CUMULATIVE RECORD FOR GNM

PERSONAL BIODATA:
Affix passport
size photograph
Name of student: …………………………………………………………………………………..

Sex: M/F Date of Birth: ………………………………..

Nationality: ........................................................

Religion: ………………….........................................

Community: FC/ BC/ SC/ ST. .............................

Blood group: ……………………...............................

Marital status: ....................................................

Date of admission: .............................................

Training Period: ...................................From...............To.......................

Name of parent/ Guardian : …………………………….

Address: Permanent Temporary

………………………………………. ……………………………………..

………………………………………. ………………………………………

……………………………………….. ……………………………………….

Mo. No: ............................................

Scholarship availed Source :…………………….. Amount:………………….Duration:…………………

Bank loan availed source:………………………….Amount::………………….Duration:…………………

Qualification:

Institutional Exam passed Year Marks/ class University

attended

SUBJECT WITH HOURS OF PLANNED INSTRUCTIONS GIVEN IN GNM NURSING

1st – year:

A] Theory demonstration:

Sr no. Subject Theory Hours Hrs. % Remark

&Supervised Attended
Practice
1 Biological Sciences 120
(i) Anatomy & Physiology 90
(ii) Microbiology 30
2 Behavioural Sciences 60
(i) Psychology 40
(ii) Sociology 20
3 Fundamentals of Nursing 215
(i) Fundamentals of Nursing 175
(ii) First Aid 20
(iii) Personal Hygiene 20
4 Community Health Nursing 150
(i) Community Health Nursing 80
(ii) Environmental Hygiene 20
 (iii) Health Education & 20
Communication Skill
(iv) Nutrition 30
5 English 30

B] Clinical Experience:

Sr.no Subject Prescribed Hrs. % Remarks

by INC Attended
1 Nursing fundamental 880
2 community health nursing 320

C] Field visit:

Sr.no Place Date

D] Examination:

Biological Behavioural Fundamental Community Remark

science science of nursing health
nursing

Theory

Practical

SIGNATURE OF THE CLASS CO-ORDINATOR SIGNATURE OF THE PRINCIPAL

 2nd year:

A] Theory demonstration:

Sr no. Subject Prescribed Hrs. % Remarks

by INC Attended
1 Medical Surgical Nursing – I 140
(Including Pharmacology)
2 Medical Surgical Nursing – II 120
(Specialties)
3 Mental Health & Psychiatric Nursing 70
4. Computer education 30

B] Clinical Experience:

Sr.no Subject Prescribed Hrs. % Remarks

by INC Attended
1 Medical surgical nursing 800
2 mental health nursing 320

C] Field visit:

Sr.no Place Date

D] Examination:

MSN-1 MSN-2 Mental health Remark

nursing

Theory

Practical

SIGNATURE OF THE CLASS CO-ORDINATOR SIGNATURE OF THE PRINCIPAL

3rd year

A] Theory demonstration:

Sr no. Subject Prescribed Hrs % Remarks

by INC attended
1 Midwifery and Gynaecology 120
2 Community Health Nursing – II 100
3 Child health Nursing 70
4 Introduction of Research and 30
statistics
5 professional trends and 30
adjustments
6 nursing administration and ward 40
management
B] Clinical Experience:

Sr.no Subject Prescribed Hrs. % Remarks

by INC Attended
1 community health 288
nursing
2 Medical surgical 288
nursing
3 mental health nursing 96
4 child health nursing 96
5 OBG 384

C] Field visit:

Sr.no Place Date

D] Examination:

OBG Community Child health Remark

health nursing nursing

Theory

Practical

SIGNATURE OF THE CLASS CO-ORDINATOR SIGNATURE OF THE PRINCIPAL

VACATION AND HOLIDAYS

TYPE OF LEAVE 1STYEAR 2ND YEAR 3RD YEAR

DAYS DAYS DAYS

Annual vacation
Sick leave
Preparatory leave
Extraordinary leave
Leave without permission

VACCINATION:

Sr no. Name of the vaccine Date

WORK ASSESSMENT:

ASSESSMENT 1ST YEAR 2ND YEAR 3RD YEAR

work

Grade: A- Excellent, B- V good, C- good, D- Average, E- Poor

A: > 85%, B- 75% to 84%, C- 65% to 74%, D- 50% to 64%, E- < 50%