Application Form for Academic Year 2019-20

(1) Fellowship in Fetal Medicine

(2) Fellowship in Basic Fetal Medicine and Advanced Obstetric

Ultrasonography

Personal Details

Name : SURNAME NAME FATHER'S NAME

Address :

Phone No : Mobile No :

E-Mail : Nationality :

Birth Date : Birth Place :

Category : OPEN / SEBC / SC / ST / EWS Gender : Male / Female

Minority : Physically Handicap : Yes / No

Academic Details

Final MBBS passing year :

University :

Post Graduate Degree :

passing year :

University :

Registration No. (MCI / State Govt.)

_________________

Applicant Signature

All filled forms should be accompanied with self-attested copies of the following documents :

1. Mark sheet (All years / semesters)

2. Degree Certificate / Provisional Degree Certificate from the University

3. Internship Completion Certificate

4. Registration Certificate (MCI / State Govt.)

5. Caste Certificate (if the candidate had applied in SC / ST / SEBC category)

6. Non Cremelayer Certificate of current financial year for SEBC category

7. EWS Certificate (If applicable)

8. Certi. from Civil Surgeon for Physically Handicapped Candidate

Applicant shal have to fill a separate form for each fellowship.

Acknowledgement

Received Application Form from ______________________________________ Admission for the

Academic Year 2019-20 for Fellowship in Fetal Medicine / Fellowship in Basic Fetal Medicine and

Advanced Obstetric Ultrasonography

Date : - - 2019 Receiver's Signature

Form Fees : 3,000/-

Internet Copy

Internet Copy

Instruction :

Course Name : Fellowship in Fetal Medicine

(1) Fellowship in Fetal Medicine Duration of Course : 1 Year

(2) Duration of Course 1 candidate per year

(3) Eligibility M.D./M.S. in Obst. & Gyn. (MCI recognised /

approved)/ PG DNB in Obst. & gyn. (NBE

recognized / approved)

No Objection Certificate from Government/Local

self Government if employed in same.

(4) Fees Rs.1,00,000/- (Separate Exam fees for VNSGU)

(5) Admission Through Entrance Test Comprising of 100 MCQs conducted

by VNSGU

(6) Teachers : Guide Fetal Medicine Specialist and Additional / Associate

Professor in Radiology

(7) Co-Guide Professor / Associate Professor - Obstetrics and Gynaecology

Other Details :

- Non Stipendary course, to spend 30 hours/ week, log book maintainance, with One project

submission, four Power Point Presentation in the Department and either One Paper

Presentation in a conference or one paper submitted for publication

- Certificate : Certificate will be signed and issued after passing the theory and practical

assessment, submission of log book and project.

Course Name : Fellowship in Basic Fetal Medicine and Advanced Obstetric

Ultrasonography

(1) Fellowship in Basic Fetal Medicine and Advanced Obstetric Ultrasonography

Duration of Course : 6 Months

(2) Duration of Course 3 candidates in a batch.

(3) Eligibility M.D./M.S./P.G.DNB (Obst. & Gyn./Radio)

DGO/DMRD from MCI/NBE recognized /

approved institute.

No Objection Certificate from Government/Local

self Government if employed in same.

(4) Fees Rs.50,000/- (Separate Exam fees for VNSGU)

(5) Admission Through Entrance Test Comprising of 100 MCQs conducted

by VNSGU

(6) Teachers : Guide Fetal Medicine Specialist and Additional / Associate

Professor Obstetrics and Gynecology

Other Details :

- Non Stipendary course, to spend 30 hours/ week, log book maintenance, with Two Power

Point Presentation in the Department and either One Paper / Poster Presentation in a

conference or one paper submitted for publication.

- Certificate : Certificate will be signed and issued after passing the theory and practical

assessment, submission of log book.