBK & KBK+ districts @ Rs. 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. Discipline - 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.50.- S. The convener of the selection committee shall be the legal person in whose name the selection committee may sue or may be sued. Odisha Asst. ON&MEB. Bhubaneswar Registrar. Odisha Joint Director. Bhubaneswar Chairperson Vice – Chairman Member Member Convener Member Member The Nodal Selection Committee shall consist of:1 2 3 4 5 6 CDMO/Director Capital Hospital Principal Tutor Senior Tutor Senior Tutor District Public Health Nurse Matron / Asst.V. SELECTION COMMITTEE. Nursing. Education Secretary. Clinical Deputy Director Nursing . Nursing.Marton /Nursing Sister Chair Person Convener Member Member Member Member (Nominated by CDMO) Selection of GNM Training Course will be under the supervision of Chair-person & Convener of the State Selection Committee. The State Selection Committee shall consist of:1 2 3 4 5 6 7 Director Nursing. Director Nursing. 18 . ONMC. All disputes pertaining to the selection and admission shall fall within the jurisdiction of Bhubaneswar only. Education Joint Director. Hospital Dhenkanal.of Seats 50 2 GNM School Of Nursing Government Hospital Kalahandi. Hospital. Sector-19 Sundergarh 769005. Orissa 40 2 General Nursing And Midwifery Training School. Burla. B Valley. Orissa No. Orissa GNM School Of Nursing Government.No 1 Name of the institutions as per dt:30.Orissa 30 19 .Annexure .Dera. At/ P O .06.Of Nsg.Talcher.2015 GNM School Of Nursing Government. Mahandi Coalflields Ltd At Po BrajarajNagar. Orissa 100 6 V S S Medical College Hospital School Of Nursing. Kandhamal. Orissa GNM School Of Nursing Government. N S Ch. Orissa 100 3 4 50 30 Govt Of India Undertaking Institutions 1 Nurses Training Institute Ispat General Hospital Rourkela. Orissa 60 5 SCB Medical College Hospital Sch. Hospital. Sambalpur 768010. Orissa 20 3 General Nursing And Midwifery TrainingSchool. 753007. Pin759103 . Jharasaguda. Orissa768216. Talcher.Po/ M-Cuttack.I List of Institution participating Online Counseling & Admission List of Government Institutions Sl. Central Hospital. Sundergarh.. Kalinga Sundergarh Rourkela769015 . Cda Cuttack . Orissa.of Seats 40 2 Ashwini School Of Nursing At .Dharmavihar.Orissa Bhubaneswar School Of Nursing At 94. Po .O. &Research Vill . Odisha .Orissa Hitech School Of Nursing Health Park. Ps RanpurNayagarh .Orissa No.Orissa Biswanath Institute Of Medical TechnologyPlot No 360/2692.Chandpur Via . Po -Mahakalabasta Via Athgarh Cuttack754029 .Pandara Po .G.Orissa Bhava Institute Of Medical Science &Research Plot -1480.06.List of the Private Institutions Sl. Chhend Colony.2015 Anjaali College Of Nursing Studies At-Uttara Chaka.Orissa D R I E M S School Of Nursing At -Kairapari.Orissa Bhagabati School Of Nursing At/Po -Padmapur.Orissa JharsugudaGNM Training College At/PoJharsugudaJharsuguda. Saragan Via: Sunhat Balasore756002 .Orissa 40 3 4 5 6 7 8 9 10 11 12 20 20 40 40 20 30 60 60 20 40 . Mahadev Nagar. Bhubaneswar751025 . Po/Via .Odisha751006. DisttKhurda. I R C Village.Orissa 40 Gopabandhu Institute Of Medical Sci.KotsahiTangi Cuttack754022 .AshwiniHospital Sector -1. P.751030. NayapalliBhubaneswar751015.Madhabpur. Dist . Orissa-751002.Ranpur.No 1 Name of the institutions as per dt:30. P. G.Orissa I I M T School Of Nursing S 3 M 4.Khurda. Jharapada Bhubaneswar. Lane No1. Po .Orissa