Submit the completed application form along with the required enclosures to the following address: Department of Continuing Nursing Education & Surgical Nursing, Christian Medical College, Vellore-632 004. Ensure to enclose the Demand Draft for Rs. 250/- as an application fee drawn in favour of 'CMC Vellore Association' and payable at Vellore. Verify that all necessary fields are filled in accurately, and all required documents are enclosed. If available, check for online submission options on the institution's website.

Important dates for this application form in 2024 and 2025 include the application submission deadlines and course commencement dates. Please refer to the prospectus for specific dates.

The purpose of this application form is to provide an opportunity for nurses and healthcare professionals to apply for the Distance Education Course in Stoma Care Nursing at Christian Medical College, Vellore. This course aims to enhance skills and knowledge in stoma care nursing through a well-structured distance education program. The application form collects necessary personal, professional, and experience details to evaluate the suitability of candidates for the course.

• 1. Name: Enter your full name as it appears in your Certificate in CAPITALS.
• 2. Name of Father / Husband: Provide the name of your father or husband in CAPITALS.
• 3. Gender: Indicate your gender by writing 'M' for Male and 'F' for Female.
• 4. Date of Birth: Enter your date of birth in the format dd/mm/yyyy.
• 5. Religion: Specify your religion.
• 6. Nationality: Mention your nationality.
• 7. RN Registration No.: Enter your Registered Nurse (RN) Registration Number.
• 8. RM Registration No.: Enter your Registered Midwife (RM) Registration Number.
• 9. Address for Correspondence: Provide the address where you would like to receive correspondence.
• 10. City: Enter the city of your correspondence address.
• 11. District: Mention the district of your correspondence address.
• 12. State: Specify the state of your correspondence address.
• 13. Permanent / Residential Address: If different from above, provide your permanent/residential address.
• 14. Pin: Enter the postal pin code of your correspondence address.
• 15. City: Mention the city of your permanent/residential address.
• 16. District: Indicate the district of your permanent/residential address.
• 17. State: Specify the state of your permanent/residential address.
• 18. Telephone Numbers: Provide your telephone numbers with the STD code.
• 19. Mobile Numbers: Enter your mobile numbers.
• 20. Email: Provide a clear email address for correspondence.
• 21. Professional Qualifications: List your professional qualifications including the institution and year of completion. Use additional sheets if necessary.
• 22. Work Experience: Detail your work experience in chronological order from the year of qualification, including the designation, period, institution, and remarks.
• 23. Stoma Care Experience: Describe your experience of caring for patients with stoma and provide relevant details.
• 24. Current Work Details: Provide the address and details of the Institution/Clinic/Hospital where you are currently working, including designation, type of work, and phone number.
• 25. Course Expectations: State what you hope to gain from the Distance Education Course in Stoma Care Nursing and how you plan to implement the acquired knowledge in your workplace.
• 26. Access to Internet: Confirm if you have access to the internet.
• 27. Payment Details: Provide the name of the bank, payment particulars, DD number, date, and amount.
• 28. Previous Application: Indicate if you have applied for the course earlier and specify the year if applicable.
• 29. Undertaking: Sign the declaration stating that all information provided is complete and accurate, and that you agree to abide by the course regulations.
• 30. Enclosures: List the documents enclosed with the application, including the Demand Draft for Rs. 250 and photocopies of your qualifications.

Failing to submit this form can result in your candidature being canceled or not being considered for the course. Ensure timely submission and verify that all required details and enclosures are complete.

• Missed Deadline: Your application will not be considered if submitted after the deadline.
• Incomplete Information: Applications with incomplete or inaccurate information may be rejected.
• Missing Enclosures: Failure to include required documents and application fees may result in cancellation of your application.

• 1. Application Submission: Submit this form to apply for the Stoma Care Nursing course.
• 2. Professional Qualification Details: Provide details of your professional qualifications and experience.
• 3. Course Expectation Statement: Indicate your experience with stoma care and your expectations from the course.
• 4. Document Enclosures: Include necessary enclosures such as qualification certificates and application fees.
• 5. Contact Information: Provide accurate contact information for future correspondence.