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
Regula
r
Enhanc
ement
2. GNM
Regula
r
Enhanc
ement
3.Basic
B.Sc N
Regula
r
Enhanc
ement
4. P B B.Sc
N
Regula
r
Enhanc
ement
5. M.Sc N
Regular
Enhanc
ement
6.(a-j)
P.B.
Diploma
Program(s)
Regular
Enhanc
ement
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
If Yes, No. of Seats Sanctioned
Year started
G.O
INC TNC University Board
(Y) / (N)
1.
A. N. M.
2.
G.N.M.
3.
B.Sc. (N)
4.
M.Sc. (N)
5.
P. B.Sc. (N)
.2
..2..
S.NO.
NURSING PROGRAMME
Yes / No
(Y) / (N)
If Yes, No. of Seats Sanctioned
:
:
:
:
Yes / No / In Process (Annexure)
Yes / No / In Process (Annexure)
____________________________
Proposed / Obtained
:
:
Yes / No / In Process / Not Applicable
..
a) Land available
Yes / No / If Yes _____ acres
b) Physical Infrastructure
1. Own
(Proof to be attached;
if leased, Registered Lease deed with
Minimum 5 years to be enclosed)
c) Total built up area (College & Hostel)
d) No. of Class Rooms
Annexure________________
e) No. of Labs
: ________________________________________
f) Library Facilities
: Available / Not Available
g) Auditorium
: Available / Not Available
h) Office Facilities
: Available / Not Available
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
9. Indian Nursing Council
:
10. a) Name of the Board to be affiliated
b) Proposed/ Obtained, Please tick the
Appropriate Boxes
11. a) Name of the University to be affiliated
b) Proposed/ Obtained
12. Physical Facilities
Year started
6.
2.Leased
:
_________sq.ft.
: _________________________________________
13. Clinical Facilities
1. Name of the own Hospital
: ________________________________________
No. of Beds
: ____________________________
Proof of the Own Hospital
: Annexure ________________________________
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
15. Proposed Budget allocated to Nursing programme
(Last year audited expenditure of nursing
Institute/ trust to be enclosed)
Name of
The Inst. /
University
Year of
Passing
R.N.
&
R.M. No.
Teaching
Exp.
: _____________________________________________
: Annexure ___________________________________
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 www.tamilnadunursingcouncil.com
17. Date of submission of Application Form
: ______________________________________
18. Whether following documents attached
: .
Check List
1.
2.
3.
4.
5.
6.
7.
Trust Deed/Registration Certificate of the Society
Government Order for each program
INC Order
Own/Leased Building Blue Print attested by Civil Engineer/State Authority
Proof of Own & Affiliated Hospital
List of Faculty
Last year audited expenditure
Date of
Joining
8. Demand Draft
-4-
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
______________________________________
