PROSPECTUS

FOR

ADMISSION INTO

A.N.M/H.W. (F) TRAINING COURSE

IN GOVERNMENT

&

INC RECOGNISED PRIVATE A.N.M/H.W (F)

TRAINING CENTRES OF ODISHA

FOR THE ACADEMIC SESSION 201516

Cost of Application Form & Prospectus: Rs.300/- (Rupees Three Hundred) only

2

Application form &Prospectus for admission into ANM/H.W (F) 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 female candidates may apply online by depositing prescribed fee Rs. 300/-

(Rupees Three 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 centers 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

3

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 ANM/HF(W) course at G.P level which is praiseworthy.

4

INDEX

Sl. No Content Page no

I.

Admission Calendar 5

II. General Information

6

III Eligibility

6

IV. Admission Procedure

7-15

Online registration

8-9

Online Choice Filling

9

Provisional Merit List, Document

Verification & Choice Locking

10 - 11

Provisional Seat Allotment (Round 1)

12

Deposition of Course Fees

12

Final Seat Allotment (Round 2)

13

List of Left Out

13

IV. Post Admission 14

V. Selection Committee 15

Annexure I List of Institution participating in Counseling 16-23

Annexure II SBI challan for Application Fee 24

Annexure III List of Nodal Centers 25

Annexure IV Cast Certificate Proforma 26

Annexure V Resident/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 30

5

I. ADMISSION CALENDAR

Publication of Advertisement

13.07.2015

Availability of Online Application form and Prospectus

in official website:www.nursingodisha.nic.in

www.nrhmorissa.gov.in/odisha.gov.in/

14.07.2015 to 12.08.2015 ( The

Mock registration process starts

from 14.07.2015 to 16.07.2015

till 2.00 PM after that 17.07.15

11.00 AM onwards the final

registration process will start.)

Last date for submission of application

12.08.2015 by 05 PM

Expected date of Publication of provisional merit list in

the official website:

www.nursingodisha.nic.in/www.dmetodisha.gov.in/

www.nrhmorissa.gov.in/odisha.gov.in/

20.08.2015

Expected date of Document Verification and choice

locking at Nodal Centres.

28.08.2015 to 01.09.2015

Expected date of Reporting at nodal centers with course

fee

10.09.2015 to12.09.2015

Final seat allotment

21.09.2015

Reporting at nodal center with course Fees for second

round counseling

28.09.2015 to 30.09.2015

Publication of list of left out Candidate 05.10.2015

6

II. GENERAL INFORMATION

- Applications are invited for admission in Auxiliary Nurse Midwife (ANM) 1training course in all Government & INC approved Private A.N.M. training centers for the year

2015-16 (detail list of institutions in annexure 1).

- The duration of the training course is 2 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 31.07.2015 will be allowed for the e-counseling process.

III. ELIGIBILITY

- Candidates must be 17 years of age or above as on 31.12.2015.

- Passed 10+2 from CHSE Odisha or equivalent.

OR

Candidates qualify in 10+2 Exams conducted by National Institute of Open School,

(equivalent to CHSE Odisha) are also eligible.

- Passed Odia up to M.E. Standard.

- Shall be domicile /permanent resident /native of Odisha but currently residing outside Odisha2.

- Only female candidates are eligible to apply.

- Physically Handicapped having locomotor disability of lower limbs from 40% to 50%

will be taken into consideration. Physically Handicapped having locomotors disability of

1 ANM & Health Worker (Female) are interchangeably used terms

2 Candidates shall have to produce (original and photocopy) certificate of Permanent Residentship of Odisha at the

time of document verification. For this purpose only District Magistrate/Additional District Magistrate/Sub-

divisional officer/Tahasildar/Additional Tahasildar are the competent Authority

7

lower limbs between 40% to 50% will be taken in to consideration. Candidates are

advised to obtain their physical handicap certificate from competent medical authority of

their district on last week of july and first week of august 2015.

- Shall be medically fit for the course (Medical certificate format in annexure- VIII).

