The Bpmt Application Form serves as a crucial document for colleges linked with the Maharashtra University of Health Sciences in Nashik, outlining a structured procedure for seeking a continuation of affiliation for the academic year 2016-2017. As part of the regulatory compliance under Section 68 of the Maharashtra University of Health Sciences Act, 1998, the form encapsulates various critical segments including the submission of a comprehensive proposal, institution details, payment information regarding the prescribed fee, and the current status of course affiliations. Furthermore, it encompasses a checklist incorporating demand drafts, previous affiliation letters, compliance reports, and much more, aimed at furnishing the university with detailed insights into the college's faculty, student statistics, teaching facilities, and hospital affiliations. This application not only facilitates the administrative bridge between colleges and the university but also ensures adherence to the quality standards laid down for medical education. The form notably underscores the need for transparency and compliance, reflecting the institutions' commitment to maintaining educational excellence. Through meticulous documentation such as principal’s undertakings on affiliation fee remittances and sanctioned intake capacities, it establishes a formal channel for academic institutions to secure their continuous affiliation, thereby underscoring the symbiotic relationship between regulatory frameworks and educational advancements.
| Question | Answer |
|---|---|
| Form Name | Bpmt Application Form |
| Form Length | 9 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 2 min 15 sec |
| Other names | bpmt application form 2019, bpmt online application, afmc bpmt admission 2020, bpmt admission 2020 maharashtra |
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Proposal for academic year |
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2016 - 2017 |
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(For Office use only) |
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Maharashtra University of Healt h Sciences, Nashik
Application Form for Continuation of Affiliation (BPMT)Medical
(Under Section 68 of the Maharashtra University of Health Sciences Act, 1998)
Instructions : The College / Institutions presently affiliated to this University applying for Continuation of affiliation shall submit three copies of application forms with D.D. of prescribed fee drawn in favour of the “Registrar, Maharashtra University of Health Sciences, Nashik” on any Nationalised Bank on or before the last day of October of the year preceding the year from which the Continuation of affiliation is sought.
(Please refer fee Schedule)
To,
The Registrar
Maharashtra University of Health Sciences,
Mhasrul, Dindori Road,
Nashik – 422 004.
Sir,
I am / we are submitting herewith an application with a request for Continuation of affiliation to the existing Undergraduate course in this College / Institute for the academic year 2016 – 17 under section 68 of the Maharashtra University of Health Sciences Act, 1998:
1) Name and address of the |
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College / Institute : |
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_________________________________________ |
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PIN code |
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Phone No. (O) _____________________________ |
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_____________________________ |
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Fax No. |
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Email Address : ____________________________ |
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2) Payment details :i) Name of the drawee Bank : __________________
__________________________________________
ii)D.D. No. _____________ Dated ______________
iii)Amount Rs. _______________________________
iv)University Receipt No. & Date ________________
(For Office use only)
3)Present status of affiliation of the existing courses in the College.
Month and year up to which College is affiliated for below mentioned courses __________
Sr. No |
Faculty |
Classes |
Medium |
No. & Date of University letter |
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granting affiliation (attach a copy) |
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BPMT |
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(Separate sheet may be used, if required) |
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4)Has the College complied with the deficiencies communicated earlier? Yes / No If yes, attach a copy of Compliance Report.
5)Statistics of the College :
a)Number of students on roll during the academic year
Sr. No. |
Faculty |
Class |
No. of students |
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BPMT |
I |
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II |
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III |
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b) Information about approved teaching staff.
(Submit the information as per the proforma attached).
c)Information about
(Attach separate sheet).
d)Information regarding Hospital :
(Submit the information as per the proforma attached)
e)Information regarding teaching facilities at College.
(Submit the information as per the proforma attached)
6)Information regarding College Establishment :
a)Date of Establishment of the College : ____________________________________
b)Latest Central Council approval letter : No. _______________ Dated____________
(Attach Latest Xerox copy of letter)
c)Latest Central Govt. approval letter : No. ________________ Dated____________
(Attach Latest Xerox copy of letter)
d) Latest permission from Maharashtra Govt. G.R. No. _____________Dated________
(Attach Latest Xerox copy of GR)
7) Latest status of affiliation :
Permanent
Periodic
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(Attach Xerox copy of affiliation letter)
(Tick mark the appropriate box)
8) Date of First Affiliation to this University
(Attach Xerox copy of affiliation letter)
Temporary (Yearly)
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9) Sanctioned intake capacity by the University _____________________________________
(Attach Xerox copy of affiliation letter)
10) Name of the Principal |
:- |
Nature of appointment |
:- |
(Tick mark the appropriate box) |
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Permanent |
Temporary |
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Officiating |
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Approved |
Not Approved |
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(If approved attach Xerox copy of approval letter)
Residential Address of the Principal :- _________________________________________
___________________________________________
PIN Code :-
Phone No. (Office) |
______________________ |
(Resident) |
______________________ |
(Mobile) |
______________________ |
(Fax) |
______________________ |
Email Address : ____________________________
Place _________________________ |
Name and Signature of the Principal |
Date ________________________ |
Seal of the College. |
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CHECK - LIST
(Continuation of Affiliation (BPMT) Medical
(Please attach papers as per check list)
Sr. No. |
Documents description |
1.Demand Draft of prescribed fees
2.Previous (Latest) Affiliation letter
3.Compliance Report
4.Undertaking by Dean/Principal
regarding remittance of outstanding affiliation fee
5.Information about approved teaching staff
6.Information about
7.Information regarding Hospital
8.Information regarding teaching facilities at College
9.Central Council permission letter
10.Central Govt. permission letter
11.Maharashtra Govt. permission letter
12.Sanctioned intake capacity from University
13.Approval letter from MUHS for Principal post
14.Audited Statement of accounts of the College for the preceding year
15.List of Local Managing Committee members and the period of their tenure.
