DIRECTORATE OF MEDICAL EDUCATION: ANDHRA PRADESH, HYDERABAD

APPLICATION FOR ADMISSION INTO PARAMEDICAL COURSES FOR THE ACADEMIC

YEAR 2003 –2004

Application No.   -----------------                                           Registration No.  ------------------             

SUMMARY

(TO BE FILLED IN BY THE CANDIDATE IN HIS / HER OWN HANDWRITING)

 Mark  tick in appropriate space.

1.   FULL NAME                                        : ............................................................                    
(in Block letters as in SSC / 10^th Pass Certificate)

2.   SEX                                                       :                              

3.   DATE OF BIRTH                                :                  

4.     Age as on  01-07-03           :

5.     reservation claimed     :    

6.     LOCAL / NON LOCAL              :

7.     PASSED S.S.C. /10^th Class EXAMINATION:

8.    IF SO                                    :  

9.    TOTAL MARKS IN SSC/10^th

       Class Marks                    

10.  No. of Enclosures               :

                                                                                                                                               Signature of the Candidate

_____________________________________________________________

FOR OFFICE USE ONLY

Remarks

Checked by                                                 

APPLICATION FOR ADMISSION INTO PARAMEDICAL COURSES FOR THE ACADEMIC

YEAR 2003 –2004.

APPLIED FOR THE COURSE OF ____________________________________

Application No. ..................................                                             Registration No. .....................................              

Total No. of enclosures (   )

Read the regulations carefully before filling the application

N.B.:

a. Filled application forms should reach the Principal, _______________College on or before 5.00 P.M. on 25.11.2003.

b. Application shall be filled in English by the candidate in his / her own handwriting.

c. Applications of the Candidates who furnish incorrect information or enclose false / incorrect certificate shall stand rejected automatically.

d. Candidates shall not be permitted to change their social status or local candidature etc., after submission of application form.

1.    Name in full                                  :

( in Block letters as in SSC or equivalent certificate)

2.    Sex                                               :

3.    a. Name of the father                  :

b. Name of the Guardian if          :

    father is not alive.

4.    Date of Birth as entered in SSC or:

Equivalent examination

 (Proof to be enclosed)

5.  Age as on 31^st December, 2003          :

6. Address for communication         :

7. Place of Birth                                :

8. Mother Tongue                             :

9. Native District                              :

10. Monthly or annual income of parent or Guardian.

A certificate of income from the Dept.,

where the parent or guardian is working

or from the Officer of the Revenue Dept.,

not below the rank of Mandal Revenue Officer

if the parent or guardian is not in service should

be submitted at the time of admission.

( the Guardians income is not acceptable if father is alive.)

11. Educational Qualifications                   :

a)    Particulars of qualifying examination:

1.     Name of the qualifying examination.

2.     Indicate the month and year of first

        appearance , H.T.No., Subjects,

      Class or division in Examination.______________________

Hall Ticket No.__________________________________

Division / Class _________________________________

Passed

           b) Particulars of study

Furnish the following details for the four / seven consecutive academic years ending with the month and year mentioned in the column (a) above. (Study, Bonafide certificate from the Heads of the Institutions / (Govt./ZPH / Private School) should be enclosed as proof).

Note:  In reckoning consecutive academic years of study, any period of interruption of study by reason of his / her failure to pass any examination other than the qualifying examination as entered in Column (a) shall be disregarded. In such cases information of the earlier academic years should also be furnished till information for four / seven academic years is furnished.

c)  If during the four / seven consecutive academic years mentioned in the column  (b) above, you did not study during the whole or any part of the four / seven consecutive academic years in any educational institution, furnish particulars of your residence as shown below for the four / seven years period immediately preceding the month and year mentioned in the column (a). A certificate from a Revenue Officer not below the rank of Mandal Revenue Officer, certifying your residence for the above period should be enclosed. (Candidates who have not studied in any school either Private or Govt. School).

   12. Furnish information on the following:

a. Whether the candidate belongs

to Scheduled Caste and if so, specify

the group, Caste and Sl.No. as in Regulations

and enclose certificate.

                                                   Caste__________________Sl.No._______

b.  Whether the candidate belongs

to Scheduled Tribe and if so, specify

the Tribe and Sl.No. as in Regulations

and enclose certificate.

