Application No

Application for proposal to start RANM/B.Sc./P.C. B.Sc./M. Sc. /

specialty Nursing programme for
Academic Year 2010-11

1. Name and Address ________________________________

of the Trust Society ________________________________
________________________________
________________________________

2. Name and Address of Chairperson: ________________________________

________________________________
________________________________
________________________________
Telephone No. With STD Code _________________
E-mail ________________________________

3. Name and Address of the prop. Institute: ________________________________

________________________________
________________________________
________________________________

4. Proposal Submitted for: New institute New Course

(Tick Appropriate) Increase seats Closing of institute

Page 1 of 1
 INDEX

Sr. No. Contents Page No.

1 Section-I Information about Society /Trust and the Institute.

Section-II; Information about the proposal for the Academic

2
year 2010- -2011.

3 Section- III: Infrastructural facilities available.

Section-IV: Declaration to be given by the Chairperson and

4
Secretary of the Society/Trust

5 Any Proofs/Documents attached to the proposal

APPENDIX – A:-Instruction for submission of proposals:

6

APPENDIX-B: Terms and conditions for the proposals.

7

Note: Please don’t take print of this form and don’t fill it by hand.
Use the word file and type all information in the form on Trust
Letter head on the computer and then take a print.

Page 2 of 2
 SECTION -1
A. Information about Society/Trust and the Institute
1. Name and Address of the Society/ ------------------------------------------------------------
Trust Name ------------------------------------------------------------
------------------------------------------------------------

Address: ------------------------------------------------------------
------------------------------------------------------------
------------------------------------------------------------
Pin Code
Tel. No with STD Code
Fax No
E-mail address:

2. Registration No. & Date of the Society/Trust: -----------------------------------------------------

With Charity Commissioner
(Attach copy of Registration Certificate)

3. Name of the present chairperson and Secretary of the society / Trust along with tenure
Chairperson : __________________________________________________
Secretary : __________________________________________________
Duration of Tenure:-from ______________________to______________________
Name of Trustees and Addresses (enclosed trust deed)

Sr. No. Name of Trustee Address of Trustee

1
2
3
4
5
6
7

4. Name and Address of the proposed new or existing Institute

Name: -------------------------------------------------------------------
-------------------------------------------------------------------
Address: -------------------------------------------------------------------
-------------------------------------------------------------------
-------------------------------------------------------------------
Pin code ---------------------------------
Phone No with STD Code ---------------------------------
Fax No ---------------------------------
E-mail address ---------------------------------

Page 3 of 3
5. Whether the above institute is already sanctioned or permitted for any course by any body
Yes / No. ---------
If yes, then give below

(i)Approval letter no. & Date: _______________________________________________

(ii)Approval letter no. & Date: ________________________________________

6. Whether the Society/Trust runs any other educational Institutions/Courses? If yes, give the
information in following table.

Whether
Name of the Name & Entry Recognized Whether Aided by
Sr.
Institutions & Level of the by the Central / State or
No.
Addresses Courses Government or Whether unaided
Any other Body

7. Course(s) with intake capacity and other details in the following table in respect of the
existing (Government /council) Institute.

Diploma/
Title of Name of Degree/
Sr. Yearly/ Sanctioned Year of Entry Level
the Affiliating Certificate/ Duration
No. Semester Intake Approval Qualification
Course Body PD/ PGD/
AD

(i) Fee charged for existing courses

Sr.No. Name of the course Tuition Fee Other fee Total

Page 4 of 4
 SECTION-II
Information about the proposal for the academic year:
2010- 2011
Proposal is submitted for (Tick Mark whichever is applicable)

(i) Permission of New Institution

OR
(ii) Introduction, of new course/s and or variation in intake in the existing
Recognized Institute
OR

(iii) Closure of Institute.

Read before filling following table.

1) The courses recognized by MAHARASHTRA NURSING COUNCIL,

Mumbai are available on website. (www.maharashtranursingcouncil.org)
1. (i) Proposal for Recognition of New Institute

Level of the
course i.e.
Degree,
Diploma.
Entry Duration
Name of UG, Intake
Sr. Course Title level Of the NOC
Affiliating PG, Capacity
No (In full form) Qualificat Course From state
Body specialty
ion Govt.
Nursing
Diploma
Certificate
etc.

