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 2015–16
Cost of Application Form & Prospectus: Rs.300/- (Rupees Three Hundred) only
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
2
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.
3
INDEX
Sl. No
Content
Page no
I.
Admission Calendar
5
II.
General Information
6
III
Eligibility
6
IV.
Admission Procedure
7-14

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
IV.
Post Admission
15
V.
Selection Committee
16
Annexure I
List of Institution participating in Counseling
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
17-23
Annexure VII Proforma for undertaking by guardian
29
Annexure VIII Proforma of Physical Fitness Certificate
30
4
I.
ADMISSION CALENDAR
Publication of Advertisement
13.07.2015
Availability of Online Application form and Prospectus
in official website: www.nursingodisha.nic.in/
14.07.2015 to 12.08.2015 ( The
Mock registration process starts
www.dmetodisha.gov.in/
from 14.07.2015 to 16.07.2015
till 2.00 PM after that 17.07.15
www.nrhmorissa.gov.in/odisha.gov.
11.00 AM onwards the final
www.odisha.gov.in/
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/www.odisha.gov.in/
20.08.2015
Expected date of Document Verification and choice
28.08.2015 to 01.09.2015
locking at Nodal Centres.
Expected date of Reporting at nodal centers with course
10.09.2015 to12.09.2015
fee
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
5
II. GENERAL INFORMATION
-
Applications are invited for admission in Auxiliary Nurse and Midwives (ANM)
1
training 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 by observing minimum eligibility criteria.
-
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
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).
1
ANM & Health Worker (Female) are interchangeably used terms
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/Subdivisional officer/Tahasildar/Additional Tahasildar are the competent Authority
2
6
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.dmetodisha.gov.in
/www.nrhmorissa.gov.in /www.odisha.gov.in on or before 12.08.2015 by 5PM.
7
The e-counseling and admission Process involves the following steps:
Step 1
• Payment of application fees & online forms filling up by the
candidates and registration for User id and Password.
Step 2
• Choice Filling by the Registered Candidates
Step 3
• 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 4
• Round – 1:
website.
Provisional Seat Allotment & publication on the
Step 5
• 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 6
• Round – 2: Seats not filled up in Round 1 will be filled up in the
Round 2 as per the merit list.
Step 7
• Left out candidate list is prepared, verified and displayed on the
website.
8
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.
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.
9
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
10
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
submitted data and the consequences thereafter.
in the
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 practice 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.
11
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 and mark sheet issued by BSE Odisha or
equivalent thereof.
3. 10+2 pass certificate and mark sheet issued by CHSE Odisha or equivalent thereof.
4. Original College Leaving Certificate / Transfer Certificate
- 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.
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 Odia 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.
12
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)
Total
Rs.34,200/- per annum
Rs.34,200/-
13
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.
14
III.
POST ADMISSION
A. Hostel Accommodation
-
There is provision for hostel accommodation in the A.N.M. Training Centers at Govt.
institution.
-
Candidate may reside outside the hostel if permitted by the Director Nursing Odisha,
only in exceptional circumstances for Govt institutions.
-
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 (Regulated as per INC guideline from time to time)
Annual Vacation
Preparatory Leave
-
30 Days (can be divided)
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.
15
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
Secretary, ON&MEB, Bhubaneswar :
Member
6.
7. Registrar, ONMC, Bhubaneswar
:
Member
:
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
The Nodal Selection Committee shall consist of:CDMO/Director Capital Hospital
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.