Enclosed at Page No. of application form
Yes Appendices Page No.
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
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(On College letter head) |
Appendix ‘D’ |
Undertaking by Dean/Principal regarding remittance of outstanding Affiliation Fee
I, Principal of _____________________________________College hereby undertake the
responsibility to remit the outstanding affiliation fee of Rs_______________/- within three months
from the date of Inspection, I am aware of the fact that if the said fee is not remitted in due period, the affiliation of our College will not be granted for the academic year_______________.
Date :
Place: |
Dean / Principal |
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Appendix ‘E’
Department Wise Statement Showing the Information of Approved Teaching Staff
Name of the College |
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Intake Capacity |
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Department |
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Ph. No. |
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Date : |
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Experience |
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Date of |
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approva |
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Lect |
Dem |
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No. |
Teacher |
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(R) & (M) |
Prof. |
A.P. |
l(Temp/ |
letter of |
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Seal & Sig
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Faculty : (BPMT)MedicalAppendix “G”
Proforma regarding Information of Hospital
(For
Hospital : Own/Attached Hospital |
: Yes/No |
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(If rented, name and full address of |
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Hospital & distance from College) |
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a) Average Indoor Admissions per day |
: …………………….. |
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b) Average Out patient attendance per day |
: …………………….. |
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c) Bed Strength |
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: ……………………... |
d) Occupancy (annual) (%) |
: ……………………… |
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e) I.C.C.U. Bed strength |
: ……………………… |
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f) Super speciality total bed strength |
: ……………………… |
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g) Laboratories |
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: ……………………… |
h) Casualty department |
: Yes/No |
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i) No. of patient attending per day |
- ……………………. |
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j) Blood Bank |
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: Yes/ No (Size : ) |
k) C.T./ M.R.I. |
- |
: ……………………… |
l) Ambulance |
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: Available/ Not available |
m) Other, if any |
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: ………………………. |
Date : |
Signature of Dean / Principal |
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Faculty: (BPMT) Medical |
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Appendix “H” |
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INFORMATION REGARDING COLLEGE TEACHING FACILITIES |
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A) College infrastructure: |
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I. |
Own Land (enclose copy of 7/12/property card) |
: 25 Acres (minimum) |
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II. |
Own College Building |
: Yes/No. |
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III. |
: ……………………… |
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IV. |
Auditorium |
: Yes/No. |
Capacity: |
V. |
Guest House with number of rooms |
: Yes/No. |
Capacity: |
VI. |
Residential Quarters for Staff |
: Available/ Not available. |
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VII. |
Staff Vehicles |
: Available/ Not available |
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VIII. |
Number of Computers Available |
:……………………….. |
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IX. |
Internet facility |
: Available/ Not available |
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X. |
Website |
:………………………… |
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XI. |
:……………………….. |
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B) Library : |
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I. No. Of Books Available |
:……………………… |
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II. No of Journals Available |
:…………………….. |
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a) National |
: ……………………. |
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b) International |
: …………………… |
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III. |
Reading Room for staff |
: Available/ Not available |
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IV. |
Reading room for students |
: Available/ Not available |
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V. |
Digital Library |
: Available/ Not available |
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C) Hostel : Girls Hostel |
: Own/Rented, Capacity:- |
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I. |
Boys Hostel |
: Own/Rented, Capacity:- |
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D) Number of Lecture Hall |
:………………….. |
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Capacity of each Hall |
:……………………. |
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E) Gymkhana Facility |
: Yes/No. |
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Date : |
Signature of Dean / Principal |
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MAHARASHTRA UNIVERSITY OF HEALTH SCIENCS, NASHIK |
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DETAIL INFORMATION OF DEPARTMENT WISE TEACHING STAFF AS ON |
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Name of the Dept. : |
____________________________________________ |
College Phone No. : _______________ |
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Name of the College : _______________________________________________ |
College |
: _______________ |
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Name of the Dean / Principal :_________________________________________ |
College website |
: _______________ |
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Faculty :- (BPMT) Medical |
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S. |
Name of the Teach. |
Desi |
Ph.N |
E- |
Dat |
Ed |
Date |
Whether |
Teach |
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Staff |
g |
o |
e of |
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of |
belongs to |
exp. |
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(Resi) |
ID |
Birt |
Qu |
appoi |
Reserved |
UG |
PG |
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h |
a |
ntme |
category (if |
yrs |
yrs |
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so specify |
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category) |
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Total
Teach
Exp in
years
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Whether |
Whether approved by |
Not |
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University. |
appro |
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FT |
PT |
CHB |
HON |
Temp |
Perm |
Letter |
ved |
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anent |
No. & |
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Dt. |
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Signature of Dean with Seal
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