PROSPECTUS

FOR

ADMISSION INTO

BASIC B.SC NURSING COURSE

IN ALL INC/ONMC RECOGNISED

GOVT.
&
PVT. NURSING COLLEGES OF ODISHA
FOR THE ACADEMIC SESSION 2018–19
Approved By

Govt. in Health & Family Welfare Department

No.ME-II-M-65/2018 17729/H., Dtd. 04/07/2018

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

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Application form and Prospectus for admission into 4 years Basic B.Sc Nursing course
for the academic session 2018-19 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 07.07.2018 to 22.07.2018. Candidates seeking admission for the course at
Govt. & Private Colleges of Nursing (recognized by the Indian Nursing
Council/ONMC) in the state of Odisha may apply in the prescribed application form
within the stipulated time.

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

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 INDEX
SL.NO CONTENT PAGE NO

I Admission Calendar 4
II General information 4
III Selection Committee Members 4-5
IV Eligibility criteria 5
V Procedure for filling up and submission of 5-7
application form
VI Merit list 7
VII Counseling overview 8
VIII Selection Procedure and reservation Policy 9
IX Fee structure 10-11

X Post admission 11-13

Annexure I Application Form 14-16
Annexure II Proforma of Permanent resident certificate 17
Annexure III Proforma of SC/ST certificate 18
Annexure IV Proforma of Ex-service men/Service men Certificate 19
Annexure V Proforma of Marriage declaration form 20
Annexure VI Proforma of Undertaking form of Self Declaration by Parent/ 21
Guardian

Annexure VII Proforma of Medical Fitness Certificate 22

Annexure VIII SBI Challan Form for Application fee 23

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 1. TENTATIVE ADMISSION CALENDAR
Availability of application form & Prospectus in
official website (www.nursingodisha.nic.in).
1 Dt.07.07.2018 to 22.07.2018
2 Last date of receipt of off-line Application Dt. 06.08.2018 by 5 P.M
3 Complying of Wanting documents after due Dt.21.08.2018 to 24.08.2018 excluding
Scrutinisation Govt. holiday on date 22.08.2018
4 Date of declaration of merit list in the Official web-site 28.09.2018
of the Nursing (www.nursingodisha.nic.in)
5 Date of Counseling & deposit of course fees Dt. 22.10.2018 to 25.10.2018 excluding
Govt. holiday on date 24.10.2018
6 Date of reporting at the concerned institutions for Dt.29.10.2018
admission both counseling student and vacant seats of
85% Govt. quota seats + 15% Management students

7 Spot Counselling For Govt. Institutions Dt. 30.10.2018 / Dt. 31.10.2018

8 Date of Commencement of classes for 1st year Dt. 01.11.2018

II.GENERAL INFORMATION
➢ The duration of the course is 4 years which includes theory and practical as per
prescribed syllabus of Indian Nursing Council, Newdelhi.
➢ All seats in (Govt. college of Nursing & 85% Govt. quota seats of private
Colleges) will be filled up through counseling from the Central merit list
approved by the state selection committee.
➢ The private Institutions will fill-up the vacant seats of 85% Govt. quota seats at their
own level by following the eligibility criteria fixed by INC New Delhi.
➢ Private institutions will fill up 15% seats under management quota as per eligibility criteria of
INC New Delhi.
➢ The recognized institutions list (Govt.&Private) will be submitted by Registrar ONMC
by 30.06.2018 and they will be allowed to participate in the counselling for the academic
session 2018-19.
➢ 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
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 2. Addl. Director Nursing, Odisha :Member
3. Dean& Principal ,MKCG,MCH,Berhampur :Vice-chairman
4. Principal, College of Nursing, Berhampur :Member
5. Deputy Director of Nursing, Odisha :Convenor
6. Assistant Director of Nursing (Admin), Odisha :Member
7. Secretary, ON&MEB, Bhubaneswar :Member
8. Registrar , ONMC, Bhubaneswar :Member
9. Section Officer , Nursing , Odisha :Member Co-ordinator

IV.ELIGIBILITY CRITERIA

Candidate must:-
➢ Be of minimum 17 years of age as on 31.12.2018.

