`

PROSPECTUS
FOR

ADMISSION INTO
BASIC B.SC NURSING COURSE
IN ALL INC RECOGNISED GOVT.
&
PVT. NURSING COLLEGES OF ODISHA

FOR THE ACADEMIC SESSION 2017–18

Approved by

Govt. in Health & Family welfare department

No.ME-II-M-10/2016 15604/H., Dtd. 09/06/2017

Cost of application form & Prospectus: Rs.500/- (Rupees Five Hundred) only

1
Application form and Prospectus for admission into 4 years Basic B.Sc Nursing course for the academic
session 2017-18 are available in the official website of the Directorate of Nursing, Odisha i.e.
www.nursingodisha.nic.in (Click News & Events) during the period from 22.06.2017 to 15.07.2017.
Candidates seeking admission for the course at Govt. College of Nursing, Berhampur & Private
Colleges (recognized by the Indian Nursing Council) in the state of Odisha may apply in the prescribed
application form within the stipulated time.
.

For any query contact: - Tel No-0674-2393840

2
 INDEX
SL.NO CONTENT PAGE NO

I Admission Calendar 4

II General information 4

III Selection Committee Members 4

IV Eligibility criteria 5

V Procedure for filling of application form 5-7

VI Merit list 7

VII Counseling overview 8

VIII Selection Procedure and reservation Policy 9

IX Fee structure 9-11

X Post admission 11-12

Annexure I Application Form 13-15

Annexure II List of Govt. and Private colleges and the no. of seats 16

Annexure III Proforma of Permanent resident certificate 17

Annexure IV Proforma of SC/ST certificate 18

Annexure V Proforma of Ex-service men/Service men Certificate 19

Annexure VI Proforma of Undertaking form of Self Declaration by 20

Parent/ Guardian

Annexure VII Proforma of Medical Fitness Certificate 21

Annexure VIII SBI Challan Form for Application fee 22

3
 I. TENTATIVE ADMISSION CALENDAR

Availability of application form & Prospectus in

1 official website www.nursingodisha.nic.in. Dt.22.06.2017 to 15.07.2017
2 Last date of receipt of Application Dt. 18.07.2017 by 5 P.M
3 Expected date of declaration of merit list in the web- Dt. 30.08.2017
site
4 Expected Date of Counseling & deposit of course fee. Dt. 12.10.2017 to 13.10.2017
5 Expected Date of Commencement of classes for 1st year 24.10.2017

II.GENERAL INFORMATION
 The duration of the course is 4 years.
 All seats in (Govt. college of Nursing, Berhampur & 85% Govt quota seats of
private Colleges) will be filled up from the Central merit list.
 Private institutions will fill up 15% seats under management quota following the eligibility criteria
of INC New Delhi.
 All the Nursing institutions (Govt. &Private) having Indian Nursing Council (INC)
recognition as on date: 31.08.2017 will be allowed to participate in the counselling
for the academic session 2017-18 as per F.no. 22-40/web/2016 of INC, New
Delhi.
 Both Female and Male candidates are eligible to apply. (10% seats reserved for
male candidate.)
III.SELECTION COMMITTEE MEMBERS:-

The State Selection Committee shall consist of:-

1. Director Nursing, Odisha :Chairperson
2. Dean& Principal ,MKCG,MCH,Berhampur :Vice-chairman
3. Joint Director of Nursing (Edu), Odisha :Member
4. Joint Director of Nursing (Clinical), Odisha :Member
5. Principal, College of Nursing, Berhampur :Member
6. Deputy Director of Nursing, Odisha :Convenor
7. Assistant Director of Nursing (Admin), Odisha :Member
8. Secretatary, ON&MEB, Bhubaneswar :Member
9. Registrar , ONMC, Bhubaneswar :Member

4
IV.ELIGIBILITY CRITERIA

Candidate must:-

 Be of minimum 17 years of age as on 31.12.2017.

 Have passed 10+2 or equivalent examination with Science (Physics, Chemistry & Biology)
from CHSE, Odisha or any other board or Council or University equivalent thereof.
 Have passed 10+2 examination in Science (physics, chemistry & Biology) conducted by
National Institute of Open School with 45% marks are also eligible to apply.