Total

a) Whether the syllabus is existing for the proposed courses in –_______________________

1) Maharashtra Nursing Council, Mumbai YES / NO

b) Whether NOC is given by the concerned

2) Indian Nursing Council, New Delhi – YES / NO

3) Maharashtra University of Health Sciences, Nashik. YES / NO

Page 5 of 5
(ii) Proposal for the Introduction New course in the existing Recognized Institute

Level of the
course i.e.
Degree,
Name
Course Diploma. Entry
Intake Full of NOC
Sr. Title (in UG, level
Capacity Yearly / Time Affiliat From Proposed
No Full PG, specialty Qualific
Semester ing state Fee
Form) Nursing ation
Body
Diploma
Certificate
etc.

(iii) Proposal for approval of seats intake of existing course/s or closure of institute.

Proposed variation in the approved

Name of Approved Intake
Title of Existing
Sr.No. Affiliating Intake of the
course/s Total
Body course Addition Deduction
Intake

(Note : For closing of institute, write zero intake in reduction column for all courses in
the institute.)

2. Give justification of the proposal in terms of Aim, Need, Employment potential

advantage of geographical location, etc.

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Page 6 of 6
3) Give reason for closure of Institute: -----------------------------------------------

------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------

4) Whether NOC is obtained from concerned authority to close

Institute/Course: (Yes/No)

Name of the authority:- -----------------------------------------------------------------

Letter No and Date: ----------------------------------------------------------------------

-----------------------------------------------------------------------------------------------

Page 7 of 7
 SECTION-III

Infrastructural facilities available for consideration of the

proposal.
1. Land (for exclusive use of the proposed / existing Institution)

(i) Location: (Metropolitan City/State Capital / District Head Quarter/Rural Area)

(Tick mark whichever is applicable)
(ii) Land: Whether owned by the applicant Society/Trust

YES NO

If yes, then Acres Hectors

2. Building (For exclusive use of the proposed /existing institution)

(i) Whether the accommodation is available or would be provided owned by the Society /
Trust or Rented? ------------------------------------

a) If owned

Existing building Area Sqm.

Name of the Institute & Programme
Area exclusively reserved for proposed Sqm.
programme

b) If rented

Building Area Sqm.

Lease Period in years (minimum 5 yrs.)
Registered Lease document YES / NO
Registration number and Date
NOC from concern authority to run the
proposed courses in premises

Note:- Minimum area of land sufficient to provide 7.0 sqm per candidate built up area of
building.
(ii) Total Built up area available exclusively for the proposed programme owned by the -------
---------- sqm.

(iii)Office area ----------------- sqm.

Page 8 of 8
3. Equipments.

(i) Equipments which are available for the

Conduct of the course/s Rs _____________lakhs
(List of the equipment should be attached)
(ii) Equipments, which shall be procured
before starting of the course/s Rs __________Lakhs
(List should be attached)
(iii)Total investment already made for Equipment till today Rs. ---------------------
(iv) Proposed investment for Equipment Rs. ---------------------------------------------

4. List of Furniture: (Attach Separate lists for the following items.)

Laboratory Class Room. Library etc.

5. Total Cost of Furniture: Rs.---------------------------------

6. Library: Built up area: ---------------------------------(in sqm)

1. No. Of books: -----------------------------------------------------------

2. No. Of volumes: ---------------------------------------------------------

3. No. Of Journals: a) Technical/Professional: ---------------------------

b) Non Technical --------------------------------------
4. Total investment on Books & Journals as on date

(a) Books: Rs.-----------------------------------------

(b) Journals: Rs.:---------------------------------------

Total Rs.-----------------------------------------

7. Staff:

(i) Staff available in existing institute

No. of Teaching Staff required as per norms & teaching staff available at present (Give
information in separate sheet showing faculty wise i.e. Principal, Tutor, Professor. Asstt.
Professor, Reader Lecturer etc. Also mention therein whether appointment is regular,
Adhoc. Visiting)
Total. Teaching load Theory ---------hrs, Practical/Workshop/Tutorials ------- hrs.

(ii) Staff (Teaching & 'non-teaching) proposed to be appointed for New Institute, New
course/s, Increase in Intake (Give in separate sheet)

Page 9 of 9
8. Students Amenities: Exclusive for the proposed course

(i)Whether drinking water arrangements are available: Yes/No

(ii) No. of water coolers: No:

(iii) Whether separate Toilet facilities for Boys & Girls are made: Yes/No

(iv) Whether common room facility, for Girls is available Yes/No

(v) Mess Facility: Yes/No

9. Financial position of the Society/Trust

(i) Fixed Deposit of the Society/Trust: Rs. -------------------------- Lacks

(Attach copy of the receipts)
(ii) Overall investment proposed to be invested for the Technical Institute
(Excluding Building)

Rs. -----------------Lacks. (Phase Manner)

(iii) Funds made available for the proposed course Rs._________lakhs

(iv) Last 3 years Audit report

Audited report for last 3 Financial Year:-F.Y 2008-09/F.Y 2007-08/F.Y 2006-07

10. Clinical Facilities – Area :
1) Name of the Hospital and Address : _____________________________
___________________________________________________________
___________________________________________________________
Name of the No. of Beds Average No. of Nursing School Distance from
Hospital sectioned occupancy affiliated College
per month

2) Name of the Affiliated Hospital : Type of experience

___________________________ _____________________________
___________________________ _____________________________

Page 10 of 10
 ___________________________ _____________________________
___________________________ _____________________________
___________________________ _____________________________

3) Classification of Beds :
Beds No. of Sanction Occupancy
Medical
Surgical /Orthopaedic
Gynec/Obstretic
Paediatric
ENT/Opththalmic
Psychiatric
I. C. C. U. /I. C. U.
Skin /infectious diseases
Emergency / Casuality
Any other specilization

3) Whether student/patient ratio is maintain by : _____________________________

institute
4) Facility for community health nursing : _____________________________
a) Name and address Urban community : _____________________________
distance from School/College of Nursing.
b) Name and Address Rural community : _____________________________
c) Distance from School / College of Nursing : _____________________________
f) Student accommodation adequate hygienic : _____________________________
and safe ?

Page 11 of 11
 SECTION-IV
Declaration to be given by the chairperson and Secretary of the
Society/Trust
We on behalf of ____________________________________________________________
Undertake to comply with Terms & Conditions of the proposal.

We attach herewith the following proofs/documents (Tick mark and give page numbers)

Sr.
Description Page No.
No.

(i) Registration certificate of the Society/Trust from the Charity Commissioner

(ii) List of the Equipment available for conducting the course/s

(iii) List of Equipment which shall be procured before starting of the course/s

(iv) List of faculty-wise teaching staff-appointed in existing Institute

(v) List of category-wise non-teaching staff appointed in the existing Institute.

List of teaching & non-teaching staff proposed to be appointed for proposed

(vi)
New course/s and proposed increase in intake of the course/s

(vii) Proofs of the Land owned by the Society/Trust'

Proofs of the building available with the Society/Trust for exclusive use of the
(viii)
Proposed new or existing institute.
(ix) Copy of fixed Deposit in trust account Receipts not less than 5 lakh

(x) NOC from concerned authority to run the proposed courses

Any other information or proof/document want to submit along with this
(xi)
proposal shall be noted below
1 Income Tax PAN Number of the Applicant/ Signatory

2 Audited Report for last 3 Financial Year :- 2006-07/2007-08/2008-09

Bank account passbook copy showing that the account is operative for the last
3 three years

4 Architect plan approved by competent authority & Earmarked space for

Institute & Hostel

We declare that no information has been concealed, false or misrepresented: If any

information is found to be incorrect, the proposal shall be liable to be rejected by the
Maharashtra Nursing Council. Mumbai.

Page 12 of 12
Proposed fee structure
(Including tuition and other fees)

Sr. Name of the

Tuition Fees Other Fees Total Fees
No. course

Name & Signature of the Name & Signature of the

Chairperson of the Society/Trust Secretary of the Society/Trust

Three Copies should be addressed to following authorities:-

1) The Registrar, Maharashtra Nursing Council, Mumbai

2) The Director, Directorate of Medical Education & Research, 4th Floor,
St’s Georges Hospital Campus, Mumbai 400 001.
3) The Secretary, Medical Education& Drugs Department, Mantralaya,
Mumbai 400 032.