III. ADMISSION PROCEDURE

- Candidates can apply for the ANM/HW (F) Course online by applying in the appropriate application form available at website www.nursingodisha.nic.in/www.dmetorissa.gov.in

on or before 12.08.2015 by 5PM.

8

The e-counseling and admission Process involves the following steps:

Payment of application fees & online forms filling up by the candidates and registration for User id and Password.

Step 1

Choice Filling by the Registered Candidates

Step 2

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 3

Round 1: Provisional Seat Allotment & publication on the website.

Step 4

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 allotted seat will be cancelled and such candidates will be deleted from the merit list.

Step 5

Round 2: Seats not filled up in Round 1 will be filled up in the Round 2 as per the merit list.

Step 6

Left out candidate list is prepared, verified and displayed on the website.

Step 7

9

Step 1: Online Registration

ASSISTANCE:

Note: Candidates are advised to first practice with the mock application form

available in the official website www.nursingodisha.nic.in (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& Common Service

Center (CSC) at Gram panchayat level .Service charges Rs. 25 /-only is to be paid

towards filling up of form at Common Service Centre.

Procedure for online Registration

Payment of Non-refundable Application fees Rs. 300 only through S.B.I.Challan.

The amount is payable through SBI Challan ( given in the annexure II)

Open the website www.nursingodishanic.in

click on "New Registration for ANM and GNM courses"

Click "apply online" and then click on "ANM".The online application form will be displayed.

Fill the details on the applicaiton form and click on save and continue.

Then the candidate will be directed to generate her own password.

10

Filling up online Application form

After login, the candidate has to fill up following details in the form.

Personal Details, Address Details, Academic details, Challan details, ColourPhoto (20-50 KB

in jpg/jpeg) & Signature (10-20 KB in jpg/jpeg)

Snapshot of the online form given below

Important Note:

Candidates are required to note or remember their password to login in future.

Confidentiality of the password is the sole responsibility of the candidate and all care

must be taken to protect its security.

11

Important Note:

1. The candidate is required to verify her personal details before submission as per documentary evidence.

2. The selection committee is not responsible for any omission & commission in the submitted data and the consequences thereafter.

3. 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.

4. 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 www.nursingodisha.nic.in (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 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 31.07.2015 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 till 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(10th or equivalent examination without extra optional) and50% of the percentage of marks

secured in CHSE (10+2 or equivalent examination without extra optional.) will be taken

into consideration.

- 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.

12

I. Secured more marks in English in 10+2.

II. 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 of self-attested photo

copy). The nodal center has to return back the original documents to the candidate after

due verification.

1. Copy of the submitted application form duly signed by the candidate or a copy received from the help center.

2. Original 10th (HSC) pass certificate issued by BSE Odisha or equivalent thereof.

3. 10+2 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.

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).The

percentage of disability should have locomotor disability of lower limbs between 40%

to 50% will be taken into consideration

10. Original SBI Challan deposit slip, Rs.300/-(Rupees Three Hundred) only towards application fees.

11. Two copy of self-attested recent passport size Colour photograph.

12. Original certificate of Ex-Serviceman from Rajya Sainik Board (Annexure VI)

13. Original Green Card (with all pages) issued by the Chief District Medical Officer. (In case of candidate claiming 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/TC) or character /conduct certificate at the time of document verification, she may be

admitted with an undertaking to submit the same before the Principal Tutor of the

concerned ANMTC.

13

Note: In case the candidate fails to produce any original document as per the prospectus,

her name will be deleted from the list.

C. Final Locking of Choices

- Candidate has to lock the choice as per her 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 www.nursingodisha.nic.in 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 fee at the nodal centre towards course fees in shape of DD in favour of the Convener ANM selection committee payable at Bhubaneswar

Fees for Government institutions

Sr.No Unit Fees for 2015-16

1 Tuition fees Rs.1200/-

2 Admission Fee Rs.1200/-

3 Hostel Charges Rs.1000/-

4 Electricity Charges Rs.500/-

5 Transportation Charges Rs.1000/-

6 Caution Money (Refundable) Rs.500/- (one time)

7 Identity Card Rs.100/-

Total Rs.5,500/-

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) Rs.34,200/- per annum

Total Rs.34,200/-

14

NB- Charge for Lodging, Boarding, Transportation, etc shall be paid separately.

