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INTRODUCTION SIPS Super Speciality Hospital , Burn & Trauma Center was started with aim to provide world class facility to cater the field of burn ,trauma ,plastic and reconstructive surgery. SIPS provides integrated services in 3 main specialties of trauma Orthopedics , Neuro Surgery & Plastic Surgery beside other super specialties viz Urology , Gastro Surgery. Sips Hospital is equipped with State of Art ICU to take care of any type of emergency and trauma with backup of ventilators. It is probably the first hospital to provide round the clock on site super specialist rather than on call to provide immediate care and prevent mortality & morbidity. SIPS also treat those patients who are most complicated or neglected e.g. Burn, Polytrauma. SIPS Institute of Nursing & Paramedical Sciences started to provide trained medical staff for serving ill people .The institute dedicated to provide quality health care with quality people .This institute aims to train and prepare world class medical staff for world class health care. The faculty of this institute is well qualified and trained from some world class institutes able to provide quality education .The patients base of the institute provide excellent opportunity for training to the medical staff .The cordial environment of this institute enhances the teaching & learning opportunities. Aims and Objectives of Institute: To create center of excellence for education and training in medical health care. To provide good job opportunity in the medical world. To make a good human being in medical sector. Approval and Affiliation Approved by Govt. of Uttar Pradesh, as per letter no. 4487(1)71-3-06AN-97/06 dated 7th November 2006. Affiliated to State Medical faculty Uttar Pradesh, Lucknow as per letter no. 4910/06 dated 11th November 2006. Approved by Indian Nursing Council for running of G.N.M course. School Code: 3102154 Name of Course

1. Diploma in Emergency & Trauma Care Technician (First time in UP) 2. Diploma in O.T. Technician. 3. Diploma in Physiotherapy. 4. Diploma in General Nursing & Mid wifery. 5. Diploma in A.N.M 6. B.Sc Nursing (4 Year Degree Course) (Coming Soon…) 7. Duration of Course: Duration of courses (1, 2, & 3) is two years followed by three months of Internship Training. Duration of course of Diploma in General Nursing & Midwifery is of 3 years followed by six months of internship training. Duration of course of Diploma in A.N.M is 1 Year followed by six months of Internship Training. Eligibility: A candidate should have a minimum qualification of Intermediate or 10+2 examination or equivalent with (Physics, Chemistry, Biology / Maths). A candidate who has appeared in examination of intermediate (science) is also eligible for entrance examination but must produce the mark sheet or certificates at the time of admission to the course. The candidate must have completed the age of 17 years by the time of admission to the course. The maximum age for G.N.M is 35 years whereas for other Paramedical courses there is no maximum age limit as such.

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Procedure for Admission: The prospectus and application forms are available at the office of the Institute, which can be obtained on payment of Rs. 150/- cash only from SIPS INSTITUTE OF NURSING & PARAMEDICAL SCIENCES. No postal order/ cheque/D.D. will be entertained. Form can be downloaded from our website http://www.SIPS.IN or Contact: 0-9473560291 Application form is to be filled by the candidate in his/her own hand writing along with D.D of Rs. 500/-(With the form obtained through SIPS Prospectus & D.D of Rs. 600/- (only with downloaded forms) for entrance examination in favor of “SIPS INSTITUTE OF PARAMEDICAL SCIENCES “payable at Lucknow .The application form should reach to the office within the specified date. List of Enclosures. The candidates are required to attach the following documents with application form duly attested by a gazetted officer. 1. Attested copy of High School certificate as proof of date of birth. 2. Attested copy of High School marks sheet. 3. Attested copy of Intermediate marks sheet. 4. Attested copy of Character Certificate from institution last attended. 5. Affixed two passport size colored recent photographs of the candidate. 6. Two self addressed envelopes (size 10” x 4.5”) affixes stamp of Rs. 25/- on each envelope. 7. One self addressed post card with affixed stamp of Rs. 3/- for acknowledgement.