Blue Wheel Institute Of Nursing Sciences At-Chandpur.KousalyagangaBhubaneswar.KhandagiriDist Khurda. Khurda.Orissa.Orissa Kuntala Devi School Of Nursing New BusStand Road.751 024. Unit Iii KharvelNagar.Orissa 40 Orissa Nursing Training Institute PensionLane. Po KhurdaKhurda.GopalsagarP.A. BaramundaKhurda. Chandrasekharpur.Orissa Netaji School Of Nursing Plot No.2764/4805. Unit-3.Orissa 50 Mahima School Of Nursing At.Kaling Nagar.751003. GhatikiaBhubaneswar. Orissa. Kalinga Hospital Limited. KhurdahDistt.Kharavela Nagar. 208. Zone -B MancheswarIndl Estate. Orissa 752069.Orissa Maa Annapurna School Of Nursing Plot No.Orissa Koshala GNM Training School Dhanupali. K .Bhubaneswar-751001. P O RasulgarhBhubaneswar 751010 . (KINS) Kalinga Nursing School. Odisha751003 . 228/237.OJagatsinghpurJagatsinghpur 754103.V) .Orissa Manjari Devi School Of Nursing. SamantaMargDist -Nayagarh. 262 (B). Buxi Bazar Dist Cuttack.SambalpurDistSambalpur768005.A T/ P O: KI I T Bhubaneswar .Orissa 20 Mothers Nursing School Plot No 120 B.Orissa National Institute Of Medical &Management Studies 392-A/B..Orissa Neelachal Institute Of Nursing School CoHousing Complex.. Orissa752055 . Nageswar Tangi Bhubaneswar Khurda 751002.KhordhaKhordha 751001.753001. Bhubaneswar .1.Orissa 20 21 60 20 30 40 60 30 40 40 20 20 .Orissa Lord Jagannath Mission's School OfNursing Plot No. Orissa Kuntala Devi School Of Nursing At/Po-Debatra Colony. Sector .District Centre ChandrasekharpurKhurdaBhubaneswar 751016 .13 14 15 16 17 18 19 20 21 22 23 24 25 26 Kalinga Institute Of Industrial Technology (Deemed University Campus.Bhubaneswar-751023.Janpath . Orissa Prativa Devi School Of Nursing Plot No 79.Kharvel Nagar.Orissa SmtSusila Devi Institute Of NursingEducationSaiPriya Nagar. Narendrakona.5. Near NyrSchoolRayagadaRayagada 765001 .Orissa Seva School Of Nursing At .PoDhanupali.Orissa. Sambalpur 768005 . Cuttack-753 010. KaransahiDistNayagarh.BhadrakBhadrak 756100. 5th Lane.Orissa 30 Shree Mahavir School Of Nursing. Po NayabazarDist Cuttack.NearPrativa Nursing Home Ward No-16.Iii Bhubaneswar. Shaikh School Of Nursing BaghraRoad. At Post KhariarRoadNuapada. Side Of New A GColonyDist Bhubaneswar.27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 Pallichandan School Of Nursing At/PoNimapara (Women's College Road) Dist -Puri.Orissa 751001.Orissa Sambalpur Nursing School At. Odisha. Orissa.Govindtola.Orissa Ramadevi School Of Nursing Pattamundai (By Pass Chak) Kendrapara DistrictKendrapara754215. HillPatna.Orissa 30 22 30 40 40 30 40 30 30 20 30 40 40 30 30 30 . MotelSquare Tehsil . Mayurbhanj. Pin757001.Orissa Sahayoga Institute Of GNM Training CollegeAt Kasturi Nagar. Behrampur-760005.753004.Orissa Sarada Devi Institute Of Medical Science #1525.Gopalpur. Orissa Sabarmati School Of Nursing At MahanadiVihar. Orissa. Po/Dist RayagadaRayagada 765001 . Orissa752106. Po PuriTownPuri.Orissa Salandi School Of Nursing Nh . Unit .Orissa PathaniSamanta Nursing Centre At.Madhusudan Nagar. Odisha752001.751012.766105.OldTown. Angul-759123.Orissa School Of Nursing & Health Sciences.Orissa S I E M S School Of Nursing Plot No 467.Orissa 40 Sri Jagannath School Of Nursing C/O MrMukesh Kumar Vasani.Orissa Sailabala School Of Nursing AtSailashrinibas.IndrahaniNagar Po Turanga. Mahanadi Vihar Cuttack 753004.Baripada. Orissa. C-51. P O Keshpura. Bhubaneshwar-751003.Hatadihi. P No. At/ Po/ DistNuapada-766105. Street: Rajpur. 