16
Annexure I
List of Institution participating Online Counseling & Admission Process
List of Government Institutions as per DT: 30.06.2015
Sl.no
Name
S.no of the institutions
1
A N M Training Centre, Bhubaneswar, Khurda
No. of seats available
50
A N M Training Centre Bhawanipatna
2
30
Kalahandi
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
17
List of Private institutions
Sl.no
Name
S.no of the institutions as per dt:30.06.2015
No. of seats
available
1
Acharya Harihara ANM Training School At Po Anlabereni,
30
Dhenkanal 75902
2
Agradoot School Of Nursing At – Khedapada Po - Balugaon
20
Nayagarh 752069
3
Aisect Junior Nursing School At MathaSahi (Near Druga
20
Mandir) Po/DistDeogarh
4
Aum Sai School Of Nursing JaganathVihar, Near BhanjaVihar
30
Berhampur, Ganjam
5
B BChhatoi School Of Nursing At/Po - Dhodra, Via -
30
UmerkoteNabarangpur 764073
6
Baba Tateswar Nursing Training School At Chhotraypur, Po N C
40
PurMayurbhanj, Odisha- 757020
7
Balasore School Of Nursing At Chittapada, Po Khantapada
20
Balasore, O
8
Bhaba Institute Of Medical Science & Research 1480, I R C
30
Village, Nayapalli Bhubaneswar-751015, Dist Khurda
9
Bhagabati ANM Training School At - Raghunathpur, Po -
20
Sayedpur
Ps-Binjharpur Jajpur 755027
10
Bhubaneswar School Of Nursing 94, Dharmavihar, Post -
30
KhandagiriKhanda, Bhubaneswar-30,
11
Bidyut School Of Nursing Plot No 1846, NuaSahi Nayapalli,
20
Bhubaneswar Khurda
12
Biswanath Institute Of Medical Technology Plot No 210/1320,
30
Sarala Nagar, Ns Road, Laxmisagar Bhubaneswar, Dist Khurda, Odisha - 751006
13
Blue Wheel Institute Of Nursing Sciences At
- Chandpur, Po - Chandpur Via - Ranpur, Ps – RanpurNayagarh
18
20
14
Creative Junior Nursing School At Kajala Po
20
&Dist Kendrapada, Odisha- 754211
15
D R I E M S School Of Nursing At - Kairapari, Po - Kotsahi
30
Tangi Cuttack 754022
16
Dhaneswar School Of Nursing At: MaitreeVihar, Link Road P O
30
: Arunodaya Market, Cuttack 753012
17
Dibya School Of Nursing At Post Kirei Sundargarh
20
18
Dibyajyoti School Of Nursing PrachiVihar, KakatpurDist - Puri-
25
752108,
19
Dr Ambedkar Institute Of Medical Science Jagda, Rourkela
40
Sundargarh 769042
20
Essen School Of Nursing 353/1903, Aiginia, Patrapada
30
Bhubaneswar
21
Gajapati School Of Nursing, Techno Park, Ranipeta,
30
Paralakhmeundi, Gajapati 761200
22
"Golap Devi School Of Nursing Plot No - Hig-1/46, Kapila
20
Prasad In Front Of Lingaraj Station Khurda Bhubaneswar
751002 ,
23
Gopabandhu Institute Of Medical Sci. & Research At-
30
Madhabpur, Po- Mahakalabasta, Via- Athgarh Cuttack 754029
24
GyanaPattnayak School Of Nursing At Post Baharana, Via-
20
Niali (Adaspur), Cuttack 754004
25
Hi- Tech School Of Nursing Health Park, Pandara Po - G. G. P.
60
Bhubaneswar 751025
26
Janakalyan School Of Nursing At - Ramchandrapur Po -
30
GulnagarKendrapara 854211
27
Jasoda Devi School Of Nursing C/O Sitaram Prasad Niishra,
30
At/Po Sonepur, GadavitarSubarnapur, Odisha- 767017
28
Jet ANM Training Centre Back Side Of Badmal Police Station
30
At/Po - Kalimandir Road Jharsuguda 768202
29
Khurda School Of Nursing Plot No 2499, Nayagarh Road
19
30
At/Po/Ps/Distt - Khurda,
30
"KoshalaAnm Training School Dhanupali, Sambalpur76800
30
31
Kuntala Devi School Of Nursing At - Debatra Colony, Po/Ps -
20
NayagarhNayagarh, Odisha - 752069
32
Lord Jagannath Mission's College & School Of Nursing Plot No.
