Cost of Application: Rs

Cost of Application: Rs

Cost of Application: Rs. 1,000/

TAMILNADU NURSES AND MIDWIVES COUNCIL

(CONSTITUTED UNDER TAMILNADU NURSES AND MIDWIVES ACT III OF 1926)

JAYAPRAKASH NARAYANAN MALIGAI

Old No: 140, New No: 56, Santhome High Road, Chennai – 600 004

APPLICATION FOR PROPOSAL TO START NEW/ENHANCMENT OF NURSING PROGRAMME

FOR THE ACADEMIC YEAR______

(Use Separate application for each course)

Is the institution is willing to submit itself for the inspection under Rule No: 37 of Tamil Nadu Nurses

& Midwives Act : Yes / No

Date: ……………………

Type of Programme applying for: Please Tick the Appropriate Boxes

1. ANM / 2. GNM / 3.Basic B.Sc N / 4. P B B.Sc N / 5. M.Sc N / 6.(a-j)
P.B. Diploma Program(s)
Regular / Enhancement / Regular / Enhancement / Regular / Enhancement / Regular / Enhancement / Regular / Enhancement / Regular / Enhancement

1. Name of the Society/Trust/Mission etc.: ______

(Trust Deed/Registration certificate attested by the notary to be attached) Annexure…………………….

2. Name of the Chairperson/Secretary: ______

3. Name of the Institution: ______

5. Address of the Nursing Institution: ______

(In Capital Letter and not the trust address): ______

District: ______Pin______

Telephone Nos.: ______(Fax)______

E-Mail: ______

6. Whether the Institution is: 1. Government

2. Private University

3. Mission

4. Private Institution

7. Details of existing Nursing Programme

S.NO. / NURSING PROGRAMME / Yes / No
(Y) / (N) / If Yes, No. of Seats Sanctioned / Year started
G.O / INC / TNC / University / Board
1. / A. N. M.
2. / G.N.M.
3. / B.Sc. (N)
4. / M.Sc. (N)
5. / P. B.Sc. (N)

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S.NO. / NURSING PROGRAMME / Yes / No
(Y) / (N) / If Yes, No. of Seats Sanctioned / Year started
6. / Post Basic Diploma Programme(s)
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
7 / Others

Present Course is permitted by:-

8. Government of Tamil Nadu: Yes / No / In Process (Annexure)

9. Indian Nursing Council ::Yes / No / In Process (Annexure)

10. a) Name of the Board to be affiliated:______

b) Proposed/ Obtained, Please tick the :Proposed / Obtained

Appropriate Boxes

11. a) Name of the University to be affiliated: Yes / No / In Process / Not Applicable

b) Proposed/ Obtained: …………………………………………………..

12. Physical Facilities

a) Land available:Yes / No / If Yes _____ acres

b) Physical Infrastructure: 1. Own 2.Leased

(Proof to be attached;:Annexure______

if leased, Registered Lease deed with

Minimum 5 years to be enclosed)

c) Total built up area (College & Hostel):______sq.ft.

d) No. of Class Rooms: ______

e) No. of Labs: ______

f) Library Facilities: Available / Not Available

g) Auditorium: Available / Not Available

h) Office Facilities: Available / Not Available

13. Clinical Facilities

1. Name of the own Hospital: ______

  • No. of Beds: ______
  • Proof of the Own Hospital: Annexure ______

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…3…

2. Name of the Affiliated Hospital, if any:

(Minimum 50 bedded Hospital)

Sl.No. / Name of the Affiliated Hospital / No. of Beds

: Annexure______

14. Teaching Faculty (Enclose details)

S.
No. / Name of
Teaching
Faculty / Designation / Qualification / Name of
The Inst. / University / Year of
Passing / R.N.
R.M. No. / Teaching
Exp. / Date of
Joining

15. Proposed Budget allocated to Nursing programme: ______

(Last year audited expenditure of nursing : Annexure ______

Institute/ trust to be enclosed)

16. Primary Inspection Fees/ (Details of Demand Draft)

S.No. / Course/Programme / Amount / D. D. Number / D. D. date

Note:

 Cheque will not be accepted. D. D. should be in favor of Registrar, Tamilnadu Nurses and Midwives Council, Chennai

 Separate D.D to be submitted for each Nursing programme.

 Application process - cost of Rs.1,000/-(Rupees One Thousand Only)to be submitted as Demand Draft

at the time of submission

For more details refer official website

17. Date of submission of Application Form : ______

18. Whether following documents attached : ………………………………………………….

Check List

  1. Trust Deed/Registration Certificate of the Society
  2. Government Order for each program
  3. INC Order
  4. Own/Leased Building Blue Print attested by Civil Engineer/State Authority
  5. Proof of Own & Affiliated Hospital
  6. List of Faculty
  7. Last year audited expenditure
  8. Demand Draft

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DECLARATION BY THE APPLICANT

I...... ………………………..S/o, D/o or W/o……………………,…………………………of the trust / Society declare that all the documents & information submitted in this application form are true and best of my knowledge. I understand that if any of the information is found wrong, my application will stand cancelled. I will abide by the rules & regulations in force in Tamil Nadu Nursing Council and as amended from time to time.

Name of the Applicant:______

Signature of the Applicant:______

Date:______

Place:______

Seal of the Institution:______

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