                                                   Caste__________________Sl.No._______

c. Whether the candidate belongs

to Backward class and if so, specify

the community and the group and

Sl.No. as in Regulations

and enclose certificate.

                                                   Caste__________________Sl.No._______

d. Whether the candidate belongs

to Scheduled Caste or Scheduled Tribe

or Backward class, whether the

candidate enjoyed any educational

concession granted by the Government

and if so, furnish details,

if not, the reasons there for.

e. Zone to which the candidate is local

or the candidate is non-local only

13. Marks obtained in SSC or its equivalent examination:

14.                       Any other particulars the candidate desires to furnish.

15.                       DOCUMENTS TO BE SUBMITTED ALONG WITH THE  APPLICATION FORM.

Documents (attested copies) to be submitted along with application.

i.  Date of Birth certificate (SSC or its equivalent pass certificate).

ii. Memo of the marks and pass certificate of the qualifying examination. (SSC or its equivalent pass certificate).

iii. Certificate of study from 6^th class to SSC.

iv. If not studied from 6^th to SSC in an School, residence certificate issued by the MRO for that period.

v. Candidates who have not studied 6^th to SSC in A.P., 10 years residence certificates of the candidate / parent.

vi. Certified copy of Permanent Caste Certificate (if the applicant belongs to SC / ST / BC) or Certificate from the competent authority as proof of their claims for reservation.

Documents to be submitted at the time of admission.

a.     All the originals noted at Sl.No.from (i) to (vi) noted under clause above.

b.     Transfer Certificate from the Institutions where the candidate last studied.

DECLARATION

          I hereby solemnly and sincerely affirm that the statement made and the information furnished by me in the application form and also in all the enclosures there to submitted by me are true and correct. I have not kept any information secret. Should it however be found that any information furnished therein is fraudulent, incorrect or untrue in material particulars. I realize my selection or admission to the course is liable to be cancelled and I am liable to criminal prosecution. Further I also agree to forego my seat in the college unconditionally.

          I shall abide by the decision of the Selection Committee which shall be final and binding on me.

                                                                                                                      SIGNATURE OF THE APPLICANT

          I have fully read the information furnished by my son / daughter / ward and affirm that it is true and if it is proved that the information was fraudulent, I am liable to criminal prosecution.

ADDRESS:

                                                                                                                      SIGNATURE OF FATHER / GUARDIAN

                                                                                                                                                (If father is not alive)

Note: No application will be deemed complete unless this declaration is signed by the candidate and parent / guardian (if father is not alive).

ANNEXURE – 1

FORM OF CASTE CERTIFICATE

Serial No.

S.C.                                                              District Code:

S.T.                       Emblem                           Mandal Code:

B.C.                                                              Village Code:

Certificate No.

COMMUNITY, NATIVITY AND DATE OF BIRTH CERTIFICATE

1.      This is to certify that Sri / Smt / Kum __________________________ Son / daughter of Sri.______________________________of Village / Town _________________Mandal_____________________District____________of the State of Andhra Pradesh belongs to _____________________Community which is recognized as Scheduled Caste/ Scheduled tribe / Backward class under:

The Constitution (Scheduled Castes) order 1950.

The Constitution (Scheduled Tribes) order 1950.

G.O.Ms.No.1793, Education Dept., dt. 25.9.1970 as amended from the time to time (BC’s) S.C’s, ST’s list (Modification) order 1956, SC’s and ST’s (Amendment) Act, 1976.

2.      It is certified that Sri / Smt / Kum ______________________ is a native of _____________________Village / Town ______________Mandal____________________District of Andhra Pradesh.

3.      It is certified that the place of birth of Sri / Smt /Kum ____________________ is  Village / Town _______________Mandal ____________________District of Andhra Pradesh.

4.      It is certified that the date of birth of Sri/Smt/Kum____________________is Day_________Month _______Year (in words)______________________________as per the declaration given by his/her father/mother/guardian and as entered in the school records where he / she studied.

Signature                :

Date                       :

Name in Capital Letters:

(Seal)                                                  Designation              :

Explanatory Note: While mentioning the Community, the Competent Authority must mention sub-caste  (in case of Scheduled Caste) and Sub-Tribe or sub-group (in case of Scheduled Tribes) as listed out in the S.C’s and S.T’s (Amendment) Act, 1976.

Note: Certifying officer should follow the orders issued in the G.O.Ms.No.58, Social Welfare (J) Dept., dt.12.5.1997.

