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

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1 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 Cost of Application Form & Prospectus: Rs.0/- (Rupees Three Hundred) only

2 Application form &Prospectus for admission into ANM/H.W (F) training course for the academic session are available in the official website of Directorate of Nursing,Odisha & DMET,Odisha & Intending female candidates may apply online by depositing prescribed fee Rs. 0/- (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:

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. 3

4 INDEX Sl. No Content Page no I. II. III IV. Admission Calendar General Information Eligibility Admission Procedure 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 Annexure VII Proforma for undertaking by guardian 29 Annexure VIII Proforma of Physical Fitness Certificate 4

5 I. ADMISSION CALENDAR Publication of Advertisement Availability of Online Application form and Prospectus in official website: to ( The Mock registration process starts from to till 2.00 PM after that AM onwards the final registration process will start.) Last date for submission of application by 05 PM Expected date of Publication of provisional merit list in the official website: Expected date of Document Verification and choice locking at Nodal Centres to Expected date of Reporting at nodal centers with course fee to Final seat allotment Reporting at nodal center with course Fees for second round counseling to Publication of list of left out Candidate

6 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 (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 will be allowed for the e-counseling process. III. ELIGIBILITY - Candidates must be 17 years of age or above as on 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 Odisha 2. - 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 Shall be medically fit for the course (Medical certificate format in annexure- VIII). 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/Subdivisional officer/tahasildar/additional Tahasildar are the competent Authority 6

7 III. ADMISSION PROCEDURE - Candidates can apply for the ANM/HW (F) Course online by applying in the appropriate application form available at website / / on or before by 5PM. 7

8 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: Provisional Seat Allotment & publication on the website. 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

9 Step 1: Online Registration ASSISTANCE: Note: Candidates are advised to first practice with the mock application form available in the official website (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. 0 only through S.B.I.Challan. The amount is payable through SBI Challan ( given in the annexure II) Open the website 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

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 (-50 KB in jpg/jpeg) & Signature (10- KB in jpg/jpeg) Snapshot of the online form given below 10

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 practice the mock format available in the official website (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 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(10 th 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

12 I. Secured more marks in English in 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 10 th (HSC) pass certificate and mark sheet issued by BSE Odisha or equivalent thereof 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.0/-(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

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 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 Tuition fees Rs.10/- 2 Admission Fee Rs.10/- 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.34,0/- per annum Rs.34,0/- 13

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 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 - The process of counseling for the Left out candidates will be notified in the website. 14

15 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) E. Discipline Annual Vacation - Days (can be divided) Preparatory Leave - 7 Days - 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

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. 16

17 List of Institution participating Online Counseling & Admission Process List of Government Institutions as per DT: Annexure I Sl.no Name S.no of the institutions No. of seats available 1 A N M Training Centre, Bhubaneswar, Khurda 50 2 A N M Training Centre Bhawanipatna 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 A N M Training centre, Bolangir A N M Training centre Sambalpur A N M Training centre, Rayagada 17

18 List of Private institutions Sl.no Name S.no of the institutions as per dt: Acharya Harihara ANM Training School At Po Anlabereni, Dhenkanal Agradoot School Of Nursing At Khedapada Po - Balugaon Nayagarh Aisect Junior Nursing School At MathaSahi (Near Druga Mandir) Po/DistDeogarh 4 Aum Sai School Of Nursing JaganathVihar, Near BhanjaVihar Berhampur, Ganjam 5 B BChhatoi School Of Nursing At/Po - Dhodra, Via - UmerkoteNabarangpur Baba Tateswar Nursing Training School At Chhotraypur, Po N C PurMayurbhanj, Odisha Balasore School Of Nursing At Chittapada, Po Khantapada Balasore, O 8 Bhaba Institute Of Medical Science & Research 1480, I R C Village, Nayapalli Bhubaneswar , Dist Khurda 9 Bhagabati ANM Training School At - Raghunathpur, Po - Sayedpur Ps-Binjharpur Jajpur Bhubaneswar School Of Nursing 94, Dharmavihar, Post - KhandagiriKhanda, Bhubaneswar-, 11 Bidyut School Of Nursing Plot No 1846, NuaSahi Nayapalli, Bhubaneswar Khurda 12 Biswanath Institute Of Medical Technology Plot No 210/13, Sarala Nagar, Ns Road, Laxmisagar Bhubaneswar, Dist - Khurda, Odisha Blue Wheel Institute Of Nursing Sciences At - Chandpur, Po - Chandpur Via - Ranpur, Ps RanpurNayagarh No. of seats available 40 18

19 14 Creative Junior Nursing School At Kajala Po &Dist Kendrapada, Odisha D R I E M S School Of Nursing At - Kairapari, Po - Kotsahi Tangi Cuttack Dhaneswar School Of Nursing At: MaitreeVihar, Link Road P O : Arunodaya Market, Cuttack Dibya School Of Nursing At Post Kirei Sundargarh 18 Dibyajyoti School Of Nursing PrachiVihar, KakatpurDist - Puri , Dr Ambedkar Institute Of Medical Science Jagda, Rourkela 40 Sundargarh Essen School Of Nursing 353/1903, Aiginia, Patrapada Bhubaneswar 21 Gajapati School Of Nursing, Techno Park, Ranipeta, Paralakhmeundi, Gajapati "Golap Devi School Of Nursing Plot No - Hig-1/46, Kapila Prasad In Front Of Lingaraj Station Khurda Bhubaneswar , 23 Gopabandhu Institute Of Medical Sci. & Research At- Madhabpur, Po- Mahakalabasta, Via- Athgarh Cuttack GyanaPattnayak School Of Nursing At Post Baharana, Via- Niali (Adaspur), Cuttack Hi- Tech School Of Nursing Health Park, Pandara Po - G. G. P. 60 Bhubaneswar Janakalyan School Of Nursing At - Ramchandrapur Po - GulnagarKendrapara Jasoda Devi School Of Nursing C/O Sitaram Prasad Niishra, At/Po Sonepur, GadavitarSubarnapur, Odisha Jet ANM Training Centre Back Side Of Badmal Police Station At/Po - Kalimandir Road Jharsuguda Khurda School Of Nursing Plot No 2499, Nayagarh Road 19

20 At/Po/Ps/Distt - Khurda, "KoshalaAnm Training School Dhanupali, Sambalpur Kuntala Devi School Of Nursing At - Debatra Colony, Po/Ps - NayagarhNayagarh, Odisha Lord Jagannath Mission's College & School Of Nursing Plot No. 228/237, Sector - A, Zone - B MancheswarIndl Estate, P O - Rasulgarh Bhubaneswar "MaaBautiAnm Training School At/Po -SankaraSundargarh 40 S Maharani Premkumari Nursing Training School At - Deulasahi 25 Po - BaripadaMayurbhan "Mahima School Of Nursing At - Gopalsagar College Square Jagatsinghpur Mamata Devi School Of Nursing At Post Jajpur Road, Bhubaneswar Jajpur, Odisha 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 "MmchtAnm Training Centre Mmc Hospital, G UdayAgiriKandhamal 40 Mother Teresa Health Worker (Female) Training Centre At/Po - Chandikhole, Barchana Block Jajpur Mothers Nursing School Plot No 1 B, Kaling Nagar, K-1, GhatikiaKhurda, Bhubaneswar, Orissa Mufti ANM Training Centre Vegan Ashram, Kundera At/Po Sorada, Gunpur Nabapravat School Of Nursing At/Po - Salipur (Near Old Fire Station) Dist - Cuttack Namitadevi School Of Nursing At-Uttara, Po - Kausalyaganga Dist - Puri, Orissa

21 45 Netaji ANM Training Centre Plot No. 262 (B), District Centre Chandrasekharpur Khurda Bhubaneswar Orissa Nursing Training Institute At - Pension Lane, P O - Buxibazar Dist - Cuttack Pally Chandan School Of Nursing At- Panimal, Po- Madhab Via- Niali, Distt- Cuttack, 48 Pathani Samanta School Of Nursing Main Road, Near Gundicha Mandap Nayagarh Pioneer ANM Training School Hig-188, KananVihar Phase - I Chandrasekharpur Bhubaneswar Premier School Of Nursing (ANM & GNM) Plot No 11, Pragati Vihar, At - Bisiapada Po Tirimal, Ps - Jatni Khurda Jatni Puri School Of Nursing Near Mit, Behind Gundicha Temple, Lane - 6 Puri Town, Dist - Puri, Odisha Rajdhani School Of Nursing Plot No 33, Forest Park Dist - Khurda, Bhubaneswar Ramadevi School Of Nursing At - Pattamundai, By Pass Chhak P O - Pattamundai, Dt - Kendra Para Raman School Of Nursing At: Hospital Road, Po: Keonjhargarh Keonjhar, Orissa Regional College Of Health Science Loharapali Road, Near Mission Hospital Khariar, Dist-Nuapada, Orissa Rourkela Institute Of Nursing At - Balughat, Po - Panposh Rourkela Sundargarh S I E M S School Of Nursing Plot No - 467, M S Nagar Side New A G Colony, Bhubaneswar Sabitridevi School Of Nursing At/Po - Panikoili, Dist - Jajpur Odisha Sailabala School Of Nursing At Sailashrinibas, Narendrakona, Post Puri Town Puri, Odisha

22 60 Salandi School Of Nursing Nh - 5, Motel Square Tehsil - Bhadrak Bhadrak Sambalpur ANM Training Center At/Po - Dhanupali Sambalpur Sankar Rukmani School Of Nursing Near Orissa Brigade School, At - Bikash Nagar (Turanga) Angul, Odisha Sarada Devi Institute Of Medical Sciences Plot-1525, Mahanadi Vihar, Cuttack Sarala Institute Of Nursing At Sapanpur, Po Sisua, P S Salepur Dist Cuttack Saswati School Of Nursing Dada Math Lane, Saradha Bali Puri Satyam Regional Institute Of Nursing At - Panda Sahi, Po - Deogarh Satyanarayan Anm Training School At Shayamacharanpur Po Dhenkanal 68 School Of Nsg, N P M Instt Of Medical Science & Research In Front Of Dist, H Q Hospital Keonjhar School Of Nursing & Health Sciences By New Hospital Society, Hillpatna Berhampur School Of Nursing (ANM) Plot No. N-5/157, Nayapalli Bhubaneswar Khurda Seva School Of Nursing At - Indra Hari Nagar, P O - TurangaAngul Shaktirupa School Of Nursing At - Ghadimul, P O - Badamundilo Via - Mandasahi, Dist - Jagatsinghpur Site ANM Training Centre PallishreeVihar At/Po - SadaipaliBalangir Sradha Institution Of Health Science At Rajendra Nagar, Po - Madhupatna Cuttack

23 75 Sradha School Of Nursing Shanti Bazar, DharmasalaDist - Jajpur, Odisha Sri Ram School Of Nursing At / Po - SohelaBargarh Srimaa School Of Nursing At/Po - Nemapoda, Dist Puri 78 Sushila Devi School Of Nursing Door No 866/1379, Strect: RajpurDistt-Nuapada 79 Swarnalata School Of Nursing Studies At - Bahadulapatna (Ipst Campus) Po - Bahugram Cuttack Tarini School Of Nursing At/Po - Baisinga, Dist - Mayurbhanj Orissa Tulsa ANM Training Centre At - Gopa, Po - KeshpurKendrapara 82 V I I T School Of Nursing At/Po - DhanmandalChandikhol Jajpur Vinayak School Of Nursing 222/1 Sastrinagar, Unit - Iv, Khurda Bhubaneshwar, Odisha Vision ANM (Female Health Worker) Training Centre Koraput Koraput Vivekananda Charitable Trust ANM Training Centre At Po Junagard Pragati Nagar Kalahandi Xavier School Of Nursing At/Po - Mukunda Prasad (MukundaBhawan) Khurda 23

24 SBI CHALLAN BANK S SLIP STATE BANK OF INDIA (POWER JYOTI ACCOUNT) HEALTH WORKER FEMALE SELECTION ACCOUNT No Name of candidate CANDIDATE S SLIP STATE BANK OF INDIA (POWER JYOTI ACCOUNT) HEALTH WORKER FEMALE SELECTION. ACCOUNT No Name of candidate-: Annexure II DEPARTMENT S SLIP STATE BANK OF INDIA (POWER JYOTI ACCOUNT) HEALTH WORKER FEMALE SELECTION. ACCOUNT No Name of candidate-: Branch Name Branch Code Amount. Rs.0/- In words (Rupees Three Hundred) only Journal No... (To be filled by Bank) Branch Name Branch Code Amount. Rs.0/- In words (Rupees Three Hundred) only Journal No... (To be filled by Bank) Branch Name Branch Code Amount. Rs.0/- In words (Rupees Three Hundred) only Journal No... (To be filled by Bank) Signature of Candidate : Signature of Candidate : Signature of Candidate : Signature of Bank Officer : 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

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 ANM TC, Sonepur Subarnapur 21 ANM TC, Bhubaneswar Khurda 22 ANM TC, Bhubaneswar Khurda 25

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 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 Round seal of Office Designation (with seal of officer) 26

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 Odisha Full Signature of the applicant Signature of the competent authority Date Round seal of the Office Designation (with seal of officer) 27

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/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: Date: Secretary Odisha Sainik Board/RazyaSainik/ Zilla Sainik Board (Office Seal) 28

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 29

30 Annexure-VIII CERTIFICATE OF PHYSICAL FITNESS IN RESPECT OF SELECTED CANDIDATES FOR ADMISSION INTO THE AUXILIARY NURSE AND MIDWIVES TRAINING COURSE-15. 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 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.

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