Page 13 of 13
 APPENDIX - A
(Not to be attached to the proposal while submitting the proposal)

Instruction for submission of proposals:

1 Copy of the prescribed application form would be available on the website
http://www.maharashtranursingcouncil.org.in which can be downloaded through the
download section of the website. The Payment of Rs 15000/- as a scrutiny fees should be
paid through a Demand Draft drawn in favor of Registrar, Maharashtra Nursing Council,
payable at Mumbai

2. The Proposal should be submitted in the prescribed Application Form in original with
TWO additional Xerox copy addressed to the concerned authority acknowledging the receipt
of the same.

3. Application form and its enclosures preferably are submitted in bound form along with
index and page numbers.

4. In the event, the Information and statements given by the applicant in the prescribed form
are found incorrect / incomplete; the, application is liable to be rejected. Any future
correspondence / information on such proposals shall not be entertained.

5. Inquiries or correspondence regarding status of the proposal during its processing shall not
be entertained or replied.

6. Creditability of the proposal will be judged by requisite experience in running or managing

higher Educational or Technical institutions.
7. Proposal will be considered as per the Technical manpower demands of the State Govt.
and employment potential.

8. Syllabus and other contents of the courses are available on website

www.maharashtranursingcouncil.org
9. The proposals will be accepted in the office of the council from 2nd May
2009 to 25th July 2009 between 10.30 am to 3 pm only for Academic Year
2010-2011.

10. The fresh proposals to be submitted by the management for each

academic year, if last academic year proposal is declined by any of the
competent authority. I.e. State Govt./ MNC/ INC

Page 14 of 14
 APPENDIX-B
(Not to be attached with the proposal while submitting the proposal)
Terms and conditions for the proposals.
1. The proposal will be considered on no grant basis & claims for grant-in-aid for recurring or
non- recurring expenditure will not be permitted by the Government at any time, at any stage
and for any reasons.

2. As soon as the proposal is considered and sanction is accorded by the council the council
will conduct the inspection for feasibility certificate then the proposals will be submitted with
recommendation to the State Government for Essentiality certificate to The Secretary,
Medical Education & Drugs Department, Mantralaya, Mumbai.
3. After approval of the proposal by the state Govt. management will get letter from the state
govt. to remit the scrutiny fees.
4. The inspection will be conducted by the Director, Medical education & Research, Mumbai
for essentiality certificate.
5. The state Govt. will issue essentiality certificate to the management
6. The management has to submit the Essentiality certificate to The Secretary, Indian Nursing
Council, New Delhi Before 31st January or any stipulated extended period by them
7. The Management has to apply again along with scrutiny fees of Rs 15000.00 to the
Maharashtra Nursing council for Permission to admit batch for Academic Year 2010-2011

8. Rules and regulation for admission to the course/s shall be observed as announced every
academic year by Maharashtra Nursing Council for Diploma Programme or MUHS, Nashik
for Degree & PG Programme.

9. Capitation fee or any other donation either in cash or in any kind will not be taken from the
students or his/her parents by the Society for admission.

10. Sufficient accommodation shall be available with the society for running the institution
and its course/s smoothly.

11. The proposal shall be in consonance with the policies, perspective plan & development
plan of the State Govt. /Maharashtra Nursing Council, Mumbai.

12. The financial position of the applicant must be sound for investment in providing related
Infrastructural and instructional facilities (institutional building, equipments, library,
computers, Hostel facilities, student’s amenities etc.) as per the requirement of smooth
running the courses and meeting the concerned recurring expenditure.

13. The proposal will be consider on the basic of academic monitoring reports for the last
year for the existing institutes.

14. The management has to submit before permission to admit batch for undertaking to
maintain all the norms & all the time in continues manner for running the programme.

Page 15 of 15
 RECIEPT
Received Date: - Time:-

Name of the Programme:

Purpose: -Increase/ New Institute/ Existing Institute New Programme

No of copies: - 1 original & 2 additional Copies

Seal
&
Receivers Signature

Page 16 of 16