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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.