- If candidate fails to deposit the requisite fees at the nodal centre on notified date the name of the candidate will be deleted from the counselling process.

Step 6: Final Seat Allotment (Round 2)

- The final allotment of seats after auto up gradation will be available on the official website www.nursingodisha.nic.in and SMS alert regarding allotment will be sent to

candidates.

- Candidate has to verify the reporting date for admission from the website.

- 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.

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 holder

- 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 seat 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 Candidate

- In this step list of candidates who have not been allotted the seat even after completion of seat allotment process, will be prepared.

- List will be verified and displayed on the web-site www.nursingodisha.nic.in.

- The process of counseling for the Left out candidates will be notified in the website.

15

III. POST ADMISSION

A. Hostel Accommodation

- There is provision for hostel accommodation in the A.N.M. Training Centers.

- 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 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.

- Candidates have to make the arrangements for uniform i.e. white saree and blouse

Salwar and Kurta for Hospital and blue saree and blouse / Salwar Kurta for community

duty.

C. Stipend

- On admission in the training centre, stipend will be paid in each month as per existing

Rules of Government of Odisha, subject to receipt of the allotment of the same from

Director Nursing, Odisha, (only Government institutions).

- In case of discontinuance from study on any ground the stipend already received by the

candidate would be recovered in full as per the provisions of the Bond and Agreement.

D. Vacation & Holidays

Annual Vacation - 30 Days (can be divided)

Sick Leave - 10 Days

Preparatory Leave - 7 Days

E. Discipline

- Absence of a student beyond 15 days in addition to the prescribed leave will not be

allowed to rejoin, except in case of candidate admitted on health ground subject to

production of medical certificate from competent authority.

- The student should not indulge herself in criminal offences. If found involved in such

activities, she will be removed from Training and stipend received 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 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.

16

IV. 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 : Convener

5. Asst. Director Nursing, Education : Member

6. Secretary, ON&MEB, Bhubaneswar : Member

7. Registrar, ONMC, Bhubaneswar : Member

The Nodal Selection Committee shall consist of:-

CDMO/Director Capital Hospital : Chair Person

1. Principal Tutor : Convener

2. Senior Tutor : Member

3. Senior Tutor : Member

4. District Public Health Nurse : Member

5. Matron / Asst Matron/Nursing Sister : Member (Nominated by CDMO

Selection of ANM Training Course will be under the supervision of the

Chairperson & Convener of 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.

