Bpmt Application Form PDF Details

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.

QuestionAnswer
Form NameBpmt Application Form
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namesbpmt application form 2019, bpmt online application, afmc bpmt admission 2020, bpmt admission 2020 maharashtra

Form Preview Example

 

Proposal for academic year

College Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2016 - 2017

 

 

 

 

 

 

 

 

 

(For Office use only)

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

College / Institute :

_________________________________________

 

_________________________________________

 

_________________________________________

 

_________________________________________

 

PIN code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone No. (O) _____________________________

 

 

_____________________________

 

Fax No.

_____________________________

 

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

granting affiliation (attach a copy)

 

 

 

 

 

BPMT

 

 

 

 

 

 

 

 

 

 

(Separate sheet may be used, if required)

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 2016-2017.

Sr. No.

Faculty

Class

No. of students

 

 

 

 

 

BPMT

I

 

 

 

 

 

 

 

II

 

 

 

 

 

 

 

III

 

 

 

 

 

b) Information about approved teaching staff.

(Submit the information as per the proforma attached).

c)Information about non-teaching staff.

(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)

_____________________________________

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)

 

___________________________________________

Permanent

Temporary

 

Officiating

 

 

 

 

Approved

Not Approved

 

 

 

 

 

(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 non-teaching staff

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

:

Intake Capacity

:

Department

:

Ph. No.

:

 

 

 

 

 

 

 

 

 

 

 

 

 

Date :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Experience

 

Nature

 

 

 

 

 

 

 

 

Date of

Date of

 

 

 

 

 

 

of

No. &

Sr.

Name of the

 

 

Qualificati

 

Categor

Ph.No.

 

 

 

 

 

approva

Date of

Post

M/F

Subject

Appointme

Retirem

E-mail

 

 

Lect

Dem

No.

Teacher

on

y

(R) & (M)

Prof.

A.P.

l(Temp/

letter of

 

 

 

 

 

 

 

nt

ent

 

 

 

 

.

o

Permea

Approv

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

nt

al

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Seal & Sig

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Faculty : (BPMT)MedicalAppendix “G”

Proforma regarding Information of Hospital

(For -------- Intake Capacity)

Hospital : Own/Attached Hospital

: Yes/No

(If rented, name and full address of

 

Hospital & distance from College)

 

a) Average Indoor Admissions per day

: ……………………..

b) Average Out patient attendance per day

: ……………………..

c) Bed Strength

 

: ……………………...

d) Occupancy (annual) (%)

: ………………………

e) I.C.C.U. Bed strength

: ………………………

f) Super speciality total bed strength

: ………………………

g) Laboratories

 

: ………………………

h) Casualty department

: Yes/No

i) No. of patient attending per day

- …………………….

j) Blood Bank

-

: Yes/ No (Size : )

k) C.T./ M.R.I.

-

: ………………………

l) Ambulance

 

: Available/ Not available

m) Other, if any

 

: ……………………….

Date :

Signature of Dean / Principal

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Faculty: (BPMT) Medical

 

Appendix “H”

 

INFORMATION REGARDING COLLEGE TEACHING FACILITIES

A) College infrastructure:

 

 

I.

Own Land (enclose copy of 7/12/property card)

: 25 Acres (minimum)

II.

Own College Building

: Yes/No.

 

III.

Built-up area

: ………………………

IV.

Auditorium

: Yes/No.

Capacity:

V.

Guest House with number of rooms

: Yes/No.

Capacity:

VI.

Residential Quarters for Staff

: Available/ Not available.

VII.

Staff Vehicles

: Available/ Not available

VIII.

Number of Computers Available

:………………………..

IX.

Internet facility

: Available/ Not available

X.

Website

:…………………………

XI.

E-mail

:………………………..

B) Library :

 

 

I. No. Of Books Available

:………………………

II. No of Journals Available

:……………………..

 

a) National

: …………………….

 

b) International

: ……………………

III.

Reading Room for staff

: Available/ Not available

IV.

Reading room for students

: Available/ Not available

V.

Digital Library

: Available/ Not available

C) Hostel : Girls Hostel

: Own/Rented, Capacity:-

I.

Boys Hostel

: Own/Rented, Capacity:-

D) Number of Lecture Hall

:…………………..

Capacity of each Hall

:…………………….

E) Gymkhana Facility

: Yes/No.

 

Date :

Signature of Dean / Principal

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MAHARASHTRA UNIVERSITY OF HEALTH SCIENCS, NASHIK

 

 

DETAIL INFORMATION OF DEPARTMENT WISE TEACHING STAFF AS ON

Name of the Dept. :

____________________________________________

College Phone No. : _______________

Name of the College : _______________________________________________

College E-mail ID

: _______________

Name of the Dean / Principal :_________________________________________

College website

: _______________

Faculty :- (BPMT) Medical

 

 

S.

Name of the Teach.

Desi

Ph.N

E-

Dat

Ed

Date

Whether

Teach

N

Staff

g

o

mail

e of

u

of

belongs to

exp.

 

 

 

(Resi)

ID

Birt

Qu

appoi

Reserved

UG

PG

 

 

 

 

 

h

a

ntme

category (if

yrs

yrs

 

 

 

 

 

 

 

nt

so specify

 

 

 

 

 

 

 

 

 

 

category)

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

Teach

Exp in

years

 

Whether

Whether approved by

Not

 

 

 

 

University.

appro

FT

PT

CHB

HON

Temp

Perm

Letter

ved

 

 

 

.

 

anent

No. &

 

 

 

 

 

 

 

Dt.

 

 

 

 

 

 

 

 

 

Signature of Dean with Seal

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