➢ 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). Candidate’s 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 up to ME standard. For Candidates to be admitted in (Govt. /85%
Govt. quota seats in INC/ONMC recognized private) institutions.
➢ Be either domicile/ permanent resident /native of Odisha but currently residing outside
Odisha ( candidate seeking admission in Govt. College of Nursing, and 85% of Govt.
quota seats in Private INC /ONMC 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. Candidates are advised to obtain their
handicapped certificate from the competent authority of the concerned district.
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
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 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.

• 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 Advertisement 07th July 2018)/nativity certificate
from the competent authority (Refer Annexure-II).
f) In case of SC/ST candidates, self-attested photocopy of the caste certificate from the
competent authority (Refer Annexure -III).
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 passing Odia as a subject at M.E / HSCE issued by Board of
secondary education or other equivalent board.
i) 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 defense category only, Refer
Annexure IV)

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 j) Marriage declaration in the prescribed form applicable for married candidates. (Annexure-
V)
k) 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.

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

• Candidates are required to send application along with required documents which should
reach this Address “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 06.08.2018 by 5 PM.

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

containing the application shall be prominently super scribed “Application for
Admission into Basic B. Sc. Nursing 2018 – 2019”.
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 (Schedule Caste)
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 o ST ( Schedule Tribe)
o Physical Handicapped
o Green card holder (GCH)
o Ex-Serviceman
o Unreserved

VII. COUNSELLING OVERVIEW

• The Date, Time & Venue of the counseling will be notified in the official website of the
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 2018-19.
• Once the candidate has opted for a seat in any institution, he/she will not be allowed to
change the option.
• Spot Counseling for Govt. Institutions – The Spot Counseling will be done within the
stipulated period as per INC, if the seats in the Govt. institution will remain vacant. The
Convenor will prepare the waiting list for spot counseling and the counseling will be
completed by the last week of October.

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 certificates and 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 original CLC/TC /Migration
Certificate at the concerned institution during the time of reporting.
Claims for admission shall be rejected if the original certificates/documents
are not submitted by the candidate at the time of admission in the concerned
Institution. No undertaking in this regard will be accepted.

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 • 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.

Spot Counseling for Govt. Institutions -

The Principal of the respective Govt. Nursing Institution will report immediately
(through an E-Mail) about the vacant seats of any course to the Chairperson of the
state Selection committee-Cum-Director of nursing, Odisha from the last date of
reporting of the students.
The Said vacant seat is to be filled up through spot counseling before cutoff date of
the admission process.

VIII. SELECTION PROCEDURE AND RESERVATION POLICY

(Common to all colleges of Nursing):

a) 22.5% for ST ( Scheduled Tribe)

b) 16.25% for SC ( Scheduled Caste)
c) 3% each for PH (Physical Handicapped)
d) 5 % GCH (Green card Holder)
e) 3% for Children of Service man & Ex-Service Man)
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.
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 Fees for Admission into 4 years Basic B.sc Course at Government
College of Nursing
Sl No. Name of Admission fees 1ST Year 2nd Year 3rd Year 4th Year
the
Institution
1 Govt. 01 Admission/Tuition Rs.14000-00 Rs.14000-00 Rs.14000-00 Rs.14000-00
College of fee
Nursing
02 Caution Rs.1000-00 ---- ----- -----

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 Rs.3000-00 Rs.3000-00 Rs.3000-00 Rs.3000-00

fee(Electricity

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 charges)(Not

applicable for Male

students)

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

Course Fees for 85% Govt. quota Seats under Private Institutions
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.

Deposition of Part-Course fees under 85% of Govt. quota seats in private Institutions

▪ The candidates those will be selected for admission into Basic B.sc Nursing Course
under 85% of Govt. quota seats in private nursing Institutions, they have to pay
Rs.20,000(Twenty thousand rupees only)to the concerned Institution as a Part course
fees during the time of counseling.
POST ADMISSION.
a. STIPEND AND SCHOLARSHIP
• Candidates admitted in Govt. College of Nursing. Will be paid stipend @Rs2500/- 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 tuition fees to SC/ST candidates in non-KBK districts for
B.Sc. Nursing. Per candidate @ Rs.15, 300/- 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. DISCONTINUANCE DURING STUDY PERIOD

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 • In case of discontinuance from study on any ground the stipend already
received, will be recovered in full as per the provisions of the
Agreement.
c. HOSTEL ACCOMMODATION:
• Hostel accommodation shall be provided to the female 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. The hostel fees including electric
charges will be excluded out of the total fees for male candidates in Govt. Institution. In
case of availability of such accommodation facility in any Govt. institution, the
candidates have to pay the actual fees as mentioned in prospectus.
• 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.
• In case of pregnant women will be allowed to prosecute the nursing course, on the
following condition;
o She may avail six months maternity leave during study period for welfare of the child
but she can’t appear the examination in that year.
o After six months she will be eligible to appear the exam for prosecuting the same course
and the course completion will be extended by six months.
▪ UNIFORM :
Selected candidates after admission have to wear uniform:
o 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.
o 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.
▪ Vacation and Holidays regulated as per INC/University guidelines from time to
time.
The state selection committee members have decided calendar of events as
per INC file No. -1-12/2018, dated 18-04-2018, as follows;
Winter Vacation
B.sc Nursing – 20th December 2018 to 3rd January 2019
Summer Vacation
B.sc Nursing – 20th may 2019 to 19th June 2019
*Dussahara puja Vcation according to calendar in each year for all courses. (B.sc
nursing for 15 days).
*As regards examination schedule for the nursing course of Basic B.sc Nursing, the
concerned University will decide at their level.

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 *Preparatory leave for the examination –One week before the examination
schedule fixed by the university.
▪ DISCIPLINE:
Students remaining absent beyond 15 days in addition to the prescribed leave will not be
allowed to re-join, except in unavoidable circumstances;i.e
▪ Natural Calamities
▪ Any accidental case
▪ Tuberculosis
▪ Heart disease
▪ Renal disease
▪ AIDS
▪ Psychiatric disease
The principal of the respective institution will report about the students detail to the
Chairperson –Cum-Director of Nursing, Odisha in time.
Other Condition- In other exceptional cases, Chairperson –Cum-Director of Nursing, Odisha
will be empowered to decide.
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 binding.
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 31/10/2018. The time line
cannot be changed without permission of INC/GOVT .All the institution have to
submit the admitted students list within one month from the last date of admission
i.e Dt. 01.11.2018 to 30.11.2018 and only those students after due verification of
their testimonials by the Convenor, then they will be considered as genuine student
as per resolution F. no.1—5/2014—INC on dated 29/10/2014.
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 ANNEXURE- I

APPLICATION FORM FOR BASIC B. Sc. NURSING COURSE 2018 - 2019

Note: To be filled in by the candidate.

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

(2) Sex :………………………

(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 31.12.2018 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) ……………………………………………………………………

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 ……………………………………………………………………..

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 …………………………………………

(15)

Sl No. Name of the Name of the Marks Percentage 50% of the

Examination Board/University/council/equivalent Without of Marks marks
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

15
 (Put Tick  mark)

(i) Self Attested copy of H.S.C.(10th ) or equivalent examination(10th ) pass Certificate& Mark sheet Yes / No
issued by Board of Secondary Education or other equivalent Board as proof of age.

(ii) Self Attested true copy of mark sheet &pass certificate of qualifying examination (10+2) issued by Yes / No
the C.H.S.E. / Board / University/Equivalent thereof.

(iii) Self Attested copy of the conduct / character certificate issued by the Head of the Institution last Yes / No
studied.