17

Annexure I

List of Institution participating Online Counseling & Admission Process

List of Government Institutions as per DT: 30.06.2015

Sl.no S.no Name of the institutions No. of seats available

1 A N M Training Centre, Bhubaneswar, Khurda 50

2 A N M Training Centre Bhawanipatna Kalahandi 30

3 A N M Training Centre Puri 40

4 A N M Training Centre ,Berhampur, Ganjam, 40

5 A N M Training Centre Daspalla , Nayagarh 40

6 A N M Training Centre Dhenkanal, 40

7 A N M Training Centre Kendrapara 40

8 A N M Training centre , Phulbani 40

9 A N M Training centre Jeypore, Koraput 40

10 A N M Training centre, Bolangir 40

11 A N M Training centre Sambalpur 40

12 A N M Training centre, Rayagada 20

18

List of Private institutions

Sl.no S.no Name of the institutions as per dt:30.06.2015 No. of seats available

1 Acharya Harihara ANM Training School At Po Anlabereni, Dhenkanal

75902

30

2 Agradoot School Of Nursing At Khedapada Po - Balugaon

Nayagarh 752069

20

3 Aisect Junior Nursing School At MathaSahi (Near Druga Mandir)

Po/DistDeogarh

20

4 Aum Sai School Of Nursing JaganathVihar, Near BhanjaVihar

Berhampur, Ganjam

30

5 B BChhatoi School Of Nursing At/Po - Dhodra, Via -

UmerkoteNabarangpur 764073

30

6 Baba Tateswar Nursing Training School At Chhotraypur, Po N C

PurMayurbhanj, Odisha- 757020

40

7 Balasore School Of Nursing At Chittapada, Po Khantapada Balasore,

O

20

8 Bhaba Institute Of Medical Science & Research 1480, I R C Village,

Nayapalli Bhubaneswar-751015, Dist Khurda

30

9 Bhagabati ANM Training School At - Raghunathpur, Po - Sayedpur

Ps-Binjharpur Jajpur 755027

20

10 Bhubaneswar School Of Nursing 94, Dharmavihar, Post -

KhandagiriKhanda, Bhubaneswar-30,

30

11 Bidyut School Of Nursing Plot No 1846, NuaSahi Nayapalli,

Bhubaneswar Khurda

20

12 Biswanath Institute Of Medical Technology Plot No 210/1320, Sarala

Nagar, Ns Road, Laxmisagar Bhubaneswar, Dist - Khurda, Odisha -

751006

30

13 Blue Wheel Institute Of Nursing Sciences At

- Chandpur, Po - Chandpur Via - Ranpur, Ps RanpurNayagarh

20

19

14 Creative Junior Nursing School At Kajala Po

&Dist Kendrapada, Odisha- 754211

20

15 D R I E M S School Of Nursing At - Kairapari, Po - Kotsahi Tangi

Cuttack 754022

30

16 Dhaneswar School Of Nursing At: MaitreeVihar, Link Road P O :

Arunodaya Market, Cuttack 753012

30

17 Dibya School Of Nursing At Post Kirei Sundargarh 20

18 Dibyajyoti School Of Nursing PrachiVihar, KakatpurDist - Puri-

752108,

25

19 Dr Ambedkar Institute Of Medical Science Jagda, Rourkela

Sundargarh 769042

40

20 Essen School Of Nursing 353/1903, Aiginia, Patrapada Bhubaneswar 30

21 Gajapati School Of Nursing, Techno Park, Ranipeta, Paralakhmeundi,

Gajapati 761200

30

22 "Golap Devi School Of Nursing Plot No - Hig-1/46, Kapila Prasad In

Front Of Lingaraj Station Khurda Bhubaneswar 751002 ,

20

23 Gopabandhu Institute Of Medical Sci. & Research At- Madhabpur, Po-

Mahakalabasta, Via- Athgarh Cuttack 754029

30

24 GyanaPattnayak School Of Nursing At Post Baharana, Via- Niali

(Adaspur), Cuttack 754004

20

25 Hi- Tech School Of Nursing Health Park, Pandara Po - G. G. P.

Bhubaneswar 751025

60

26 Janakalyan School Of Nursing At - Ramchandrapur Po -

GulnagarKendrapara 854211

30

27 Jasoda Devi School Of Nursing C/O Sitaram Prasad Niishra, At/Po

Sonepur, GadavitarSubarnapur, Odisha- 767017