 Have passed in the subject of PCB & English individually and must have obtained a
minimum of 45% marks taken together in PCB at the qualifying examination i.e. (10 +2) .
Candidates belongings to SC/ST the marks obtained in PCB taken together in qualifying
examination be 40% instead of 45 % as stated above. English is a compulsory subject in
10+2 for being eligible for admission to B.Sc nursing.

 Have passed odia upto ME standard. For Candidates to be admitted in (Govt. /85% Govt.
quota seats in INC recognized private) institutions.

 Be either domicile/ permanent resident /native of Odisha but currently residing outside Odisha (
candidate seeking admission in Govt College of Nursing, Berhampur and 85% of seats (
Govt. quota) in Private INC recognized institutions)

 Be medically fit to undergo the course.

 Loco motor disability of lower limbs between 40% to 50% only will be taken into consideration for
Physical handicapped category.

V. PROCEDURE FOR FILLING UP AND SUBMISSION OF APPLICATION.

 All applicants are advised to go through the Prospectus thoroughly before filling up the
application form.
 Candidate must apply in the prescribed application form along with requisite fees and self
attested photocopies of the documents/testimonials.
 The application form must be filled up by the candidate and signed at the appropriate
column.
 Incomplete Application will be summarily rejected. Application form
Overwriting/cutting/ineligibility are also liable to rejected.
 If ineligibility of a candidate is detected at any stage before or after publication of merit
list/ counseling/Admission, his/her candidature/admission will be cancelled without any
notice.
In case any candidate is found to have furnished false information or certificate etc. or is found to
have withheld or concealed any information in his/her application, he/she will be debarred from
admission.

5
 It is the responsibility of the candidate to ensure that correct details including address,
Email Id, contact number is filled in the Application Form. The Convenor will not be
responsible for any loss in transit or for incorrect address given by the applicant in the
Application Form.
 Payment of application fees will be accepted in shape of SBI Challan, not through any other mode.
(Challan form can be downloaded from ANNEXURE-VIII of the prospectus).
 No candidate is allowed to submit for more than one application.

The following Documents are to be furnished by the candidate along with

the application form
a) Self-attested photocopy of 10th (HSC) or equivalent examination mark sheet& pass
certificate.

b) Self-attested photocopy of (10+2) Science (PCB&E) mark sheet & pass certificate
issued by CHSE, Odisha or equivalent thereof.

c) Self-attested photocopy of conduct /character certificate from the head of the

institution last attended.

d) Colour passport size photograph (5cmx7cm approximately) self attested on front side
should be affixed at the space provided in the application form.

e) Self-attested photocopy of the resident certificate (Must have been issued within 06
month prior to the date of 18th July 2017)/nativity certificate from the competent
authority (Refer Annexure-III).
f) In case of SC/ST candidates, self-attested photocopy of the caste certificate from the
competent authority (Refer Annexure -IV).

g) Self-attested photocopy of physically handicapped certificate from the competent

authority (For Loco motor disability of lower limbs between 40% to 50% physically
handicapped candidates.).

h) Self-attested photocopy of the certificate issued by the Rajya Sainik Board. ( In case
of candidates claiming seats reserved for Children of Ex-Serviceman & for children of
Serviceman from the competent authority of defence category only, Refer Annexure
V)

i) Self attested photocopy of Green Card (with all pages) issued by the Chief District
Medical Officer. ( Candidates claiming seats reserved under Green Card quota)
The name and Date of birth in green card should match with the name and Date of
birth mentioned in the HSE/equivalent certificate. Any difference regarding this
should be supported by an affidavit duly sworn in before the executive magistrate.

j) Original challan deposit slip of SBI Challan of Rs.-500/- towards application fees
(Refer Annexure –VIII).

6
  Candidates are required to send application along with required documents which should
reach the “Convenor, Basic B.Sc Nursing Selection Committee, Odisha, O/O the
Directorate of Nursing, Heads of Deptt. Building, Bhubaneswar, Khorda,
Odisha, Pin – 751001 on or before 18.07.2017 by 5 PM.

a. Applicant has to send application through Regd.Post/Speed Post. The envelope

containing the application shall be prominently superscribed “Application for
Admission into Basic B. Sc. Nursing 2017 – 2018”.
b. Applications received after due date & time shall be summarily rejected.
C. Incomplete applications /application without requisite documents shall be
summarily rejected.
d. No candidate is allowed to submit more than one application.
e. The cost of application fee is non-refundable.
VI. MERIT LIST
 The merit list will be prepared on the basis of career marks.