474. Baramunda. Orissa-767065 Susila Devi Batakrishna Nursing School. DistBalangir.P O KumarbastKhurda 752055 .Door No866/1379.Orissa SundergarhGNM Training College AtSankaraSundargarh 770001 .Orissa.Orissa 75 Tulasi G N M Training Centre.Dist Kenojhar Kenojhar-758082.Orissa Vivekananda Institute Of Social Work &Social Science ( V I S W A S S ) School OfNursing.44 45 46 47 48 49 50 Sum Nursing School.Orissa Surya School Of Nursing At/Po . PallishreeVihar.Orissa 40 23 35 30 40 40 60 . At/ Po-Sadaipali. Pitapalli Square N H-5. Near T V Centre Kendrapara. B D A H I GDuplex.Nuapada. Orissa Sushree Institute Of Technical Education ASchool Of Nursing. Gopa. 500/In words (Rupees Five Hundred) only Journal No.ODISHA ACCOUNT NO-30760830432 Name of candidate-: Branch Name Branch Code Amount.ODISHA ACCOUNT No.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-CUMDIR.NURSING. …………………. (To be filled by Bank) Signature of Candidate Signature of Bank Officer Signature of Candidate : : Signature of Bank Officer Signature of Candidate : Signature of Bank Officer : : : Fees remitting Branch may collect Rs. Rs.ODISHA ACCOUNT No.500/In words (Rupees Five Hundred) only Journal No.500/In words (Rupees Five Hundred) only Journal No..NURSING.NURSING. (To be filled by Bank) Branch Name Branch Code Amount. Rs.30760830432 Name of candidate-: GNM SELECTION COMMITTEE-CUMDIR... (To be filled by Bank) Branch Name Branch Code Amount.50/.(Rupees Fifty) only towards non-home charges from the remitter SEPARATELY. ………………….30760830432 Name of candidate GNM SELECTION COMMITTEE-CUMDIR. Rs. …………………. 24 . Baripada Baripada. Sundergarh Sundergarh. Dhenkanal Dhenkanal. Jagatsinghpur 13 ANM TC. Puri Puri 16 ANM TC. Angul 10 ANM TC. Daspalla Nayagarh 8 ANM TC. Cuttack Cuttack. Boudh Boudh 20 ANM TC. Jharsuguda 19 ANM TC. No. Berhampur Gajapati 6 GNM TC. Nabarangapur. Phulbani Kandhamal 15 ANM TC. Balasore Balasore. Jaypore Koraput. Kendrapara Kendrapara. Berhampur Ganjam 7 ANM TC. Bhawanipatna Kalahandi. Bhubaneswar Khurda 22 ANM TC. 1 ANM TC. Malkangiri. Rayagada 11 ANM TC. Sambalpur Sambalpur 18 ANM TC. Nuapada 5 ANM TC. Sambalpur Baragarh 17 GNM TC. Deogarh Deogarh 9 ANM TC. Keonjhar Keonjhar 14 ANM TC. Jajpur 12 GNM TC. Bhadrak 2 ANM TC. Sonpur Subarnapur 21 ANM TC. Mayurbhanj 4 ANM TC. Bhubaneswar Khurda Nodal Centre Tagging District 25 .Annexure – III List of Nodal Center Sl. Bolangir Bolangir 3 ANM TC. …………………………………….. Sri / Smt.S... ……………………………… Tahasil …………………………… in the District of ……………….. and ………………. family are ordinarily reside in Village / Town ……………………………………………………………… P.……… in the State of Odisha belongs to the …………………………………….Annexure – IV CASTE CERTIFICATE Miscellaneous Certificate No. ………………………………………………. / Miss ………………………………………………………… Son / Daughter / Wife of Sri …………………………………………………………………… of Village / Town …………………………………………………. Tahasil ……………………………………… in the District of ………………………………………………….S. 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..…………………… of the State of Odisha Full Signature of the applicant Signature of the competent authority Date – Round seal of Office Designation officer) 26 (with seal of .…………………………… P. This is to certify that Sri / Smt. ………………………………………. / Miss …………………………………………………………. ……………………………………. years The certificate is being granted only for the purpose of G... RESIDENT / NATIVITY CERTIFICATE This is to certify that Sri / Smt.. III Office of the ………………………………………………………………….. in the District of……………………………….N. since ………………………….M.