(iv) Self Attested copy of certificate in support of category claimed (S.C./S.T. /Physically Yes / No
Handicapped/Ex-Servicemen or Servicemen/Green Card Holder)

(v) Self Attested copy of Residential (Must have been issued within 06 month prior to the Yes / No
date of Advertisement 07th July 2018)// Nativity for candidate who claims as permanent
resident of Odisha.

(vi) Self attested copy of Marriage declaration in prescribed form applicable for married candidates. Yes / No

(vii) Self Attested copy of passing odia as a subject at M.E / HSCE issued by Board of secondary Yes / No
education or other equivalent board

(viii) One attested copy of recent passport size photographs affixed in the space provided in the Yes / No
application form

(ix) Original Department’s slip portion of SBI Challan of Rs.500/- Yes / No

I declare that the above statement of particulars furnished by me are true in all respect and as such, I
undertake that if subsequently, I will be found to have given wrong information with regard to the marks,
certificates and documents produced by me in connection with my admission, then my name will be
immediately removed from the 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…………………………

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 ANNEXURE – II

PERMANENT RESIDENT CERTIFICATE FOR BASIC B.Sc.

NURSING COURSE 2018 - 19

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

Miscellaneous Certificate Case No.……………………………………………... of 2018

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 – 2018-19 Odisha.

Full Signature of the applicant Signature of Revenue Officer

Date –

Designation (with seal of officer)

Round seal of the Office

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.

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 ANNEXURE – III

SC/ST CERTIFICATE BY BIRTH FOR BASIC B.SC NURSING

COURSE 2018- 19
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 – IV

CERTIFICATE OF EX-SERVICEMAN / SERVICEMAN FOR

BASIC B.SC NURSING COURSE 2018- 19

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 – V

MARRIAGE DECLARATION FORM

1. I , Sri/Smt/Kumari ------------------------------------------------------ declare as under:-

i) That I am unmarried /a widower/a widow

Recent colour
ii) That I am married and have only one wife living
iii) That I am married and my husband has no other living wife, to the passport
best of knowledge. photograph of
iv) That I am married to a person who has already one wife or more the spouse duly
living. Application for grant of exemption is closed. attested

2. The details of my spouse are :

a) Name: Sri/Smt. ---------------------------------------------

b) Date of Birth of the Spouse is -----------------------/------------------------/----------

c) Date of Marriage is :-----------------------------/------------------------------

I solemnly affirm that the above declaration is correct and I understand that the event of the
declaration being found to be incorrect after my joining in Basic B.sc Nursing course for the
academic session 2018-19. I shall be liable to be rejected of my candidature.

Date: ----------------------------- ______________________________________

Signature (in full)

Name in CAPITAL Letters:________________________________________

Note:

• Please delete clauses which are not applicable.

• Applicable in case of clause ( i), (ii), (iii),and (iv) only.
• Please fill Sl No. 2 only if you are married.

20
 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

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

Signature in full of the Candidate

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 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 2018-19

Name of the Candidate in full ………………………………………………………………… Age

………………… , Sex – Male/Female(Put Tick mark(√) whichever is applicable , 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 with Seal

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.

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 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. CHAIRMAN, BASIC B.Sc. Nsg. SELEC. COMM. CHAIRMAN, BASIC B.Sc. Nsg. SELEC.
Nsg. SELEC. & DIRECTOR NURSING,ODISHA
COMM. &DIRECTOR NURSING,ODISHA
COMM. & DIRECTOR ACCOUNT No. 30760841412
NURSING,ODISHA ACCOUNT No. 30760841412
Name of candidate:-
ACCOUNT No. Name of candidate:-
30760841412

Name of candidate:- Branch Name

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

Journal No.
............................................... Sign. Sign.
... Candidate Bank Off. Sign. Sign.
Candidate Bank Off.
(To be filled by Bank)

Sign.
Sign
Candidate
Bank Off.

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

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