Entrance Examination The Candidate has to appear for entrance examination before admission to the course. The written test consists of sixty multiple choice questions & duration of sixty minutes. The entrance test will be of sixty marks. The test will cover the related subjects Physics, Chemistry, Biology / Maths and General Knowledge. There is no negative marking. The merit list shall be prepared by aggregation of marks of written test (60), viva voce (20) & 20% of marks obtained in intermediate examination. The selection is based on the merit basis .The date of entrance examination will be declared at the time of submission of application form and also will be advertised later on , before examination. Before admission a medical test will be carried out of every selected student. The right to admission is reserved. The decision of selection committee shall be final in all respects. One candidate can apply for multiple courses but one form is valid for one course only. If candidate wants to appear in other courses also he/she should apply on fresh form along with separate examination fees (D.D of Rs. 500/-). Fee Structure:

1. Paramedical

The selected candidates have to pay the following fees: Admission fees (Once only) Rs. 5000/- Caution money Rs. 5000/- Tuition Fees Rs. 30,000/- Yearly Hostel Fees Rs.3500/- Monthly (Amount is variable from time to time)

2. G.N.M : Course Fee Rs. 1,50,000 (Rs. 50,000 Per Year)

3. A.N.M : Course Fee Rs. 60,000. The payment of fees is by demand draft in favor of “SIPS INSTITUTE OF PARAMEDICAL SCIENCES” payable at Lucknow. Rs. 50 /- per day will be charged as fine if the fee is not deposited on or before the due date.

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Schedule for final examination each year: Prescribed application form for appearing in the final examination each year to be held by the U.P State Medical Faculty shall be submitted one month prior the date of commencement of examination along with the prescribed examination fee through the head of the Institute.

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Diploma: The U.P State medical faculty shall award the diploma to the successful candidates after passing the examination conducted by the above faculty.

• For G.N.M course the Hostel Facility is preferred to be compulsory and beneficial for smooth academic session of the students

Registration: The candidates after completion of the course shall be registered with U.P State Medical faculty and INC, New Delhi. Important Information: • Last date for form submission – 25th June. • Right to admission is reserved. • Fees will not be refunded if student leaves the course any time after admission. • Formation of any type of association or union is strictly prohibited. • Students will not be allowed within the premises without prescribed uniform. • Leaves will be granted only after written request. • For appearing in the final examinations a student must have 80% attendance. • Term exams (internal) will be held every six months along with class tests. The performance in those exams will be

considered in final exams. • Every student has to follow the rules and regulations of the institute, failing which he/she can be resticated. • The students are expected to take care of the Institute’s movable / immovable properties. • Any damages done will amount to strict action and proper compensation on the part of the student. • Any kind of intoxication is strictly prohibited within the Institutes premises. • Hostel is not guaranteed .Only depends on availability. • Separate hostel fees and rule and regulations apply.

Course of Study Diploma in Emergency & Trauma care Technician. Diploma in O.T Technician. Diploma in Physiotherapy. Diploma in General Nursing & Midwifery Diploma in Auxillary Nursing & Midwifery Ist Year & II nd Year There will be two written text (Paper followed by Practical Test & Viva Voce. Paper I =50 Paper II =50 Practical =400 …………… Total =500 Signature of Parent’s / Guardian’s Yours faithfully Place: ………………………….. Date: ………………………… (Signature of the Candidate)

Form No:……………….

APPLICATION FORM 2010-11

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To, THE DIRECTOR SIPS INSTITUTE OF NURSING & PARAMEDICAL SCIENCES 29, SHAHMEENA ROAD, LUCKNOW Dear Sir / Madam I would like to apply as a candidate according to my choice for the admission in the course. (Please tick √ on any one course). Name of Course: Diploma in Emergency & Trauma Care Technician

Dipl Diploma in O.T Technician Dipl Diploma in Physiotherapy Dipl Diploma in G.N.M Dipl Diploma in A.N.M

*Diploma in Emergency & Trauma Care Technician ,* Diploma in O.T Technician ,* Diploma in Physiotherapy, *Diploma in General Nursing & Midwifery,* Diploma in A.N.M.

1. Name of applicant (Block Letters)………………………………………………………………………………………………………………… 2. Correspondence Address………………………………………………………………………………………………………………………….