 For career marks, 50% of the aggregate marks secured in HSC/10th & 50% of the
aggregate marks secured in Physics, Chemistry, Biology in 10+2 /12th examination will be
taken together.

 For example: (if in 10th examination 60% mark secured and in 10 +2 (Physics+
Chemistry+ Biology = 50% of mark is secured then career marks will be 30 + 25 =55
marks )
 In case of candidates having equal marks in aggregate “on the above career marking”,
inter-se-merit shall be decided as follows.
1st. -- According to the total marks secured in Biology at the qualifying
examination.
2nd. --- In case of a further tie, according to the total marks secured in
English at the qualifying examination.
3rd. --- In case of a further tie, candidate senior according to the date of birth
will be considered.
 Eligible candidates as per their merit will be directed to appear before the Selection
Committee on the schedule date, time and venue for counseling and admission.
The merit list will be prepared Male/Female separately for the following category.
SC
o ST
o Physical Handicapped
o Green card holder.
o Ex-Serviceman
o Unreserved

VII. COUNSELLING OVERVIEW

 The Date, Time & Venue of the counseling will be notified in the official website of the

7
 Directorate of Nursing (www.nursingodisha.nic.in ).

 Intimation letter will be also sent to the candidate in his/her address.

 In case the candidate fails to receive the intimation by post/ download from the website,
he/she may collect a copy from the Convenor ( Dy. Director Nursing) in any working day
between 10 A.M- 5 P.M during the pre-counselling period.

 Candidates are required to attend counseling on the scheduled date and time. No
representative in his/her favour for the purpose shall be entertained.

 Counseling and admission against reserved category will be done at beginning.

 If a Candidate fails to attend counseling on the scheduled date will not be allowed for
admission during the session 2017-18.

 Once the candidate has opted for a seat in any institution, he/she will not be allowed to
change the option.

Documents to be produced by the candidate at the time of counseling and

admission.

 All the documents in original mentioned in page no: 6 would be verified during the counselling
with regard to the facts and figures furnished in the application in support of her / his
candidature. Claims for admission would be rejected if the original certificates and documents
are not submitted by the candidate at the counselling spot. Undertaking for extension of time to
submit the original certificate / certificates and document / documents will not be entertained
under any circumstances.

N.B: Candidates are required to submit CLC/TC /Migration Certificate and Medical
Fitness Certificate during the time of counseling. In case of non availability of these
aforesaid documents i.e CLC/TC /Migration Certificate the candidate shall submit an
undertaking that he/she will submit the same at the concerned institution during the
time of reporting.

 Undertaking as per Annexure – VI of this Prospectus, signed by the

parent/husband/guardian/ local guardian of the candidate shall be submitted.

 Applications for change of training institution during the training period are not
permissible at any circumstance.

NOTE. 1 Claims for admission shall be rejected if the original certificates/documents are
not submitted by the candidate at the counseling spot. No undertaking in this
regard will be accepted.

VIII. SELECTION PROCEDURE AND RESERVATION POLICY

(Common to all colleges of Nursing):

8
 a) 22.5% for ST
b) 16.25% for SC
c) 3% each for PH
d) 5 % GC
e) 3% for Children of Service men & Ex-Service Men
f) 10% reservation for male candidate out of the total seats as per the reservation
policy.

N.B: Seat inter-convertibility:

 In case the seats reserved for SC category will not be filled up because of non
availability of candidates belonging to the particular category the vacant seats will
be filled up by the candidates belonging to Scheduled Tribe category and vice
versa.
 In case candidates do not qualify from the SC/ST category, vacant seats will be
filled by the candidates from the general category.
 Similarly, in case the seat remains vacant against any reserved quota then these
seats shall be filled by the candidates from the general category.

NOTE. I All reserved category candidates who qualify in the common merit list can attend the
counselling for unreserved category seats and exercise her/his option. Her/his
candidature will be considered as per the position in the common merit list.