30

28 Jet ANM Training Centre Back Side Of Badmal Police Station At/Po -

Kalimandir Road Jharsuguda 768202

30

29 Khurda School Of Nursing Plot No 2499, Nayagarh Road

At/Po/Ps/Distt - Khurda,

30

30 "KoshalaAnm Training School Dhanupali, Sambalpur76800 30

31 Kuntala Devi School Of Nursing At - Debatra Colony, Po/Ps - 20

20

NayagarhNayagarh, Odisha - 752069

32 Lord Jagannath Mission's College & School Of Nursing Plot No.

228/237, Sector - A, Zone - B MancheswarIndl Estate, P O - Rasulgarh

Bhubaneswar 751010

20

33 "MaaBautiAnm Training School At/Po -SankaraSundargarh S770001 40

34 Maharani Premkumari Nursing Training School At - Deulasahi Po -

BaripadaMayurbhan 757001

25

35 "Mahima School Of Nursing At - Gopalsagar College Square

Jagatsinghpur 754103

20

36 Mamata Devi School Of Nursing At Post Jajpur Road, Bhubaneswar

Jajpur, Odisha- 755019

30

37 Manjari Devi School Of Nursing Plot No 68, Rasnlgarh (Near Bank Of

India) Bhubaneswar -10, DistKhurda

40

38 "Mayurbhanj School Of Nursing At - Indapahi, Po - Laxmiposhi, Via -

BaripadaDist - Mayurbhanj, Odisha 757107

40

39 "MmchtAnm Training Centre Mmc Hospital, G UdayAgiriKandhamal 30

40 Mother Teresa Health Worker (Female) Training Centre At/Po -

Chandikhole, Barchana Block Jajpur 754029

30

41 Mothers Nursing School Plot No 120 B, Kaling Nagar, K-1,

GhatikiaKhurda, Bhubaneswar, Orissa 751003

20

42 Mufti ANM Training Centre Vegan Ashram, Kundera At/Po Sorada,

Gunpur 752110

40

43 Nabapravat School Of Nursing At/Po - Salipur (Near Old Fire Station)

Dist - Cuttack 754202

20

44 Namitadevi School Of Nursing At-Uttara, Po

- Kausalyaganga Dist - Puri, Orissa 751002

30

45 Netaji ANM Training Centre Plot No. 262 (B), District Centre

Chandrasekharpur Khurda Bhubaneswar 751016

30

46 Orissa Nursing Training Institute At - Pension Lane, P O - Buxibazar

Dist - Cuttack - 753001

20

47 Pally Chandan School Of Nursing At- Panimal, Po- Madhab Via-

Niali, Distt- Cuttack,

30

21

48 Pathani Samanta School Of Nursing Main Road, Near Gundicha

Mandap Nayagarh 752070

30

49 Pioneer ANM Training School Hig-188, KananVihar Phase - I

Chandrasekharpur Bhubaneswar 751031

30

50 Premier School Of Nursing (ANM & GNM) Plot No 11, Pragati Vihar,

At - Bisiapada Po Tirimal, Ps - Jatni Khurda Jatni 752050

20

51 Puri School Of Nursing Near Mit, Behind Gundicha Temple, Lane - 6

Puri Town, Dist

- Puri, Odisha - 752002

30

52 Rajdhani School Of Nursing Plot No 33, Forest Park Dist - Khurda,

Bhubaneswar-751009

40

53 Ramadevi School Of Nursing At - Pattamundai, By Pass Chhak P O -

Pattamundai, Dt - Kendra Para 754215

30

54 Raman School Of Nursing At: Hospital Road, Po: Keonjhargarh

Keonjhar, Orissa 758001

30

55 Regional College Of Health Science Loharapali Road, Near Mission

Hospital Khariar, Dist-Nuapada, Orissa-766107

40

56 Rourkela Institute Of Nursing At - Balughat, Po - Panposh Rourkela

Sundargarh 769004

40

57 S I E M S School Of Nursing Plot No - 467, M S Nagar Side New A G

Colony, Bhubaneswar-751012

40

58 Sabitridevi School Of Nursing At/Po - Panikoili, Dist - Jajpur Odisha

755043

25

59 Sailabala School Of Nursing At Sailashrinibas, Narendrakona, Post

Puri Town Puri, Odisha- 752001

30

60 Salandi School Of Nursing Nh - 5, Motel Square Tehsil - Bhadrak

Bhadrak 756100

20

61 Sambalpur ANM Training Center At/Po - Dhanupali Sambalpur