……. / Miss ……………………………………………………… Son / Daughter / Wife of Sri ………………………………………………………………… is a native of the district of …………………………………………………………………. ………………………………….16 Odisha Full Signature of the applicant Signature of the competent authority Date – Round seal of the Office Designation (with seal of officer) 27 .S. Tahasil …………………………...Annexure –V FORM No. Date …………….... Miscellaneous Certificate Case No. in the State of Orissa and he / she belongs to P.. Training Course 2015. Name Vill P. Shri/Kumari is the dependent son/daughter of the above named Ex-serviceman/widew of serviceman/ Ex-serviceman.sheet/ Exam.S Dist.Annexure . (Odisha) is a bonafide Serviceman/ Ex-serviceman of of the widow: Indian Army/Air force/Navy/CRPF/BSF.O P. Admit Card/ Board Certificate/ Military Discharge Book/issued by bearing the No. He/She is eligible for admission Srl. Certificate that Rank No. Cause of death: Battle Casualty killed in action/death on duty attributable to Military Service/death after discharge from Armed Forces*).VI GOVERNMENT OF ODISHAOFFICE OF THE ORISSA SAINIK BOARD. date of death of husband . (*Strike out those are not applicable) Place: Date: Secretary Odisha Sainik Board/ Razya Sainik/ Zilla Sainik Board (Office Seal) 28 . He/ She been issued with Exserviceman/ Identify Card bearing Machine No. His/Her date of birth is as per his/her Birth Certificate/ SLC/Mark. 2. in Education/ Technical Institutions in seats reserved for the children of Defence Serviceman/ Exserviceman personnel/ Defence personnel killed in action. BONAFIDE CERTIFICATE 1.(In (Name) case Smt._ . Daughter / Wife of Sri …………………………………………………………………………. I also undertake to act on behalf of the parents / husband of the said student during the period of study in the G.M. Address ……………………………………………………………………………………… ……………………………………………………………………………………... 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..Training Centre.... for which I have been empowered by the parent / guardian / husband of the said student. Place: Signature in full of the Parent/Guardian/Husband Date : Signature in full of the Student 29 .. Date ……………………………… Signature in full of the Local Guardian ATTESTATION BY PARENT / HUSBAND / GUARDIAN The above undertaking has been signed in my presence.. ……………………………………. Place ……………………………... ……...to act as Local Guardian of my daughter / wife Miss / Smt...during her period of study in the H. ……………………………………..Annexure-VII UNDERTAKING (To be submitted by the selected candidates after admission in the respective Training Centre) I Sri / Smt... (Name of the Local Guardian) ……………………………………………………....N.M .(F) Training Centre.W.……………………………………………………………………….. ……………………………………….. I empower Sri /Smt. ………………………………………………… during the period of her studentship in the G..N.. ……………………………………... Under take to act as the Local Guardian of Miss / Smt... Training Centre.. Department. (In case of female candidate) Previous Medical History. 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. SIGNATURE OF THE CANDIDATE Signature & Seal of authorized Medical Officer (Govt.Annexure-VIII CERTIFICATE OF PHYSICAL FITNESS IN RESPECT OF SELECTED CANDIDATES FOR ADMISSION INTO THE GENERAL NURSING & MIDWIFERY TRAINING COURSE-2015. of Odisha) Designation – Date - 30 . if any Personal Remarks of Identification 1.M. 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.P.W. 31 . 24 .