IX.FEE STRUCTURE
The following fees are to be deposited at the time of admission into 1st Year/2nd Year/3rd year
/4th year Basic B. Sc. Nursing Course.

Fee for Admission into 4 years Basic B.sc Course at Government

College of Nursing, Berhampur:

9
Sl No. Name of the Admission fees 1ST Year 2nd Year 3rd Year 4th Year
Institution
1 Govt. College 01 Admission/Tuition fee Rs.14000-00 Rs.14000-00 Rs.14000-00 Rs.14000-00
of Nursing,
02 Caution Rs.1000-00 ---- ----- -----
Berhampur
Money(Refundable)

03 University Athletic Rs. 60-00 Rs. 60-00 Rs.60-00 Rs.60-00

fee

04 University cultural Rs.40-00 Rs.40-00 Rs.40-00 Rs.40-00

fee

05 Youth Red cross fee Rs.10-00 Rs.10-00 Rs.10-00 Rs.10-00

06 University Rs.100-00 ---- ----- -----

Registration fee

07 University Rs.100-00 ---- ----- -----

Recognition fee

08 Student Aid fund Rs.1-00 ---- ----- -----

(SAF)

09 Hostel fee(Electricity Rs.3000-00 Rs.3000-00 Rs.3000-00 Rs.3000-00

charges)

10 Water charges Rs.180-00 Rs.180-00 Rs.180-00 Rs.180-00

TOTAL Rs.18,491-00 Rs.17,290-00 Rs.17,290-00 Rs.17,290-00

 A candidate selected for admission shall have to deposit the fee for the 1 st year at the time of
admission at College of Nursing, Berhampur in shape of bank challan drawn in favour of “The
Principal, College of Nursing, Berhampur” payable at SBI (Bank code-2064)., Medical College
Campus, Berhampur, Ganjam, Odisha.
Course Fees for 85% Govt. quota Seats under Private Institutions

10
 Fees 1st Year 2nd Year 3rd year 4th year
Tuition Fee/Admission Rs.42,000/- Rs.42,000/- Rs42,000/- Rs.42,000/-
Fees
TOTAL Rs.42,000/- Rs.42,000/- Rs.42,000/- Rs.42,000/-

Besides the above, the hostel fees, electric charges, University registration & examination fees &
other college/institution dues etc shall be paid extra by the candidate.

X. POST ADMISSION.

a. STIPEND AND SCHOLARSHIP

 Candidates admitted in Govt. College of Nursing. Berhampur will be paid stipend

@Rs1500/- P.M during internship.

 SC / ST candidates for admission into B.Sc. Nursing Course in private recognized

institutions in the State will get Scholarship by NHM, Government of Odisha under
Public-Private Partnership (PPP) scheme titled “Swasthya Sebika Nijukti Yojana” ,Subject
to approval of competent authority /funding agency as under:-

- Partial Scholarship as tution fees to SC/ST candidates in non-KBK districts for

B.Sc. Nursing. Per candidate @ Rs.15, 000/- per annum.

- Full Scholarship as tuition fees to SC/ST candidates in KBK + districts for B.Sc
Nursing. Per candidate @ Rs.50,000/- per annum.

- Sponsored SC / ST candidates have to execute a bond with Government which will

be provided during admission subject to provision of funds by the appropriate
authority.

b. HOSTEL ACCOMMODATION:

 Hostel accommodation shall be provided to the candidates at Govt. College of nursing by

the Principal as per merit and subject to availability.

 There is no provision of hostel for male candidates in Govt. College of Nursing and they
are required to stay outside in their own arrangement. If there will be accommodation for
male students, they have to pay usual hostel fees.

 Hostel provision for male candidates of Private Nursing Colleges is optional.

 In exceptional circumstances, outside hostel accommodation for married women

candidates will be considered by the Director of Nursing, Odisha keeping in view the
genuineness of the case.

b. UNIFORM :
11
 Female candidates have to wear bottle green Saree / Salwar and Punjabi during field duty,
and white colour Saree, Blouse / Salwar and Punjabi with white Coat during clinical duty.
Male candidates have to wear bottle green trouser and shirt during field duty and white
colour trouser and shirt with white coat during clinical duty.
c. DISCIPLINE:

 Candidates got admitted should abide by the Rules and Regulations of the College, Hostel
& concerned University/examining body.
 Those found disobeying the Rules and Regulations shall be debarred from the Hostel and
College without any notice.

