Nepal Medical College (NMC) Attarkhel, Jorpati V.D.C. G. P. O.Box 13344, Kathmandu, Nepal Ph: 4911008-Ext-205 Fax: 977-01-4912118, E-mail:[email protected] Clip Five Recent P/P Size Photographs Form No ………………………… For Office Use Only STUDENT TYPE Resident Nepalese SAARC Extra SAARC NMC Roll No Fee Paying Freeship K.U. Regd. No. APPLICATION FOR SELECTION TO THE MBBS PROGRAM 2010-2011 PERSONAL DETAILS OF APPLICATION (Write in Capitals with one letter in one square) Website: www.nmcth.edu Surname or Family Name Middle Name Female Male MR [ MISS 0 MRS. [ MS [ First Name For Nepalese Student Citizenship For SAARC & EXTRA SAARC STUDENT Date of Issue ………………………………. Place of Issue ……………………………… Visa Category…………… Valid Up to …………………… Certificate No………………………………….. Dist…………………………………………………. Date of Issue …………………………………… Date of Birth in B.S. ……………………………………….. Date of Birth in A.D. ………………………………….. Place of Issue ………………………...... FATHER’S FULL NAME MOTHER’S FULL NAME FATHERS OCCUPATION (SPECIFY EXACTLY WITH DESIGNATION) MOTHER’S OCCUPATION (SPECIFY EXACTLY WITH DESIGNATION) PERMANENT Address House Number : Ward No : VDC/Municipality / Locality Town / City District : Country : Tel No : Fax No: P.O. Box No : E-Mail For NMC CORRESPONDENCE (IF DIFFERENT FROM PERMANENT) N.B: All correspondence will be done at the above address and if letters and other items are not delivered due to failure to provide the correct information’s. NMC will no be held responsible. Sc 6..………………………………………………………………………………………………………………………….SC or A level of PCL G. I. College Leaving Certificate (Character Certificate) 5... . Provisional Certificate/ Certificate of 10+2 or I. ....... School Leaving Certificate (Character Certificate) 3. Eligibility Certificate issued by the Medical Council of INDIA (for Indian Students only)...... 9..Sc or equivalent 4. Mark-Sheet of 10+2 or I. Mobile No …………………………………………………………………………………………………………………………………………………… For Emergency Telephone Number to be contacted by NMC………………………………………………………………………… ACADEMIC BACKGROUND Examination SLC Class 10 O Level Other 10+2 A Level I..Sc.. PCL equivalent from Board or University 7... Mark sheet of SLC/Class 10 or O Level or equivalent 2..NAME OF LOCAL GUARDIAN ………………………………………………………………………………….Sc.. Equivalency Certificate (For all Qualification Done from Outside Nepal). Migration Certificate or after 10+2...SC PCL in General Science School/College Year Roll No... or A Level or PCL G.TEL#.. Marks Obtained in English Mathematics Science Health Science English Physics Chemistry Biology Total Marks in Percentage Aggregate in Aggregate APPLICANT MUST ATTACH PHOTOCOPIES OF THE FOLLOWING GTESTIMONIALS 1. Citizenship Certificate/ Passport 8.. A level.. ADDRESS IN KATHMANDU.... I also understand that I am liable to be expelled from the NMC for any indisciplinary activity on my part inside or outside the NMC or committed by me against the interest of the NMC.........Phone:………………………………… .... illness or disability and consider myself medically fit for admission.................... I understand that Nepal medical College reserves the right to vary or reverse any decision on the above mentioned information and I further understand that Nepal Medical College may wish to obtain further information from any university or college or Board or other educational institution attended to my admission or during my study of MBBS after getting admission... Date : ………………………………… Signature of Applicant…………………………………......... trimester fee and other dues as may be required to be paid during the entire period of his/her studies in the college..... Date……………………………………………… Date :………………………………………………… Address …………………………………………………………………………………………………… ..... BOND BY THE STUDENT I hereby submit this bond that as long as I remain a student of Nepal Medical College...... and wish to be considered for admission to the MBBS Program at Nepal Medical College (NMC)...... existing or that may be adapted afterwards for the interest of the College.... BOND BY THE PARENTS We submit this bond that our daughter/son ……………………………………………………………….. SOLEMAN UNDERTAKING BY THE PARENTS We do hereby make our soleman promise that in the event of our daughter/son ………………………………………… (Name of the Applicant) becoming successful in obtaining admission into the MBBS program of NEPAL MEDICAL COLLEGE ... Signature of the Mother……………………………… Name of the Father ………………………………Name of the Mother………………………………….. We shall make all arrangements to the satisfaction of the college authorities for the timely payment of enrollment fee.... I also declare that I am not suffering from any disease.......... (Name of the Applicant) will abide by the Rules and Regulation of Nepal Medical College existing or that may be adapted afterwards for the interest of the College...... The principal of NMC shall remain the highest authority to decide on matters related to me..... I shall abide by the Rules and Regulations of the College........ I shall do nothing inside or outside the college that may be damage the good name of the college....DECLARATION BY THE STUDENT I have obtained this form from………………………………………………………………………………………………………………. and declare that the information on my academic qualifications obtained by me and mentioned above are true and correct... The college authority shall have the right to take any disciplinary action against our daughter/ son including expulsion from the NMC College of our daughter/ son in case our daughter/son be the cause of indiscipline/unrest in the college and hospital or behave unmannerly in the College and Hospital Signature of the Father …………………………...... edu Website: http://www.D. NEPAL PH : 4911008 Fax: 977-01-4912118. Interviewee must be accompanied by both the parents for the interview and must bring original Nationality Certificate and all academic testimonials mentioned in the application form. IMPORTANT NOTICE TO INTERVIEWEE 1.O. 3. 