ANNEXURE-II

ADMISSION INTO PARAMEDICAL COURSES

(RESIDENCE CERTIFICATE TO BE SUBMITTED BY THOSE CANDIDATES WHO HAVE NOT STUDIED IN ANY EDUCATIONAL INSTITUTIONS  i.e., PRIVATE OR GOVERNMENT SCHOOL)

It is hereby certified:

a)    That _______________________________________Son / Daughter of  _____________________________________a candidate for admission into paramedical courses appeared for the first time for the _______________examination (being the minimum qualifying examination for admission into the paramedical courses mentioned above in ____________month____________year.

b)   That in the 4/7 years immediately preceding the commencement of the aforesaid examination he/she has resided in the following place / places falling within the local area in respect of University.

Namely_______________________________________________

          The above candidate is, therefore, a local candidate in relation to the local specified in paragraph 4 (1), 4 (2) of the Andhra Pradesh Educational Institutions (Regulation of Admissions) Order, 1974 as amended.

Office Seal                                                Officer of Revenue Department

                                                                 not below the rank of Mandal

                                                                 Revenue Officer independent

                                                                 charge of Mandal area.

  Notification

           Applications from the eligible candidates belonging to A.P State only are invited for admission into the following Paramedical courses, in Government Medical Colleges / Hospitals / the Director of MNJ Institute of Oncology & Regional Cancer Centre, Hyderabad noted here under for the academic year 2003-04 batch.

Educational Qualifications:

          Candidates should have passed SSC / 10^th Class qualification for all the Paramedical courses.

Age:

          The minimum age shall be 15 years as on 1-7-2003. The upper age limit is 35 years of age. The upper age limit for the candidates belonging to SC, ST and BC’s relaxable by 3 years.

Applications:

2.     Prescribed application form can be obtained from ­­20.11.2003 to 25.11.2003, from   the offices of the Principals of Government Medical Colleges for all courses except Diploma in Radio Therapy course which is available from the Director, MNJ Institute of Oncology and Regional Cancer Center, Red Hills, Hyderabad and Diploma in Hearing Language and Speech Therapy Course which is available from the Superintendent, Government E.N.T. Hospital, Koti, Hyderabad.

3.     The cost of application form is Rs. 100/- (One Hundred Only) for all courses. The mode of payment is through Demand Draft from any Nationalized bank drawn in favour of the concerned Principal, College Development Society except for

a.     Diploma in Radio Therapy course: Demand draft is to be drawn in favour of the Director, MNJ Institute of Oncology and Regional Cancer Centre, Red Hills, Hyderabad.

b.     Diploma in Hearing Language and Speech Therapy Course: Demand draft is to be drawn in favour of the Superintendent, Hospital Development Society, E.N.T. Hospital, Koti, Hyderabad.

4.     The candidates belonging to the Districts mentioned under column 2 below should send their applications to the Government Medical College / General Hospital under column 1.

5.      The filled in applications along with necessary certificates and Demand Draft of Rs.100/- (Rupees One Hundred Only) drawn in favour of The concerned Chairman, College Development Society, towards Registration Fee should reach the Principal / Superintendents of Govt. Medical College / Hospital concerned on or before 26.11.2003  by 5:00 P.M.

6.     The Tution fee prescribed per month / per student is Rs.1000/-.

Note:

1.     Selections will be made purely on merit, on the basis of aggregate marks obtained by the candidates in SSC / 10^th Class excluding the marks obtained in 2^nd language. In deciding merit, candidates who qualify under compartmental system will be placed after candidates who passed in a single attempt.

2.     Incomplete applications or applications submitted without attested copies of relevant documents will not be entertained.

3.     The SC / ST / BC candidates should furnish the prescribed community certificate signed by the competent authority not below the rank of M.R.O.

4.     85% of seats in local area are reserved in favour of local candidates in relation to the local area and the remaining seats are un-reserved as per A.P. Educational Institutions (Regulation of admission order 1974 as issued in G.O.P.No.646, Education (w) Dept., dt. 10.7.1979.

5.     Out of the seats available for admission 15% SC, 6% for ST and 25% for BC’s are reserved.

6.     Migration Certificates of the Students admitted from other than Andhra Pradesh State should be produced otherwise will be cancelled by the Selection Committee.

The duration of the Para Medical Courses are mentioned as follows: