PROSPECTUS FOR ADMISSION INTO ANM/HW (F) COURSE IN SAMBALPUR
ANM TRAINING CENTRE (UNIT OF ASA TRUST) FOR THE
SESSION 2013-14
(Please read this Prospectus thoroughly and carefully. Incomplete, illegible or incorrect
applications are liable for rejection)
Introduction
The Sambalpur ANM Training Centre is approved by Indian Nursing Council, New
Delhi (INC) (under Ministry of Health and Family Welfare, Govt. of India) vide File No. 1824/5664-INC, Dt.04-02-2010, permitted by Health and Family Welfare Department, Govt. of
Odisha vide letter no. ME-II-IXM-46/06/20167/H, Dt.17-08-2006, Recognition by Odisha
Nurses & Midwives Council vide letter no. 220 NR-2/2008, Bhubaneswar Dt.21-09-2011,
managed by ASA Trust vide Regd. No. 516, Dt.11-05-2005 is taking admission of ANM/Health
Worker (Female) training course as per the syllabus of Indian Nursing Council, New Delhi and
the rules and regulation of Odisha State Nursing Council for the session 2013-14. The institution
gives importance to Nation’s commitment to bring primary health and education services within
the reach of every individual. We have initiated steps to create health awareness and health care
among the public in rural areas particularly in Western Odisha.
Vision
-
To create awareness of health in the society.
To provide quality education and training in nursing profession.
Create professionalism and service motivation in the student profile.
Public awareness of environment factor with regard to nursing care for physical and
mental health.
To be leaders in Health Service Education sector in India by 2020.
Later stage the institute will extend its operation in the areas of Health Management,
Research and Medical Education.
-
Objectives
1.
2.
3.
4.
5.
6.
7.
To provide training on basic health care activities of the people of Western Odisha.
To plan, implement and evaluate health plan in communities and families.
To be capable of rendering primary health care i.e. maintenance and promotion of
health.
To maintain and restore normal life function in respect to physical and emotional state.
To create awareness to assess environmental factors which plays a major role in the
implementation and provision for health care based on scientific principles.
To develop health awareness in rural areas.
To develop the health services and education at par with international level by
adopting new systems and technology.
The Training Centre
The centre is situated on Main Road, Dhanupali in Sambalpur which is very well
connected to Bus Stand and Railway Station.
The Course
The Course is of two year’s duration. Only female candidates between the age of 17 to 35
are allowed to take admission into this course, subject to change of regulation of Indian Nursing
Council, New Delhi (INC) and State Nursing Council, Orissa (SNC). The theory and practical
will be conduced as per the syllabus of INC and final examination will be conducted by SNC.
The Certificate will be issued from SNC.
Clinical and Community Training
The Clinical/Practical training will be at District Head Quarter Hospital, Sambalpur and
Field training will be at CHC Thembra, and New PHC Dhanupali.
Selection
Selection to ANM/HW(F) Course shall be made from the eligible candidates in order of
merit on the basis of marks secured by them in the qualifying examination together with the
marks secured in Personal Interview, by the Selection Committee of the Training Centre and
then admission will be offered on first come, first serve basis. The selection of batches will be as
per the convenience of the Training Centre.
Eligibility for Application
To be eligible to apply for ANM / HW (F) a candidate:
1. Must have passed the (12th ) CHSE or Equivalent examination.
2. Must have completed 17 years of age on or before 31st Dec 2013 and not more than 35 years
by the said date.
3. Must have passed Oriya up to M.E. Standard.
4. Must be a permanent resident of Orissa, (Certificate as defined in Govt. of Orissa, Home
Department Resolution 38 – Reforms dated 18th June 1949) to be furnished.
5. Only Female candidates are eligible to apply.
6. Physically Handicapped category candidates should not have below 40% or above 50% of
disability.
Submission of Application
The candidates are required to submit their applications (along with requisite documents)
in the prescribed form. The application form must be complete in all respects and shall be sent by
“Registered Post/Speed Post” to Sambalpur ANM Training Centre, At/P.O.– Dhanupali,
Dist.– Sambalpur, PIN– 768005 (Odisha)” before the closing date.
1.
2.
3.
4.
5.
One envelope for one application.
The application form must be filled in by candidate’s own handwriting, corrections if
any must be legible and initialized by the candidate.
The office shall have no responsibility for applications that reach late for any reason
including postal delay. Such applications shall be summarily rejected and no
correspondence/representation in this regard shall be entertained.
Applications that are incomplete, illegible or incorrectly filled in or are not
accompanied with essential documents shall be rejected summarily.
Address of the candidate must be correctly written on the envelope with requisite
postal stamps and enclosed with the application in the envelope.
No reason shall be prescribed for rejection. No opportunity shall be given to rectify
the defects or deficiencies after last date of receipt of application.
Documents to be furnished by the Candidate along with application
1. For evidence of age, the candidate must submit an attested copy of pass certificate of the
Board of Secondary Education. Other certificates of age, such as certificate from Hospital
/ Municipality / Affidavits etc. are not acceptable.
2. Attested true copy of pass certificate in the qualifying examination from the concerned
Board.
3. Attested true copy of the Mark List of the qualifying examination showing aggregated
marks from the concerned Board.
4. Attested true copy of conduct and character certificate from the Headmaster / Principal of
the School / College last studied.
5. Six identical copies of recent passport size photograph (5X7 cm approximately) duly
attested by a Gazetted officer with seal, out of which one will be pasted at the space
earmarked in the application form and the other will be stapled with application form.
6. A self addressed envelope of size (23X10 cm) affixing postage stamp worth Rs.25/- for
dispatch of intimation letter through Regd. Post.
7. In case of candidates belonging to SC/ST community, certificate from the Competent
Authorities.
8. In case of candidates claiming to be permanent residents of Orissa, a Certificate from the
Competent Authorities. (For this purpose only District Magistrate / Additional District
Magistrate / Sub – Divisional Officer / Tahasildar / Additional Tahasildar are the
competent authorities).
9. All selected candidates have to submit at the time of admission an undertaking from local
guardian in the Performa prescribed (Appendix – 3)
10. Attested copy of certificate by the Community Development & Social Welfare
Department / Panchayati Raj Department / District Social Welfare Officer, Government
of Orissa for handicapped candidates.
11. If a candidate is found to have furnished any false information in certificate or to have
withheld or concealed any relevant information to gain undue advantage, her application
shall be cancelled at any stage of her study and such other action as deemed necessary
may be taken against the candidate. The candidates are required to furnish an undertaking
to this effect in the application form.
Admission
1. A Selected candidate shall be required to produce all original documents at the time of
counseling and admission. In case a candidate fails to submit the original C.L.C. (College
Leaving Certificate) at the time of admission, she may be admitted with an undertaking to
submit the C.L.C. in the institute at the time of joining positively, failing which her
admission will be cancelled and the amount paid by the candidate towards admission fee
will be forfeited. The candidate has to be found physically and mentally fit for Nursing
Work on medical examination by a Lady Doctor (O. & G. Specialist ) appointed by the
training Centre.
2. In addition to documents already submitted at the time of admission an undertaking from
the local guardian as per appendix – 3 of this prospectus, which should be signed by the
parent / guardian of the candidate and by the local guardian.
3. The following fees are to be deposited at the time of admission into 1st year ANM course.
Fees
Course fee
1st Year
Rs. 55,000/-
2nd Year
Rs.55,000/-
Total
Rs.1,10,000/-
This excludes Hostel Charges (Accommodation & Fooding, Transportation, Clinical &
Field Training expenses). Registration fee, State Board Examination fee, Caution money, etc will
be paid by the student as and when required and this excludes the above said course fee.
Hostel Accommodation
The Principal/Director shall make allotment of seats in Hostel.
Uniform
Students have to wear prescribed uniform during ward and field duty.
Discipline
Students who are admitted should abide by the Rules and Regulations of the Centre and
Hostel as well. Those who found disobeying the Rules and Regulations or showing, any antisocial attitude shall be debarred from the Hostel and Centre within few hours notice.
Declaration
This prospectus is always subject to the prevailing law as time being in force.
Important Information
All Original documents to be brought on the day of the admission. The following original
certificates, mark sheets and other documents will be verified during the admission. Undertaking
for extension of time for submission of original documents will not be entertained.
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
Intimation letter.
Original +2 Pass Board Certificate.
Original+2 Pass mark sheet of Examination issued by the concerned Board.
Original 10th Pass (Matric Board Certificate).
Original mark sheet of Matriculation Examination issued by the concerned Board.
Original Caste Certificate (in case of SC / ST candidates) only issued by the
competent authority.
Original P.H. certificate issued by the competent authority (in case of Physically
Handicapped candidates) only.
Six copies of recent colour passport size photograph & three copies of recent
colour stamp size photograph duly attested by a Gazetted officer on the front side.
Original character/conduct certificate from the Head of the Institution last
attended.
Original Residential/Nativity Certificate issued by the Competent Authority.
Original Certificate from competent authority in support of children of Exserviceman/Serviceman (in case of Ex-Serviceman/Serviceman candidate) only.
Original School/College Leaving Certificate / Transfer Certificate (to be kept by
the Centre).
N.B.:1.
2.
3.
All original Certificates must be produced for verification by Orissa Nursing
Council / Indian Nursing Council / Competent Authorities.
All the above rules and regulations are subject to change as per the INC,
New Delhi, SNC, Orissa and Govt. of Orissa as and when necessary.
Fees shall not be refunded at any cost.
Form No. SANMTC ____________
Issued Date ______________
APPLICATION FORM FOR A. N. M. / H. W. (F) TRAINING COURSE (2013-14)
(To be filled in by candidate’s own handwriting)
(1) Full Name of the candidate (in block letter)
Paste a passport size
photograph attested
by a Gazetted
Officer on the front
here. (Do not pin)
(2) Category(General/S.C. / S.T. ) …………………………………
(3) Date of Birth (as per Board Certificate) ……………………………………………….
(4) Age on 31st Dec 2013 of the year of admission …………Year.………Month…………Day
(5) Nationality ………………………………………...
(6) Married / Unmarried ………………………………
(7) Religion ……………………………………………
(8) Educational Qualification …………………………………………………………………...….
(9) Permanent (home address):- D/O. - ………….…………………………………………………
At.- …….………………………P.O. - ………………..…..……Via. - ……………………..…….
P.S.- …….……………………..Dist. - ...………………………PIN CODE No-…………………
E-mail .………………………….…………………….. Mob. No .……..…………………………
(10) Present/Correspondence address:- C/O. - ………………………………………………..……
At.- …….………………………P.O. - …………………………Via. - ………………………..….
P.S.- …….……………………..Dist. - ...……………………PIN CODE No-……………………
E-mail .………………………….…………………….. Mob. No .……..…………………………
(11) Full Name of Father / Husband ……………………………………………………….
Occupation …………………………………………………………………………
(12) Name of the Guardian ……………….. ……………………………………………...
(if parent not alive)
Address …………………………………………………………………………....
………………………………………………………………………..……
Relationship with candidate ………………………………………………………..……..
(13) Academic Details: (A) (i) M.E. School Name (7th) ………………………………………
(ii) High School Name (10th) ……..……………………………………….……..
(iii) Name of the Board (10th)(State Board / CBSE / ICSE/Other) …………..……
(iv) Division ………… % of marks……….. (v) Year of passing ……….............
(B) (i) +2 College Name …….. ……..……………………………………….……..
(ii) Name of the Board (+2) (CHSE / CBSE / ICSE/Other) ……………..…..……
(iii) Division ………… % of marks……….. (iv) Year of passing ……….............
(v) Other qualifications: …………………………………………………………..
(14) Documents and Certificates enclosed:(i)
Attested copy H.S.C. or equivalent Certificate issued by Board
of Secondary Education or equivalent Board as evidence of age. Yes / No
(ii)
Attested copy of the Mark Sheet of qualifying Examination
(Matriculation or equivalent Examination)
Yes/No
(iii)
Attested copy +2 or equivalent Certificate issued by CHSE
or equivalent Board.
Yes / No
(iv)
Attested copy of the +2 Mark Sheet of qualifying Examination
(CHSE or equivalent Examination)
Yes/No
(v)
Attested copy of conduct certificate issued by the Principal/Head
Master of the Institution last studied.
(vi)
Six attested copies of recent colour passport size photograph
& three copies of recent colour stamp size photograph.
Yes/No
Yes/No
(vii)
Original money receipt of the purchase of application form.
Yes/No
(viii) Attested copy of Caste Certificate.
Yes/No
(ix)
Attested copy of Residential/Nativity Certificate.
Yes/No
(x)
Attested copy of M.E. Standard Oriya Pass Certificate from
the concerned authority (Headmaster/Headmistress).
Yes/No
(xi)
A self addressed envelope of size 23X10 cm affixing postage stamp
of Rs.50/- for dispatch of intimation letter through Regd. Post.
Yes/No
I declare that the above statement of particulars furnished by me are true in all respect
and as such, I undertake that if subsequently, I will be found to have given wrong information
with regard to the marks, certificates and documents produced by me in connection with my
admission, then my name will be immediately removed from the centre. In addition to this, legal
action may be taken against me. I agree to abide by the rules of the Training Centre and Hostel
and pay all sorts of fees and dues/charges of the Training Centre and Hostel in-time. More I
agree that if the authorities take any action against me such as rusticating from the institute or
withdrawal of my studentship during my study, in answer to my act of misconduct/mischief or
any unlawful deed, I won’t go for legal proceeding.
I certify that I do not suffer form mental disease.
I certify that I have not been prosecuted or convicted for any criminal offence involving
moral turpitude.
Fees deposited shall not be refunded at any cost.
Countersigned by Parents / Guardian
Full Signature of the Applicant
For official use only:
APPENDIX – I
(ATTACH CASTE CERTIFICATE)
APPENDIX – II
(To be filled in by the candidate’s own handwriting)
1.
Are you a permanent resident of Odissa ……………………
2.
If No, then what is your Period of residence in Odisha ……………………
3.
Can you read, write and speak Odia.
(Yes/No)
a) Read ……………………………….
b) Write ………………………………
c) Speak ……………………………...
4.
Have you passed M.E. Standard in Odia.
(Yes/No)
If Yes, form Where ( Write the Name and address of the School) :- …………………
…………………………………………………………………………………………..
…………………………………………………………………………………………..
Signature in full of the candidate.
APPENDIX – III
(ATTACH RESIDENTIAL / NATIVITY CERTIFICATE)
APPENDIX – IV
(Hostel Boarders Local Guardian Certificate)
Frequent change of Local Guardian is not permitted Aged & Married persons are
preferred
I authorize Mrs./Mr. …………………………………………………….……. as the Local
Guardian of my daughter/ward/wife- Miss./Mrs. ..………………………………………...
Signature of Student
Date:
Paste the
Passport size
photograph
of Local
Guardian
Signature of Parent/Husband
Date:
Paste the
Passport size
photograph
of Father or
Mother
Local Guardian
Guardian
(To be filled up by Local Guardians own hand writing)
I, Mr. / Mrs. ……………………………………………………………………..………….
Address …………………...………………………………………………………………..
…………………………………… …………………………...……………………………
Tel. No. …………………...…….…… is related as ………………………………….……
to the student, do hereby undertake to act as the Local Guardian of the above student during her
period of study in Sambalpur ANM Training Centre, which I have been empowered by her
parent/guardian/husband of the above said student. I further undertake to take custody of the
above student if and when required by the Training Centre and to ensure that she maintains the
academic discipline and good conduct during the period of study in the aforesaid institution.
Signature of Parent/Husband
Date:
Full Signature of the Local Guardian
Date: