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

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

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.

INDEX
Sl. No

Content

Page no

I.

Admission Calendar

II.

General Information

III

Eligibility

IV.

Admission Procedure

7-15
8-9

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

9
10 - 11
12
12
13
13

IV.

Post Admission

14

V.

Selection Committee

15

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

16-23

Annexure VII Proforma for undertaking by guardian

29

Annexure VIII Proforma of Physical Fitness Certificate

30

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

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

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

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

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

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.

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.

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.
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 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.
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 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.

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

Tuition fees

Rs.1200/-

Admission Fee

Rs.1200/-

Hostel Charges

Rs.1000/-

Electricity Charges

Rs.500/-

Transportation Charges

Rs.1000/-

Caution Money (Refundable)

Rs.500/- (one time)

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.

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
Sick Leave
Preparatory Leave

30 Days (can be divided)

10 Days
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

No. of seats available

A N M Training Centre, Bhubaneswar, Khurda

50

A N M Training Centre Bhawanipatna Kalahandi

30

A N M Training Centre Puri

40

A N M Training Centre ,Berhampur, Ganjam,

40

A N M Training Centre Daspalla , Nayagarh

40

A N M Training Centre Dhenkanal,

40

A N M Training Centre Kendrapara

40

A N M Training centre , Phulbani

40

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
1

S.no
Name of the institutions as per dt:30.06.2015

No. of seats available

Acharya Harihara ANM Training School At Po Anlabereni, Dhenkanal

30

75902
2

Agradoot School Of Nursing At Khedapada Po - Balugaon

20

Nayagarh 752069
3

Aisect Junior Nursing School At MathaSahi (Near Druga Mandir)

20

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 Balasore,

20

O
8

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

30

Nayapalli Bhubaneswar-751015, Dist Khurda

9

Bhagabati ANM Training School At - Raghunathpur, Po - Sayedpur

20

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, Sarala

30

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 Tangi

30

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 Bhubaneswar

30

21

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

30

Gajapati 761200
22

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

20

Front Of Lingaraj Station Khurda Bhubaneswar 751002 ,

23

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

30

Mahakalabasta, Via- Athgarh Cuttack 754029

24

GyanaPattnayak School Of Nursing At Post Baharana, Via- Niali

20

(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, At/Po

30

Sonepur, GadavitarSubarnapur, Odisha- 767017

28

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

30

Kalimandir Road Jharsuguda 768202

29

Khurda School Of Nursing Plot No 2499, Nayagarh Road

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

19

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 S770001

40

34

Maharani Premkumari Nursing Training School At - Deulasahi Po -

25

BaripadaMayurbhan 757001
35

"Mahima School Of Nursing At - Gopalsagar College Square

20

Jagatsinghpur 754103
36

Mamata Devi School Of Nursing At Post Jajpur Road, Bhubaneswar

30

Jajpur, Odisha- 755019

37

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

40

India) Bhubaneswar -10, DistKhurda

38

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

40

BaripadaDist - Mayurbhanj, Odisha 757107

39

"MmchtAnm Training Centre Mmc Hospital, G UdayAgiriKandhamal

30

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 Sorada,

40

Gunpur 752110
43

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

20

Dist - Cuttack 754202

44

Namitadevi School Of Nursing At-Uttara, Po

30

- Kausalyaganga Dist - Puri, Orissa 751002

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 - Buxibazar

20

Dist - Cuttack - 753001

47

Pally Chandan School Of Nursing At- Panimal, Po- Madhab ViaNiali, Distt- Cuttack,

20

30

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 Vihar,

20

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

51

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

30

Puri Town, Dist

- Puri, Odisha - 752002
52

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

40

Bhubaneswar-751009
53

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

30

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 Mission

40

Hospital Khariar, Dist-Nuapada, Orissa-766107

56

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

40

Sundargarh 769004
57

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

40

Colony, Bhubaneswar-751012
58

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

25

755043
59

Sailabala School Of Nursing At Sailashrinibas, Narendrakona, Post

30

Puri Town Puri, Odisha- 752001

60

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

20

Bhadrak 756100
61

Sambalpur ANM Training Center At/Po - Dhanupali Sambalpur

768005

21

30

62

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

30

Bikash Nagar (Turanga) Angul, Odisha 759122

63

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

40

Cuttack 753004
64

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

30

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 - Deogarh

40

768108
67

Satyanarayan Anm Training School At Shayamacharanpur Po

30

Dhenkanal
68

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

30

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 Bhubaneswar

30

Khurda 751015
71

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

30

759123
72

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

20

- Mandasahi, Dist - Jagatsinghpur 754114

73

Site ANM Training Centre PallishreeVihar At/Po - SadaipaliBalangir

40

767065
74

Sradha Institution Of Health Science At Rajendra Nagar, Po -

30

Madhupatna Cuttack 753010

75

Sradha School Of Nursing Shanti Bazar, DharmasalaDist - Jajpur,

20

Odisha 755008
76

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

22

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 Orissa

30

757028
81

Tulsa ANM Training Centre At - Gopa, Po - KeshpurKendrapara

20

82

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

30

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 Junagard

30

Pragati Nagar Kalahandi 766014

86

Xavier School Of Nursing At/Po - Mukunda Prasad

(MukundaBhawan) Khurda

23

30

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

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

ANM TC, Bolangir

Bolangir

ANM TC, Baripada

Mayurbhanj

ANM TC, Bhawanipatna

Kalahandi, Nuapada

ANM TC, Berhampur

Gajapati

SONMKCGMCH
Berhampur

Ganjam

ANM TC, Daspalla

Nayagarh

ANM TC, Deogarh

Deogarh

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

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 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 & 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