2.NEPAL MEDICAL COLLEGE Attarkhel. Failure to comply interview. Program Applied for: MBBS ………………………………………… Signature of the Applicant Paste Recent P/P Size photograph For NMC Official Use Only INTERVIEW DATE ……………………………… TIME ……………………………….nmcth. with the instructions may disqualify the applicant from appearing in the . Jorpati V.C G. 4.P. Interview shall be held only on the date and time mentioned overleaf.edu NMC INTERVIEW NOTIFICATION FOR MBBS 2010-2011 Name of Applicant ………………………………………………………………. You must reach NMC on the date and time specified overleaf..Box 13344. Kathmandu. E-mail:nmc@nmcth. Nursing Staff. relatives and obey all the NMC rules and regulations. failing which. Formation of student Union or Association or Association at the NMC is prohibited Direct or indirect involvement and participation of students in own hunger strikes or Gherao or Lock-up of class rooms and teaching learning activities. 4. . Administrative and Ancillary staff. NMCTH and other Hospital and Community Satellite Health Centers. 5. Nepal Medical College has fixed student fees for the MBBS program starting in academic session 2010-2011 that must be paid at the time of admission. Patients Relatives and their friends attending NMCTH and the local general public at large. Likewise. They must always be polite to all including their colleagues. 8. A student must pass in all the Examination Papers of First and Second Year in Four ATTEMPTS within two years of completing the course of study . 7. No student will be promoted a to the FIFTH SEMESTER OF THE MBBS Program without passing in all the examination papers held at the end of First and Second Years. without passing in all the Examination papers held at the end of SEVENTH SEMESTER. Technical Staff. 3. Students must maintain strict discipline at NMC. No student’s name will be registered in the ATTENDANCE RECORD Register without payment of full amount of fees by students. food and lodging if required of students during such programmes. no student will be promoted to the NINTH SEMESTER. Students are strictly prohibited from being involved in party politics of any kind and are debarred from getting themselves involved directly in the party politics. will be expelled from the academic programme of NMC without prior warning. the name of such a student will be struck off the NMC Register and discontinued from the MBBS program.Rules and Regulations of Nepal Medical College (NMC) that must be strictly followed by medical student admitted in the MBBS Program of NMC 1. 6. Students must behave well with the Faculty Medical Doctors. patients. mess charges and personal expenditures will have to be paid separately by individual student separately and are not included in the fees structure paid to the NMC. Expenditure during Community Field Experience placement must be paid by individual student and NMC will not be held responsible for meeting the expenditure incurred in travel. Patients. 2.. Hostel charges. All students must attend classes / practical/ clinicals by wearing NMC uniform regularly and must respect their teachers and the staff of NMC. Complaints received against any NMC student will be dealt sternly by the NMC and disciplinary actions will be taken against such accused students. 10. NMCTH. and vow not to cause any hindrance in preventing NMC in taking necessary action. Substance Abuse is strictly prohibited inside and outside NMC. 11. s/he will be discontinued from MBBS program and will have to leave the hostel. In case NMC student is found guilty. NMC and Student hostels. and have agreed to abide by them fully and in good faith. We also hereby declare and give our consent in free and conscious mind to Nepal Medical College.9. Signature of the Applicant Signature of the Father the Applicant Signature of the Mother of the Applicant Name Date Name Date Name Date . Student must live in the hostel accommodation during the entire MBBS program and must obey the rules and regulations of the respective hostels and must pay hostel charges separately in advance at the time of admission. such student will be penalized and damages recovered from the student. We the undersigned declare that we have read very carefully the Rules and Regulations of NMC as stated above to be followed strictly by medical student admitted in the MBBS program in NMC. in case the applicant whose signature is affixed below be found guilty of such charges during the course of study which may even be expulsion from the MBBS program. All parents and local guardians are requested to visit NMC and make inquiry on the progress made by their wards. parents and guardians must comply to the request and should make note of such requests and make it a point to meet the person who so ever has made the request. Should one fail to report immediately and be found guilty of damaging NMC property by the NMC authority. Whenever request for visits of parents or guardians to NMC is made by NMC . we the parents of such student fully agree to abide by the NMC decisions including his/her discontinuation from the MBBS program at NMC. No students will cause damage to NMC property and if one damages accidently or unknowingly. one must report to the NMC Administration immediately. to executive its rules and regulations strictly for the national interest of maintaining a high standard of academic excellence at NMC.