Application for Admission - B.Sc Nursing Courses(only Female Candiates to apply)
+2 Reg No
Photo: (Upload JPG,PNG and GIF Image Only)
Name of Applicant
Expansion of Initial
Date of Birth
Age
Place of Birth
Studet Mobile No
Student Email id
Identification Mark: (Please Enter the two Identification)
Mother Tongue
Blood Group
Nationality
Religion & Community Name
Details of Parents
DETAILS
FATHER
MOTHER
NAME
QUALIFICATION
PERMANENT ADDRESS
PHONE NO
EMAIL ID
ANNUAL INCOME
Details of School Last Studied:
Name
Address
Medium of Instruction
Board
Select
CBSE
State Board
ISC
Others
Extra Curricular Activities participated Sports / NSS / NCC / Others (Specify):
EMIS No (Refer 12th TC)
Details of Marks Obtained: 12th Standard:
Subject
Marks Obtained
Max Marks
Month/Year of Passing
No of Attempts
Language
Select
100
200
1
2
3
4
5
6
7
8
9
10
English
Select
100
200
1
2
3
4
5
6
7
8
9
10
Subject I
Select
100
200
1
2
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5
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8
9
10
Subject II
Select
100
200
1
2
3
4
5
6
7
8
9
10
Subject III
Select
100
200
1
2
3
4
5
6
7
8
9
10
Subject IV
Select
100
200
1
2
3
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5
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7
8
9
10
Subject V
Select
100
200
1
2
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8
9
10
Subject VI
Select
100
200
1
2
3
4
5
6
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8
9
10
Total
Local Guardian Name and Address and contact no
Amount :
₹1550
Marksheet: (Please attach your marksheet in PDF format if you have)
I hereby declare all the above information are true to the best of my Knowledge.
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