768005

30

22

62 Sankar Rukmani School Of Nursing Near Orissa Brigade School, At -

Bikash Nagar (Turanga) Angul, Odisha 759122

30

63 Sarada Devi Institute Of Medical Sciences Plot-1525, Mahanadi Vihar,

Cuttack 753004

40

64 Sarala Institute Of Nursing At Sapanpur, Po Sisua, P S Salepur Dist

Cuttack- 754202

30

65 Saswati School Of Nursing Dada Math Lane, Saradha Bali Puri -

752002

50

66 Satyam Regional Institute Of Nursing At - Panda Sahi, Po - Deogarh

768108

40

67 Satyanarayan Anm Training School At Shayamacharanpur Po

Dhenkanal

30

68 School Of Nsg, N P M Instt Of Medical Science & Research In Front

Of Dist, H Q Hospital Keonjhar 758001

30

69 School Of Nursing & Health Sciences By New Hospital Society,

Hillpatna Berhampur

- 760005

20

70 School Of Nursing (ANM) Plot No. N-5/157, Nayapalli Bhubaneswar

Khurda 751015

30

71 Seva School Of Nursing At - Indra Hari Nagar, P O - TurangaAngul

759123

30

72 Shaktirupa School Of Nursing At - Ghadimul, P O - Badamundilo Via

- Mandasahi, Dist - Jagatsinghpur 754114

20

73 Site ANM Training Centre PallishreeVihar At/Po - SadaipaliBalangir

767065

40

74 Sradha Institution Of Health Science At Rajendra Nagar, Po -

Madhupatna Cuttack 753010

30

75 Sradha School Of Nursing Shanti Bazar, DharmasalaDist - Jajpur,

Odisha 755008

20

76 Sri Ram School Of Nursing At / Po - SohelaBargarh - 768033 25

23

77 Srimaa School Of Nursing At/Po - Nemapoda, Dist Puri 30

78 Sushila Devi School Of Nursing Door No 866/1379, Strect:

RajpurDistt-Nuapada

30

79 Swarnalata School Of Nursing Studies At - Bahadulapatna (Ipst

Campus) Po - Bahugram Cuttack 754200

30

80 Tarini School Of Nursing At/Po - Baisinga, Dist - Mayurbhanj Orissa

757028

30

81 Tulsa ANM Training Centre At - Gopa, Po - KeshpurKendrapara 20

82 V I I T School Of Nursing At/Po - DhanmandalChandikhol Jajpur

754024

30

83 Vinayak School Of Nursing 222/1 Sastrinagar, Unit - Iv, Khurda

Bhubaneshwar, Odisha - 751001

20

84 Vision ANM (Female Health Worker) Training Centre Koraput

Koraput 764020

30

85 Vivekananda Charitable Trust ANM Training Centre At Po Junagard

Pragati Nagar Kalahandi 766014

30

86 Xavier School Of Nursing At/Po - Mukunda Prasad

(MukundaBhawan) Khurda

30

24

Annexure II

SBI CHALLAN

BANKS SLIP STATE BANK OF INDIA

(POWER JYOTI ACCOUNT)

CANDIDATES SLIP STATE BANK OF INDIA

(POWER JYOTI ACCOUNT)

DEPARTMENTS SLIP STATE BANK OF INDIA

(POWER JYOTI ACCOUNT)

HEALTH WORKER FEMALE

SELECTION

ACCOUNT No.3180967668- 3

Name of candidate

Branch Name

Branch Code

Amount. Rs.300/-

In words (Rupees Three

Hundred) only

Journal No. .. (To be filled by Bank)

Signature of

Candidate :

Signature of

Bank Officer :

HEALTH WORKER

FEMALE SELECTION.

ACCOUNT No.3180967668-3

Name of candidate-:

Branch Name

Branch Code

Amount. Rs.300/-

In words (Rupees Three

Hundred) only

Journal No. .. (To be filled by Bank)

Signature of

Candidate :

Signature of

Bank Officer :

HEALTH WORKER

FEMALE SELECTION.

ACCOUNT No.3180967668-3

Name of candidate-:

Branch Name

Branch Code

Amount. Rs.300/-

In words (Rupees Three

Hundred) only

Journal No. .. (To be filled by Bank)

Signature of

Candidate :

Signature of

Bank Officer :

Fees remitting Branch may collect Rs.50/- (Rupees Fifty) only towards non-home charges from the remitter SEPARATELY.