AS PER DIRECTION OF HONOURABLE SUPREME COURT OF INDIA PASSED IN

SLP (C) No.24295/2004, SLP No.14356/2005, WPC No.173/2006 AND SLP (C)
No.24296 – 24299/2004.
IF ANY INCIDENT OF RAGGING COMES TO THE NOTICE OF THE AUTHORITY, THE
CONCERNED CANDIDATE SHALL BE GIVEN LIBERTY TO EXPLAIN AND IF HER / HIS
EXPLANATION IS NOT FOUND SATISFACTORY, THE AUTHORITY WOULD EXPEL
HER / HIM FROM THE INSTITUTION.
o Ragging in all forms in the Nursing Institution is strictly prohibited; The Institution has to
take immediate appropriate action in this matter.

Affidavit (1) by the candidate (2) by the parent shall be taken as per the circular
No.22-1 O (Web)-INC (Part) dated 14th May 2013.
o In case any dispute in respect of the stipulation in this prospectus and admission of
students, the interpretation and decision of the admission committee shall be final
and bounding.
o In case of legal disputes the counter/P.W(c) will be filled by the convener on behalf
of selection committee/Govt.
IMPORTANT INFORMATION FOR ALL INSTITUTIONS

 All the admission process is to be completed on or before 31/10/2017. The time line
cannot be changed without permission of INC/GOVT .All the institution have to submit
the admitted student list within one month from the last date of admission and only
those students will be considered as genuine student as per resolution
F. no.1—5/2014—INC on dated 29/10/2014.

12
 ANNEXURE- I
APPLICATION FORM FOR BASIC B. Sc. NURSING COURSE 2017 - 2018

Note: To be filled in by the candidate.

(1) FULL NAME OF THE CANDIDATE AS RECORDED Affix a
IN THE H.S.C.E OR EQUIVALENT EXAMINATION. passport size
photograph
(In block attested by a
letter) ……………………………………………………………………………
Gazetted
officer on the
(2) Sex :……………………… front side.

(3) CATEGORY CLAIMED – GENERAL / S.C./ S.T./ P.H./ Green Card Holder /
Ex – Servicemen or Servicemen (Put Tick  mark whichever is applicable & mentioned the
category).

(4) Date of Birth ……………………………………………………..

(As recorded in H.S.C. or equivalent examination)

(5) Age as on 31.12.2017 of the year of Admission …………………………………………

(6) Nationality ……………… (7) Married / Unmarried …………….. (8) Religion ………….

(9) Educational Qualification …………………………………………

(10) Permanent home Address:-

Village / Town ……………………………………………………………..
P.O - . ………………..………….Police Station …………………………
Tahasil - ……………………………………………………………..……….
Dist. - …………………………State: ………….. Pin ……………………
(11) Present Address
…………………………………………………………………….……………………………….
(For correspondence) ……………………………………………………………………
……………………………………………………………………..
Personal Contact no ……………………………Email Id………………………………………
(12) Full Name of Father / Husband / Guardian (if father is dead)
………………………………………………………………………
Occupation ………………………………………………………………………….
Address …………………………………………………………………………..…
………………………………………………………………………………
(13) SBI Journal No. -----------------------------

(14) Academic Details:

Name of the Examination (+2) Science or its equivalent…………………………
Name of the University / Council / Board …………………………………………

13
(15)
Sl No. Name of the Name of the Marks Percentage 50% of the
Examination Board/University/council/equivalent Without of Marks mark
thereof Ext. without secured
Opt. Ext. Opt.
1. HSC or
equivalent

(16) Marks secured in (10 + 2) Science Examination

SUBJECT TOTAL MARK PERCENTAGE 50% OF THE
MARKS
SECURED
PHYSICS
CHEMISTRY
BIOLOGY
GRAND TOTAL
Marks in English Secured mark

(17) Documents and Certificates enclosed

(Put Tick  mark)

(i) Self Attested copy of H.S.C. or equivalent examination pass Certificate Yes / No
issued by Board of Secondary Education or equivalent Board as proof
of age.
(ii) Self Attested true copy of the 10th Pass certificate &mark sheet. Yes / No