………………………………………..Ph…………………………………Mobile………………………………………………………………… Permanent Address……………………………………………………………………………………………………………………………………………… ……………………………………..Ph………………………………….Mobile………………………………………………………………… 3. Father’s /Husband’s /Guardian’s Name……………………………………………………………………………………………………………. i. Occupation/Designation……………………………………………………………………………………………………………………………….. ii. Name & Address of the Employer (if any)………………………………………………………………………………………………………….. 4. Place and Date of Birth…………………………………………………………………………………………………………………………….. 5. Nationality…………………………………………………………………………………………………………………………………………….

6. Married / Unmarried…………………………………………………………………………………………………………………………………

7. Religion & Caste ……………………………………………………………………………………………………………………………………

8. Educational Qualification (High School Onwards)

Examination Passed Board University Year Division Aggregate % Subjects

i. Extra Curricular Activities (if any): ……………………………………………………………………................................. ii. Prizes / Awards: ………………………………………………………………………………………………………………... iii. Do you require Hostel Accommodation (if yes please fill up the Hostel form ) Yes / No

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DECLARATION I hereby solemnly affirm and declare that: 1. The entries in this form and the additional particulars in reply to the questions above are true, complete and correct to

the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligibility being detected before or after the admission , my admission or diploma may be cancelled or withheld by the DIRECTOR,”SIPS INSTITUTE OF NURSING & PARAMEDICAL SCIENCES”.

2. I am mentally and physically fit and do not suffer from any physical deformity or any communicable disease. 3. I shall be willing to serve in any department of the Institute /Hospital/Urban or Rural area at any time during my theory

and practical training classes / period of field practice at my own expenses. 4. I will neither use any intoxicants, stimulants, drinks and drugs of dangerous nature , smoke or consume barbiturates

etc. in the hostel and Institute’s premises / campus. 5. I do hereby agree to pay the cost of damages caused by me to the movable and immovable property of the Institute or

any department concerned due to negligence of duties/work. 6. I will not keep myself absent from the classes without obtaining due and prior permission from the Principal / Director

and assure to attend 80% classes (theoretical and practical). 7. I have noted that the fees once paid by me neither refundable nor adjustable in any circumstances. College will not be

responsible for any change in circumstances or my personal or family problems or for reimbursement of my fees / expenditure by an Authority / Mission / Central or State Government etc.

8. I hereby agree that in case of any dispute between me and the Institute during my training period or after that the matter will be referred to the Managing Committee of the SIPS Institute of Nursing & Paramedical Sciences whose decision will be final in all respects.

9. I shall not take part in the political activities and Student’s Union / Association / Action Committee etc. Of the Institute. 10. I have never been convicted by the Court Of Law. 11. All disputes shall be subject to Lucknow Jurisdiction only.

Signature of Guardian’s / Parent’s Signature Of Applicant

UNDERTAKING

1. I hereby agree to abide by the Rules and Regulations / Terms and Conditions of the “SIPS Institute of Nursing & Paramedical Sciences “, Lucknow as mentioned in the prospectus. I have obtained the consent of my parents / guardian to join the course and have noted that fees once paid is neither refundable nor adjustable in any circumstances.

2. I am aware that the “Institute “ does not guarantee or assure employment in Central or State Government or Semi Govt. or Autonomous Bodies / Private or Voluntary Sector in any part of the country.

3. I shall obey the instructions issued by the “Institute “, “UP State Medical Faculty, Lucknow” and “Indian Nursing Council, New Delhi”.

4. In case of any dispute the jurisdictions for legal proceedings will be in Lucknow Only. 5. I shall not use any type of intoxicants drug in the premises of the hostel of the Institute and I assure to maintain high

standard of character, behavior and hygiene during my training period.