25

Annexure III 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 Mayurbhanj

4 ANM TC, Bhawanipatna Kalahandi, Nuapada

5 ANM TC, Berhampur Gajapati

6 SONMKCGMCH

Berhampur

Ganjam

7 ANM TC, Daspalla Nayagarh

8 ANM TC, Deogarh Deogarh

9 ANM TC, Dhenkanal Dhenkanal, Angul

10 ANM TC, Jeypore Koraput,Malkangiri,

Nabarangapur, Rayagada

11 ANM TC, Kendrapara Kendrapara, Jajpur

12 SONSCBMCH Cuttack Cuttack, Jagatsinghpur

13 ANM TC, Keonjhar Keonjhar

14 ANM TC, Phulbani Kandhamal

15 ANM TC, Puri Puri.

16 ANM TC, Sambalpur Sambalpur.

17 SONVSSIMSAR Burla , Bargarh

18 ANM TC, Sundergarh Sundergarh, Jharsuguda

19 ANM TC, Boudh Boudh

20 ANM TC, Sonepur Subarnapur

21 ANM TC, Bhubaneswar Khurda

22 ANM TC, Bhubaneswar Khurda

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. . Tehsil In the District of . in the State of Odisha

Belongs to the . Caste / Tribe which is recognized as Scheduled Caste / Tribe under Constitution (Scheduled Caste /

Tribe) order 1950 as amended by the Scheduled Castes and Scheduled Tribes

(Amendment) orders Act 1976.

Sri / Smt. / Miss . and ..

.. Family are ordinarily reside in Village / Town P.S. Tehsil in the District of .. of the State of Odisha.

Full Signature of the applicant

Round seal of Office

Signature of the competent authority

Date

Designation (with seal of officer)

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. ...

Tehsil .... in the District of ...

since . years

The certificate is being granted only for the purpose of A.N.M. / HW (F) Training Course

2015- 16 Odisha

Full Signature of the applicant

Round seal of the Office

Signature of the competent authority

Date

Designation (with seal of officer)

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 Ex-serviceman/

Identify Card bearing Machine No._________________________.

2. Shri/Kumari __________________________________________________is

the dependent son/daughter of the above named Ex-serviceman/widow of

serviceman/ Ex-serviceman. His/her date of birth is

___________________________as per his/her Birth Certificate/ SLC/Mark-

sheet/ Exam. Admit Card/ Board Certificate/ Military Discharge Book/issued by

the _____________________________bearing Sr.

No._____________________He/She is eligible for admission in Education/

Technical Institutions in seats reserved for the children of Defence Serviceman/

Ex-serviceman personnel/ Defence personnel killed in action.

(*Strike out those are not applicable)

Place:

Secretary

Date: Odisha Sainik Board/RazyaSainik/

Zilla Sainik Board

(Office Seal)

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

Undertake 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 H.W.(F) 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 H.W.(F) Training Centre,

.........

Place:

Date :

Signature in full of the

Parent / Guardian / Husband

Signature in full of the Student

30

Annexure-VIII

CERTIFICATE OF PHYSICAL FITNESS IN RESPECT OF SELECTED

CANDIDATES FOR ADMISSION INTO THE GENERAL NURSING & MIDWIFERY

TRAINING COURSE-2015.

Name of the Candidate in full _______________________________________________

Age ______________ Sex _________ Height ___________ Weight ______________

Heart _______________ Eye ______________ Teeth ___________ Liver ___________

Lungs ______________ Spleen _______________ Blood Pressure ________________

Blood Group ______________

Please indicate if Pregnant _________________________ (In case of female candidate)

Date of L.M.P. ___________________________________ (In case of female candidate)

Previous Medical History, if any ______________________

Personal Remarks of Identification

1. ________________________________________________________________

2. ________________________________________________________________

I certify that I have examined the above named candidate and cannot discover that she /he has any

diseases, constitutional weakness or bodily infirmity and I consider that the candidate is physically and

mentally fit to undergo General Nursing and Midwifery Training Course under Health & F.W.

Department.

SIGNATURE OF THE CANDIDATE WITH DATE Signature & Seal of authorized Medical Officer

(Govt. of Odisha)

Designation

Date -

NOTE: - This certificate is to be detached for submission only by the selected candidates on

the date of counseling.

Not to be submitted along with Application Form.

31