(iii) Self Attested true copy of mark sheet &pass certificate of qualifying Yes / No
examination (10+2) issued by the C.H.S.E. / Board /
University/Equivalent thereof.
(iv) Self Attested copy of the conduct / character certificate issued by the Yes / No
Head of the Institution last studied.
(v) Self Attested copy of certificate in support of category claimed Yes / No
(S.C./S.T. /P.H./Ex-Servicemen or Servicemen/Green Card Holder)
(vi) Self Attested copy of Residential (Must have been issued within 06 Yes / No
month prior to the date of 18th July 2017)// Nativity for candidate
who claims as permanent resident of Odisha.
(vii) One attested copy of recent passport size photographs affixed in the Yes / No
space provided in the application form
(ix) Original Department’s slip portion of SBI Challan of Rs.500/- Yes / No

14
I declare that the above statement of particulars furnished by me are true in all respect and as such, I
undertake that if subsequently, I will be found to have given wrong information with regard to the marks,
certificates and documents produced by me in connection with my admission, then my name will be
immediately removed from the College in addition to whatever legal action that be taken against me, I
agree to abide by the rules of the College / Hostel and pay all fees and deposit all other dues as laid down in
the College.
I certify that I have not been prosecuted or convicted for any criminal offence involving moral
turpitude.

Date Full Signature of the Applicant

Countersigned by Parents / Guardian / Husband

Name ………………………………….
Date…………………………

15
 ANNEXURE- II

All the Nursing institutions (Govt. & Private) having INC recognisation as on date 31.08.2017 will be
allowed to participate in the counselling for the academic session 2017-18.

For more information check on INC website link:

www.indiannursingcouncil.org/Recognized-Nursing-Institution.

16
 ANNEXURE – III

PERMANENT RESIDENT CERTIFICATE FOR BASIC B.Sc. NURSING COURSE 2017 - 18

Office of the ………………..…………….………………………………………………..

Miscellaneous Certificate Case No.……………………………………………... of 2017

This is to certify that Sri / Smt. / Miss / …..…………………………………………….…

Son / Daughter / Wife / of Sri …………………………………………………………

is a native of the district of ………………………………………………………………..

in the State of Odisha and he / she belongs to P.S. ………………………………………..

Tahasil ………………………………………………..

The certificate is being granted only for the purpose of Basic B.Sc. Nursing Course – 2017-18 Odisha.

Full Signature of the applicant Signature of Revenue Officer

Date –

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

NOTE :- 1. Revenue Officer means the Chief Officer in charge of Revenue Administrative in the
District, Sub-Division of Tahasil & includes Additional Magistrate and Additional Tahasildar.

17
 ANNEXURE – IV

SC/ST CERTIFICATE BY BIRTH FOR BASIC B.SC NURSING COURSE 2017- 18

This is to certify that Sri / Smt. / Miss ……………………………………………………………

Son/ Daughter / Wife of Sri ………………………………………………………………………
of Village / Town …………………………………………………………………………………
P.S. ………………………………………………. Tahasil ………………………………………
in the District of ……………………………………………………… in the State of Odisha
belongs to the ……………………………………. Caste / Tribe which is recognized as
Scheduled Caste / Tribe and under Constitution (Scheduled Caste) order 1950 / the Constitution
(Scheduled Tribe) order, 1950 as amended by the Scheduled Castes and Scheduled Tribes
(Amendment) orders Act 1976.

The place of birth of Sri / Smt. / Miss ……………………………………………………….. is of

Village / Town ……………………………………………………… P.S.
………………………………………Tahasil ………………………………………………. in
the District of ……………………………………. of the State of Odisha.