20
228/237, Sector - A, Zone - B MancheswarIndl Estate, P O Rasulgarh Bhubaneswar 751010
33
"MaaBautiAnm Training School At/Po -SankaraSundargarh
40
S770001
34
Maharani Premkumari Nursing Training School At - Deulasahi
25
Po - BaripadaMayurbhan 757001
35
"Mahima School Of Nursing At - Gopalsagar College Square
20
Jagatsinghpur 754103
36
Mamata Devi School Of Nursing At Post Jajpur Road,
30
Bhubaneswar Jajpur, Odisha- 755019
37
Manjari Devi School Of Nursing Plot No 68, Rasnlgarh (Near
40
Bank Of India) Bhubaneswar -10, DistKhurda
38
"Mayurbhanj School Of Nursing At - Indapahi, Po - Laxmiposhi,
40
Via - BaripadaDist - Mayurbhanj, Odisha 757107
39
"MmchtAnm Training Centre Mmc Hospital, G
30
UdayAgiriKandhamal
40
Mother Teresa Health Worker (Female) Training Centre At/Po -
30
Chandikhole, Barchana Block Jajpur 754029
41
Mothers Nursing School Plot No 120 B, Kaling Nagar, K-1,
20
GhatikiaKhurda, Bhubaneswar, Orissa 751003
42
Mufti ANM Training Centre Vegan Ashram, Kundera At/Po
40
Sorada, Gunpur 752110
43
Nabapravat School Of Nursing At/Po - Salipur (Near Old Fire
20
Station) Dist - Cuttack – 754202
44
Namitadevi School Of Nursing At-Uttara, Po
- Kausalyaganga Dist - Puri, Orissa – 751002
20
30
45
Netaji ANM Training Centre Plot No. 262 (B), District Centre
30
Chandrasekharpur Khurda Bhubaneswar 751016
46
Orissa Nursing Training Institute At - Pension Lane, P O -
20
Buxibazar Dist - Cuttack - 753001
47
Pally Chandan School Of Nursing At- Panimal, Po- Madhab Via-
30
Niali, Distt- Cuttack,
48
Pathani Samanta School Of Nursing Main Road, Near Gundicha
30
Mandap Nayagarh 752070
49
Pioneer ANM Training School Hig-188, KananVihar Phase - I
30
Chandrasekharpur Bhubaneswar 751031
50
Premier School Of Nursing (ANM & GNM) Plot No 11, Pragati
20
Vihar, At - Bisiapada Po Tirimal, Ps - Jatni Khurda Jatni 752050
51
Puri School Of Nursing Near Mit, Behind Gundicha Temple,
30
Lane - 6 Puri Town, Dist
- Puri, Odisha - 752002
52
Rajdhani School Of Nursing Plot No 33, Forest Park Dist -
40
Khurda, Bhubaneswar-751009
53
Ramadevi School Of Nursing At - Pattamundai, By Pass Chhak
30
P O - Pattamundai, Dt - Kendra Para – 754215
54
Raman School Of Nursing At: Hospital Road, Po: Keonjhargarh
30
Keonjhar, Orissa 758001
55
Regional College Of Health Science Loharapali Road, Near
40
Mission Hospital Khariar, Dist-Nuapada, Orissa-766107
56
Rourkela Institute Of Nursing At - Balughat, Po - Panposh
40
Rourkela Sundargarh 769004
57
S I E M S School Of Nursing Plot No - 467, M S Nagar Side
40
New A G Colony, Bhubaneswar-751012
58
Sabitridevi School Of Nursing At/Po - Panikoili, Dist - Jajpur
25
Odisha – 755043
59
Sailabala School Of Nursing At Sailashrinibas, Narendrakona,
Post Puri Town Puri, Odisha- 752001
21
30
60
Salandi School Of Nursing Nh - 5, Motel Square Tehsil -
20
Bhadrak Bhadrak 756100
61
Sambalpur ANM Training Center At/Po - Dhanupali Sambalpur
30
768005
62
Sankar Rukmani School Of Nursing Near Orissa Brigade School,
30
At - Bikash Nagar (Turanga) Angul, Odisha 759122
63
Sarada Devi Institute Of Medical Sciences Plot-1525, Mahanadi
40
Vihar, Cuttack 753004
64
Sarala Institute Of Nursing At Sapanpur, Po Sisua, P S Salepur
30
Dist Cuttack- 754202
65
Saswati School Of Nursing Dada Math Lane, Saradha Bali Puri -
50
752002
66
Satyam Regional Institute Of Nursing At - Panda Sahi, Po -
40
Deogarh 768108
67
Satyanarayan Anm Training School At Shayamacharanpur Po –
30
Dhenkanal
68
School Of Nsg, N P M Instt Of Medical Science & Research In
30
Front Of Dist, H Q Hospital Keonjhar 758001
69