Yours Faithfully Signature of Candidate

TO BE FILLED BY THE PARENT’S / GUARDIAN’S OF THE APPLICANT I have gone through the above mentioned particulars and allow my son/daughter/wife to join Diploma Course (which are mentioned below) of the SIPS Institute of Nursing & Paramedical Sciences and I assure you that my son / daughter / wife will obey the instructions / orders issued by the DIRECTOR/PRINCIPAL of the Institute directly or by any authorized person. (Please tick √ on any course)

Name of Course: Diploma in Emergency & Trauma Care Technician Diploma in O.T Technician Diploma in Physiotherapy Diploma in G.N.M Diploma in A.N.M ………………………………………. Signature of the Guardian‘s / Parent’s Place………………….. Date…………………… a. Name ………………………………. b. Relationship with the Applicant ………………………………… Enclosures: 1. ……………………………………………………………………………… 2. ……………………………………………………………………………… 3. ……………………………………………………………………………… 4. ……………………………………………………………………………… 5. ……………………………………………………………………………… 6. ……………………………………………………………………………… 7. ……………………………………………………………………………… 8. ……………………………………………………………………………… Date:……………………………. (Signature of the Candidate)

Right of Admission Reserved Admission cannot be claimed as a matter of Right in the “SIPS Institute of Nursing & Paramedical Sciences “and the selection committee reserves the right of Admissions.

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(For Office Use Only) REPORT BY THE SELECTION COMMITTEE

Selected / Not Selected Merit No:………………………. 1. Marks obtained in Entrance Examination (60)…………………………………………………………………... 2. Marks obtained in Viva Voce (20)…………………………………………………………………………………

3. Marks 20% of Intermediate Examination ………………………………………………………………………...

4. Total Aggregate (1+2+3)……………………………………………………………………………………………

5. Course Offered………………………………………………………………………………………………………

………………………………………………….. …………………………………………………. Signature of Representative of the Signature of Member of the Selection UP State Medical Faculty Committee SIPS INSTITUTE OF NURSING & PARAMEDICAL SCIENCES. Dated:…………………………………………….. To be filled by the Director / Principal / Authorized Officer of the Institute of Nursing & Paramedicals Please admit Mrs. / Miss / Mr. ………………………………………………………………………………………………………….. Wife/daughter/son of …………………………………………………………………………………………………….. R/O…………………………………………………………………………………………………………………………. In the Diploma Course in ………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………. Place:…………………………….. Date:……………………………… ……………………………………………………………….. Seal & Signature of the Director / Principal / Incharge/

Autorised Officer

Office Slip SIPS Institute of Nursing & Paramedical Sciences

29, Shahmeena Road, Lucknow (U.P) ADMIT CARD

Entrance Examination For Admission for Session 2010-11

Diploma in Emergency & Trauma Care Technician Diploma in A.N.M Diploma in O.T Technician Diploma in Physiotherapy Diploma in G.N.M Applicant Form No: Roll No: 1. Name of Applicant:

(IN BLOCK LETTERS)

2. Fathers name……………………………………………………………………………………………………. 3. Permanent Address…………………………………………………………………………………………….

…………………………………………………………………………………………………………………….

4. Entrance examination Center: TRAINING CENTER SIPS INSTITUTE OF NURSING & PARAMEDICAL SCIENCES 29, SHAHMEENA ROAD, LUCKNOW (UP)

Date of Entrance Exam:…………………………………………….. Date of interview/ Viva Voce………………………………………..

5. Full Signature of Candidate…………………………………… (In entrance Examination Room) Full Signature Of Candidate -----------------------------------------------------------------------------------------------------------------------------------------------------------------

Applicant’s Slip

SIPS Institute of Nursing & Paramedical Sciences 29, Shahmeena Road, Lucknow (U.P)

ADMIT CARD Entrance Examination For Admission for Session 2010-11

Diploma in Emergency & Trauma Care Technician Diploma in A.N.M Diploma in O.T Technician Diploma in Physiotherapy Diploma in G.N.M Applicant Form No: Roll No: 1. Name of Applicant:

(IN BLOCK LETTERS)

Affix your Photo Here

2. Fathers name………………………………………………………………………………………………………… 3. Entrance examination Center: TRAINING CENTER

SIPS INSTITUTE OF NURSING & PARAMEDICAL SCIENCES 29, SHAHMEENA ROAD , LUCKNOW (UP)

4. Date of Entrance Exam:…………………………………………… 5. Date of interview/ Viva Voce…………………………….………… The possession Of This Slip Does Not Mean that The Applicant has appeared in The Entrance Examination) (INTERVIEW / VIVA – VOCE WILL START FROM 10:00 A.M ONWARDS) Authorized Signatory

SIPS Institute of Nursing & Paramedical Sciences 9

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