Full Signature of the applicant Signature of Revenue Officer

Date –

Round seal of Office Designation (with seal of officer)

18
 ANNEXURE – V
CERTIFICATE OF EX-SERVICEMAN / SERVICEMAN FOR BASIC B.SC NURSING
COURSE 2017- 18

1. Name of the ex-Serviceman / Serviceman :

2. Permanent address as per service records :

3. Rank in Defense Service :

4. Last place of posting (in case of Ex-Servicemen) :

5. Present place of posting (in case of serving personnel) :

6. Full name of the candidate :

7. Relationship of the ex-Serviceman / Serviceman with the :

candidate

Full Signature of Station Commander / Officer

Commanding /
Officer-in-Charge / Secretary,
Zilla / RajyaSainik Board

Full signature of candidate’s Parent

Designation with Seal of Office

Date -

19
 ANNEXURE – VI

UNDERTAKING FORM

SELF DECLARATION BY PARENT /GUARDIAN

(To be submitted by the selected candidates at the time of admission)

I Sri /Smt. ……………………………………………………………………. Name of the Local
Guardian (Address of the Local Guardian) ……………………………………………….
……………………………………………………………………………………………………
…. Undertake to act as the Local Guardian of Miss / Smt./Sri …………………………………
Daughter / Wife / Son/Ward of Sri / Smt. …………………………………………………….
………………………………………… During her / his period of study in the College of
Nursing, …………………………………………………...
……………………………………….
I also undertake to act on behalf of the parents / husband of the said candidate during the
period of study in the College of Nursing, ………………………………………... for which I
have been empowered by the parent / guardian / husband of the said candidate.

I further undertake to take custody of the above candidate if and when required by the
College authorities and to ensure that she / he maintains the academic discipline and good
conduct during the period of study in the aforesaid institution.

Place - …………………………….. Signature in full of the Local Guardian

Date - ………………………………

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/Son/ Ward, Miss/ Smt./ Sri…………………………………………….. during
the period of her/his candidateship in the College of Nursing ……………………….. ..
…………………………………………………………

Place - ……………………………. Signature in full of the

Parent / Guardian / Husband
Date - ………………………………

Signature in full of the Candidate

20
 ANNEXURE-VII
MEDICAL FITNESS CERTIFICATE
CERTIFICATE OF PHYSICAL FITNESS IN RESPECT OF SELECTED
CANDIDATES FOR ADMISSION INTO BASIC B.SC NURSING COURSE FOR
THE SESSION 2017-18
Name of the Candidate in full ………………………………………………………………… Age
………………… , Sex – Female , Height …………………. , Weight …………………. ,
Heart …………………. , Eye ………………… , Teeth …………..……, Liver ………..…… , Lungs
………………… , Spleen …………………….. ,Blood Pressure …………..………… ,
Any Loco motor disorder ………………, Neurological disorder…………………………,
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
has any diseases, constitutional weakness or bodily infirmity and I consider that the
candidate is physically and mentally fit to undergo BASIC B.SC NURSING Nursing
course.

SIGNAURE OF THE CANDIDATE Designation –

Date -
NOTE: - 1. This certificate is to be detached for submission only by the selected
candidates on the date of counselling.
2. This certificate must be obtained from the Govt. medical officer not prior to
15 days of the counselling date.
 ANNEXURE –VIII

SBI CHALLAN

BANK’S SLIP CANDIDATE’S SLIP DEPARTMENT’S SLIP

STATE BANK OF INDIA STATE BANK OF INDIA STATE BANK OF INDIA
(POWER JYOTI ACCOUNT) ( POWER JYOTI ACCOUNT) (POWER JYOTI ACCOUNT)
CHAIRMAN, BASIC B.Sc. Nsg. SELEC. CHAIRMAN, BASIC B.Sc. Nsg. SELEC. CHAIRMAN, BASIC B.Sc. Nsg. SELEC.
COMM. & DIRECTOR NURSING,ODISHA COMM. & DIRECTOR NURSING,ODISHA COMM. &DIRECTOR NURSING,ODISHA
ACCOUNT No. 30760841412 ACCOUNT No. 30760841412 ACCOUNT No. 30760841412
Name of candidate:- Name of candidate:- Name of candidate:-

Branch Name Branch Name Branch Name

Branch Code Branch Code Branch Code
Amount Rs. Amount Rs. Amount Rs.
In words ………………………..………Rupees only In words……………………………..Rupees only In words……………………………..Rupees
Journal No. .................................................. Journal No. .................................................. only
(To be filled by Bank) (To be filled by Bank) Journal No. ..................................................
(To be filled by Bank)

Sign. Sign Sign. Sign.

Candidate Bank Off. Candidate Bank Off. Sign. Sign.
Candidate Bank Off.

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

22