School Of Nursing & Health Sciences By New Hospital Society,
20
Hillpatna Berhampur
- 760005
70
School Of Nursing (ANM) Plot No. N-5/157, Nayapalli
30
Bhubaneswar Khurda 751015
71
Seva School Of Nursing At - Indra Hari Nagar, P O -
30
TurangaAngul– 759123
72
Shaktirupa School Of Nursing At - Ghadimul, P O -
20
Badamundilo Via - Mandasahi, Dist - Jagatsinghpur– 754114
73
Site ANM Training Centre PallishreeVihar At/Po -
40
SadaipaliBalangir 767065
74
Sradha Institution Of Health Science At Rajendra Nagar, Po Madhupatna Cuttack 753010
22
30
75
Sradha School Of Nursing Shanti Bazar, DharmasalaDist -
20
Jajpur, Odisha – 755008
76
Sri Ram School Of Nursing At / Po - SohelaBargarh - 768033
25
77
Srimaa School Of Nursing At/Po - Nemapoda, Dist – Puri
30
78
Sushila Devi School Of Nursing Door No 866/1379, Strect:
30
RajpurDistt-Nuapada
79
Swarnalata School Of Nursing Studies At - Bahadulapatna (Ipst
30
Campus) Po - Bahugram Cuttack 754200
80
Tarini School Of Nursing At/Po - Baisinga, Dist - Mayurbhanj
30
Orissa – 757028
81
Tulsa ANM Training Centre At - Gopa, Po - KeshpurKendrapara
20
82
V I I T School Of Nursing At/Po - DhanmandalChandikhol
30
Jajpur 754024
83
Vinayak School Of Nursing 222/1 Sastrinagar, Unit - Iv, Khurda
20
Bhubaneshwar, Odisha - 751001
84
Vision ANM (Female Health Worker) Training Centre Koraput
30
Koraput 764020
85
Vivekananda Charitable Trust ANM Training Centre At Po
30
Junagard Pragati Nagar Kalahandi 766014
86
Xavier School Of Nursing At/Po - Mukunda Prasad
(MukundaBhawan) Khurda
23
30
Annexure –II
SBI CHALLAN
BANK’S SLIP
STATE BANK OF INDIA
(POWER JYOTI ACCOUNT)
CANDIDATE’S SLIP
STATE BANK OF INDIA
(POWER JYOTI ACCOUNT)
DEPARTMENT’S SLIP
STATE BANK OF INDIA
(POWER JYOTI ACCOUNT)
HEALTH WORKER FEMALE
SELECTION
ACCOUNT No.3180967668- 3
Name of candidate
HEALTH
WORKER
FEMALE SELECTION.
ACCOUNT No.3180967668-3
Name of candidate-:
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)
Branch Name
Branch Code
Amount. Rs.300/In words (Rupees Three
Hundred) only
Journal No. …………………..
(To be filled by Bank)
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 :
:
Signature of
Candidate :
Signature of
Candidate :
Signature of
Bank Officer :
Signature of
Bank Officer :
Fees remitting Branch may collect Rs.50/- (Rupees Fifty) only towards non-home charges from the remitter SEPARATELY.
24
Annexure – III
List of Nodal Center
Sl.
No.
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
Nodal Centre
Tagging District
25
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
Signature of the
competent authority
Date –
Designation (with seal of officer)
Round seal of Office
26
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
Signature of the competent authority
Date –
Designation (with seal of officer)
Round seal of the Office
27
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/Marksheet/ 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
Odisha Sainik Board/RazyaSainik/
Zilla Sainik Board
Date:
(Office Seal)
28
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)
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:
Signature in full of the
Parent / Guardian / Husband
Date :
Signature in full of the Student
29
Annexure-VIII
CERTIFICATE OF PHYSICAL FITNESS IN RESPECT OF SELECTED
CANDIDATES FOR ADMISSION INTO THE AUXILIARY NURSE AND MIDWIVES
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 & Seal of authorized Medical Officer
(Govt. of Odisha)
SIGNATURE OF THE CANDIDATE WITH DATE
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.
30
31